dfwabel

Football and CTE

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And as for concussions...

 

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Abstract

Background: Head injuries have been associated with subsequent suicide among military personnel, but outcomes after a concussion in the community are uncertain. We assessed the long-term risk of suicide after concussions occurring on weekends or weekdays in the community.

 

Methods: We performed a longitudinal cohort analysis of adults with diagnosis of a concussion in Ontario, Canada, from Apr. 1, 1992, to Mar. 31, 2012 (a 20-yr period), excluding severe cases that resulted in hospital admission. The primary outcome was the long-term risk of suicide after a weekend or weekday concussion.

 

Results: We identified 235 110 patients with a concussion. Their mean age was 41 years, 52% were men, and most (86%) lived in an urban location. A total of 667 subsequent suicides occurred over a median follow-up of 9.3 years, equivalent to 31 deaths per 100 000 patients annually or 3 times the population norm. Weekend concussions were associated with a one-third further increased risk of suicide compared with weekday concussions (relative risk 1.36, 95% confidence interval 1.14–1.64). The increased risk applied regardless of patients’ demographic characteristics, was independent of past psychiatric conditions, became accentuated with time and exceeded the risk among military personnel. Half of these patients had visited a physician in the last week of life.

 

Interpretation: Adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends. Greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented.

 

Suicide is a leading cause of death in both military and community settings.1 During 2010, 3951 suicide deaths occurred in Canada2 and 38 364 in the United States.3 The frequency of attempted suicide is about 25 times higher, and the financial costs in the US equate to about US$40 billion annually.4 The losses from suicide in Canada are comparable to those in other countries when adjusted for population size.5 Suicide deaths can be devastating to surviving family and friends.6 Suicide in the community is almost always related to a psychiatric illness (e.g., depression, substance abuse), whereas suicide in the military is sometimes linked to a concussion from combat injury.710

 

Concussion is the most common brain injury in young adults and is defined as a transient disturbance of mental function caused by acute trauma.11 About 4 million concussion cases occur in the US each year, equivalent to a rate of about 1 per 1000 adults annually;12 direct Canadian data are not available. The majority lead to self-limited symptoms, and only a small proportion have a protracted course.13 However, the frequency of depression after concussion can be high,14,15 and traumatic brain injury in the military has been associated with subsequent suicide.8,16 Severe head trauma resulting in admission to hospital has also been associated with an increased risk of suicide, whereas mild concussion in ambulatory adults is an uncertain risk factor.1720

 

The aim of this study was to determine whether concussion was associated with an increased long-term risk of suicide and, if so, whether the day of the concussion (weekend v. weekday) could be used to identify patients at further increased risk. The severity and mechanism of injury may differ by day of the week because recreational injuries are more common on weekends and occupational injuries are more common on weekdays.2127 The risk of a second concussion, use of protective safeguards, propensity to seek care, subsequent oversight, sense of responsibility and other nuances may also differ for concussions acquired from weekend recreation rather than weekday work.2831 Medical care on weekends may also be limited because of shortfalls in staffing.32

 

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https://jamanetwork.com/journals/jamaneurology/article-abstract/2739480

 

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Question  What are the contributions of white matter rarefaction and cerebrovascular disease to dementia in older, deceased individuals who had played football and developed chronic traumatic encephalopathy?

Findings  In this cross-sectional study of 180 deceased individuals older than 40 years who had played football and had chronic traumatic encephalopathy, the number of years of football play (a proxy for repetitive head impacts) was associated with worse white matter rarefaction and greater dorsolateral frontal cortex neurofibrillary tangles. White matter rarefaction and neurofibrillary tangles were associated with dementia; arteriolosclerosis was not associated with the number of years of play, but it contributed to dementia.

Meaning  In chronic traumatic encephalopathy, dementia is likely a result of neuropathologic changes associated with repetitive head impacts, including white matter rarefaction and phosphorylated tau, in addition to nonhead trauma–associated pathologic changes, such as arteriolosclerosis.

 

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Importance  Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts, including those from US football, that presents with cognitive and neuropsychiatric disturbances that can progress to dementia. Pathways to dementia in CTE are unclear and likely involve tau and nontau pathologic conditions.

Objective  To investigate the association of white matter rarefaction and cerebrovascular disease with dementia in deceased men older than 40 years who played football and had CTE.

Design, Setting, and Participants  This cross-sectional study involves analyses of data from the ongoing Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study, which is conducted via and included brain donors from the Veterans Affairs–Boston University–Concussion Legacy Foundation brain bank between 2008 and 2017. An original sample of 224 men who had played football and were neuropathologically diagnosed with CTE was reduced after exclusion of those younger than 40 years and those missing data.

Exposures  The number of years of football play as a proxy for repetitive head impacts.

Main Outcomes and Measures  Neuropathological assessment of white matter rarefaction and arteriolosclerosis severity (on a scale of 0-3, where 3 is severe); number of infarcts, microinfarcts, and microbleeds; and phosphorylated tau accumulation determined by CTE stage and semiquantitative rating of dorsolateral frontal cortex (DLFC) neurofibrillary tangles (NFTs) (none or mild vs moderate or severe). Informant-based retrospective clinical interviews determined dementia diagnoses via diagnostic consensus conferences.

Results  A total of 180 men were included. The mean (SD) age of the sample at death was 67.9 (12.7) years. Of 180, 120 [66.7%]) were found to have had dementia prior to death. Moderate to severe white matter rarefaction (84 of 180 [46.6%]) and arteriolosclerosis (85 of 180 [47.2%]) were common; infarcts, microinfarcts, and microbleeds were not. A simultaneous equations regression model controlling for age and race showed that more years of play was associated with more severe white matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and greater phosphorylated tau accumulation (DLFC NFTs: β, 0.15 [95% CI, 0.004-0.30]; P = .04; CTE stage: β, 0.27 [95% CI, 0.14-0.41]; P < .001). White matter rarefaction (β, 0.16 [95% CI, 0.02-0.29]; P = .03) and DLFC NFTs (β, 0.16 [95% CI, 0.03-0.28]; P = .01) were associated with dementia. Arteriolosclerosis and years of play were not associated, but arteriolosclerosis was independently associated with dementia (β, 0.21 [95% CI, 0.07-0.35]; P = .003).

Conclusions and Relevance  Among older men who had played football and had CTE, more years of football play were associated with more severe white matter rarefaction and greater DLFC NFT burden. White matter rarefaction, arteriolosclerosis, and DLFC NFTs were independently associated with dementia. Dementia in CTE is likely a result of neuropathologic changes, including white matter rarefaction and phosphorylated tau, associated with repetitive head impact and pathologic changes not associated with head trauma, such as arteriolosclerosis.

 

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USA Football is piloting the game’s first long-term development program in hopes of growing the game and catching up to other sports around the world.

 

The sport’s governing body launched its Football Development Model on Thursday, announcing that six youth leagues will team up with USA Football in the hopes of attracting more young players and improving skills.

 

The leagues will experiment with new ways to coach fundamentals in practice, aiming to hone skills while cutting down on full-speed contact that ends with players hitting the ground. The FDM also will encourage leagues to experiment with different ways to play the game, including flag football, padded flag football and modified games with smaller fields and fewer than 11 players on each team.

 

“My son started playing tackle football at 7, and I still wonder if that was the best thing to do,” Hallenbeck said. “When you look at it from a skill development lens, why can’t flag football be like T-ball is for baseball? In flag, you can teach how to pass, catch, backpedal and get into a breakdown position defensively. You can learn how to play football without contact.”

 

When your organization's CEO questions if he made the right choice for his child, then the dangers are not fallacy.

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2 hours ago, Gothamite said:

Ugh.  

 

Tackle football at 7?  That’s legit child abuse. 

 

I’ve compared letting kids play tackle football to child sexual abuse before, as far as damaging the mental health of the kids. While that’s an exaggeration, I don’t think it’s far off. 

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Previous conversations have discussed tackle football at 11.  Which is bad enough.  But 7?  That’s downright obscene. 

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This is the stance of the 72-year-old NFF, which was founded in 1947 by General Douglas MacArthur and Army coaching legend Red Blaik. Its mission is to promote amateur football at all levels. The NFF's annual December awards dinner in New York is the game's unofficial yearly summit meeting. "Football Matters" was launched in 2018 as a broad media campaign "to celebrate the positive impact of the game."

 

Pop Warner has seen membership stabilize after a decline from 2010-12.

 

"I can tell you I think we're all feeling a whole lot better now than we were three to four years ago," said Jon Butler, Pop Warner's executive director. "There's not that feeling of imminent doom. People that we're working with are doing a great job. Nobody is talking about getting out of the business or jumping [insurance] rates."

Butler is frustrated with what he says is media hyperbole reporting on player safety. He wouldn't name the insurance executive but emphasized the industry's current stance: "First, we have a duty to football. This means too much to people and has for so long we can't turn our back on it. We figured out tobacco. We figured out asbestos. We'll figure this out."

More: https://www.cbssports.com/college-football/news/college-football-takes-aim-at-its-greatest-issues-as-it-tries-to-reinvent-the-game-for-the-future/

 

 

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https://www.healio.com/orthopedics/sports-medicine/news/online/{095e875c-8c2c-4f31-8340-b0aaf576a4ce}/high-school-football-concussion-risk-greater-for-young-athletes-and-on-turf

 

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BOSTON — Concussion risk in high school football is greater for younger players and on practices on turf-based surfaces, according to a study presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.

The epidemiological study examined high school football concussion data in male players aged 14 to 18 years at 1,999 U.S. high schools. Scott Burkhart, PsyD, and colleagues collected data between 2012 to 2017 using the Rank One Health Injury Surveillance Database, a software used for mandatory and voluntary student-athlete injury documentation.

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“While concussion prevention efforts like education and safe tackling appear to be working in high school football, it may be advantageous to provide more sports medicine coverage at more vulnerable time points like freshman and JV football,” Burkhart told Orthopedics Today. “Further, data supports reducing practice exposures on turf-based surfaces may lead to lower concussion incidence.”

 

The study included nearly one million male athletes who played football. Researchers recorded a total of 14,103 concussions in this group, accounting for 6% of all injuries in high school sports and making this the largest epidemiological high school football concussion study to date.

Rates of injury decreased from 2012 to 2016 in both practices and games. Burkhart noted injury proportion ratios decreased by year from 2012 to 2016 with an increase in 2017. He added that more concussions occurred in games (51.8%) than during practices (48.2%).

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“No matter how we looked at this – whether it was injury proportion rates, overall incidence rates or risk ratios – you can see significant difference from games to practices,” he said at a presentation at the ASSOM meeting.

Turf outweighed all other mechanisms of injury, including helmet-to-helmet and grass. Almost 90% of all injuries occurred on turf-based surfaces, according to Burkhart.

“You can exponentially see the difference in terms of the amount of injuries occurring on turf versus anywhere else,” he said. “While we’ve done a great job in terms of educating athletes and reducing the number of helmet-to-helmet concussions, you can see that turf drastically outweighs others as the mechanism of injury. This gets even more pronounced when you look at game day.”

Burkhart noted that athletes aged 14, 15 and 16 years were at a greater risk for concussion compared players aged 17 and 18 years. He concluded that schools could mitigate risks by avoiding turf and examining coaching techniques.

 

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Head trauma in former NFL players may be linked to low testosterone and erectile dysfunction later in life, according to a study by Harvard researchers.

 

More than 3,400 former professional football players, the largest group studied to date, were surveyed by investigators at the Harvard T.H. Chan School of Public Health and Harvard Medical School as part of the university's ongoing Football Players Health Study. They found that former NFL players who previously reported concussion symptoms after head injuries were more likely to report erectile dysfunction and low testosterone levels.

 

"We found the same association of concussions with ED among both younger and older men in the study, and we found the same risk of ED among men who had last played 20 years ago," said Andrea Roberts, one of the study's senior authors. "These findings suggest that increased risk of ED following head injury may occur at relatively young ages and may linger for decades thereafter."

 

The study was published Monday in JAMA Neurology.

 

 

Of all the study's participants, 18% reported low testosterone, almost 23% reported ED and slightly less than 10% of participants reported both symptoms.

Players who reported the most concussion symptoms had nearly twice the risk of ED as those reporting the fewest symptoms. Notably, even former players with relatively few concussion symptoms had an elevated risk for low testosterone, which researchers think suggests that there may be no safe threshold for head trauma.

 

Those findings didn't change based on the player's position on the field either.

 

"We threw all those things into the model and in that scenario position never lit up. There was never enough noise — we had 10 position category's and just didn't see any effect," said Rachel Grashow, the study's lead author.

 

That ED risk persisted even when researchers accounted for other possible causes for the condition.

More: https://www.cnbc.com/amp/2019/08/26/concussions-in-nfl-players-linked-to-erectile-dysfunction-harvard-study.html

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"First, we have a duty to football. This means too much to people and has for so long we can't turn our back on it. We figured out tobacco. We figured out asbestos. We'll figure this out."

 


When you're analogizing the sport of amateur football to tobacco and asbestos, you've not only lost the public relations battle... you've clearly lost the moral high ground, as well.  
 

 

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3 hours ago, Gothamite said:

It just gets worse. 

How? It’s something that’s suppose to keep the brain from moving and bashing into the insides of the skull. 

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On 8/28/2019 at 2:44 PM, dfwabel said:

 

 

 

 

That made me really sad.

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Posted (edited)
22 minutes ago, dont care said:

How? It’s something that’s suppose to keep the brain from moving and bashing into the insides of the skull. 

https://theconversation.com/concussion-prevention-sorting-through-the-science-to-see-whats-sound-105246

 

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The device, known as the Q-Collar and previously sold as NeuroShield, is designed to mimic the woodpecker’s method of injury protection by keeping more blood inside the skull to create a “bubble wrap” effect around the brain.

 

As a physiologist and sports medicine researcher, I study how the body responds to exercise and other stressors. I also study ways to prevent and treat sports injuries. As the public learns more about the potential long-term dangers of contact sports, including chronic traumatic encephalopathy (CTE), parents, athletes and sports organizations are desperate to find a quick fix to the concussion crisis. Unfortunately, I do not think there is an easy solution to make inherently high-risk sports safe.

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Supposedly, the Q-Collar also replicates how woodpeckers naturally protect themselves from headaches. According to company information, woodpeckers compress their jugular vein using their neck muscles to induce “tighter fit” and reduce brain “slosh.” While this amazing-sounding mechanism is often presented as a fact, it does not seem to be mentioned anywhere in over a century of scientific studies examining woodpeckers.

 

I thoroughly examined all of the woodpecker papers I could find, and then tracked down all of their references, and repeated the process. I discovered ornithology papers from the 1700s through cutting-edge engineering models of woodpecker biomechanics, but none mentioned jugular compression. Thus, it is not surprising that the company does not cite any scientific references to woodpecker literature.

 

Even if this mechanism does exist and has been somehow overlooked by woodpecker researchers, evolution gave the woodpecker numerous unique protective adaptations. I teamed up with a woodpecker researcher and published a summary of these mechanisms in October 2018. These include a specialized skull bone structure and a shock-absorbing beak. Woodpeckers even use very specific postures and movements to brace themselves, which helps to dissipate force away from their brains. We concluded that these multiple protective mechanisms work in harmony, which cannot be replicated by simply pushing on one’s jugular vein.

 

New research suggests that woodpeckers may indeed experience brain injuries similar to those seen in humans. Regardless, the physics of woodpecker drumming are quite different than that of sports concussions, which generally happen with unpredictable timing, and involve considerable head rotation. Despite its intuitive appeal, I believe that a woodpecker-mimicking collar is more pseudoscience than innovation.

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As my colleagues and I have been debunking the scientific rationale for the Q-Collar, research examining the Q-Collar seems to have shifted from reducing the risk of concussions, or distinct events following a single hit, to a less tangible goal of reducing brain damage from repeated subconcussive impacts.

 

An article published in October 2018 from a small study showed that the brains of female soccer players who wore collars for a season seemingly showed no brain damage. Those who did not wear the collar did show small changes in some areas of their brain.

 

However, some other researchers have expressed concerns over the small numbers of subjects and the high dropout rates in similar studies about the collar. Some physicians have concluded that this evidence is not enough to suggest that it does protect the brain from injury and current promotional campaigns are “potentially misleading.” I also remain skeptical of these findings, since the clinical utility of this particular type of MRI data remains unclear, especially in relation to long-term health.

 

Edited by dfwabel

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https://www.bostonglobe.com/metro/2019/08/30/nfl-players-six-times-more-likely-than-general-public-report-cognitive-problems-study-finds/6BKMul9OC019g9eAudBQTP/story.html

 

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Anyone who watches football knows that NFL players — particularly running backs, linebackers, and defensive linemen — are going to absorb some punishing hits to the head.

But a new study shows just how devastating that toll can be on brain functioning and mental health, even 20 years after a player took his last hit on the field.

Harvard researchers surveyed 3,500 former NFL players and found that they were six times more likely than members of the general public to report serious cognitive problems such as confusion and memory loss.

The study also found that the longer their professional careers, the more likely the players were to experience cognitive impairments as well as signs of depression and anxiety.

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The Harvard study, which was based on self-reported survey results from former players, found that 12 percent overall reported serious cognitive problems, compared to 2 percent of the general population. Nearly one in four players reported symptoms of anxiety and depression.

Roberts said she was disturbed to find that even 13 percent of former players under age 45 and 11 percent of former players under age 35 reported cognitive problems such as memory loss and confusion typically associated with old age.

“Those are numbers that make you feel sad,” she said.

Cognitive problems, depression, and anxiety were twice as likely to be reported by players who spent 10 seasons or more in the NFL, compared with those who played a single season. The risks for those veteran players were high even if they were kickers, punters, and quarterbacks, considered relatively low-impact positions.

 

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