Influence of factors within the context of daily life on the reporting of post concussion-like symptoms in university students

Background: Concussions commonly occur in contact and collision sports. Following a concussion, serial assessments of symptoms are conducted to track recovery of a concussed athlete for 7–10 days and beyond to assist in making decisions on return-to-play. Several studies have reported the presence of base-rates of postconcussion-like symptoms in normal (non-concussed) individuals. However, factors within the context of daily life that can potentially influence the reporting of these postconcussion-like symptoms in a non-concussed cohort are yet to be explored. Thus, the purpose of this study was to explore the natural variation of postconcussion-like symptoms and also investigate factors within the context of daily life that influence the symptoms reported over a definitive period of time (7 days) in university students. Methods: University students aged 18–30 years were recruited to participate in this time series study. The symptoms experienced by participants on a daily basis were sampled by adopting an ecological momentary approach using the Sport Concussion Assessment Tool 2 (SCAT2) postconcussion symptom scale. Each participant was signaled randomly each day via text message to complete a mini online questionnaire which lasted for seven consecutive days. In this questionnaire, they were asked to report their symptoms experienced at that moment they were texted along with other factors (predictors) such as stress, anxiety and their location at a time of reporting etc. The effect of predictors on the total symptom score (TSS) was estimated using a mixed-effects model with the level of significance set at p < 0.05. Results: 110 university students (26 males and 84 females) consented to participate in this 7-day study. On average, each student had their TSS decrease (Estimate = −0.29) on each day across the 7-day period. Out of the 10 predictors included in the stepwise multivariate mixed-effects model, 3 predictors that include location at the time of reporting, physical fatigue (Estimate = −0.98) and mental fatigue (Estimate = −0.53) contributed to the prediction of TSS. Post-hoc analysis for the predictor of location at the time of reporting revealed that, students reported increased TSS at university or a cafe/restaurant compared to their flat/college of residence. Discussion: This daily variation and the influence of potential factors within the context of daily life on these symptoms in non-concussed individuals serve as a forewarning for clinicians to account for these factors while interpreting symptom scores associated with making decisions on return-to-play of a concussed athlete

Infographic: top social media tips for sports and exercise medicine practitioners

Top social media tips for sports and exercise medicine practitioner

“I’m very visible but seldom seen”: consumer choice and use of mobility aids on public transport

Purpose: The number of mobility aid users continues to rise as the population ages. While mobility aid users rely on public transport due to its affordability, evidence suggests access can be difficult. This study aims to describe people who use mobility aids to access public transport and the role of public transport access in influencing mobility aid choice. Methods: Sixty-seven mobility aid users participated in telephone surveys which predominantly used a structured quantitative format. Data were analysed descriptively and any additional comments were simply categorized. Results: Thirty-six participants were female (54%), with a total sample mean age of 58.15 years (SD = 14.46). Seventy-two percent lived in metropolitan areas, 48% lived alone, and the sample experienced a variety of conditions including spinal cord injury (37%) and arthritis (18%). Sixty-four percent of all respondents used two or more mobility aids including powered wheelchairs, scooters and walking frames. The most important features when choosing a mobility aid were reliability, turning ability and size. Fifty-two percent of all respondents strongly agreed that public transport is generally accessible. Conclusions: While work continues to ensure that public transport vehicles and stations are fully accessible, mobility aid users must manage current infrastructure and access a system which has been shown through this research to have many limitations. Mobility aid users, vendors and health professionals need to work together to identify mobility aids that fulfil needs, and are reliable and safe, so that mobility aid users are both “visible and seen” when accessing the public transport network.Implications for rehabilitationSome mobility aid users experience difficulties accessing and using public transport and further research is required to ensure the whole public transport network is fully accessible to people using mobility aids.Many people have more than one seated mobility aid, suggesting people can choose different aids for different purposes and environments.Health professionals may need to increase their involvement in assisting individuals to select and use mobility aids. © 2017 Informa UK Limited, trading as Taylor & Francis Grou

Accelarated immune ageing is associated with COVID-19 disease severity

Background: The striking increase in COVID-19 severity in older adults provides a clear example of immunesenescence, the age-related remodelling of the immune system. To better characterise the association between convalescent immunesenescence and acute disease severity, we determined the immune phenotype of COVID-19 survivors and non-infected controls. Results: We performed detailed immune phenotyping of peripheral blood mononuclear cells isolated from 103 COVID-19 survivors 3–5 months post recovery who were classified as having had severe (n = 56; age 53.12 ± 11.30 years), moderate (n = 32; age 52.28 ± 11.43 years) or mild (n = 15; age 49.67 ± 7.30 years) disease and compared with age and sex-matched healthy adults (n = 59; age 50.49 ± 10.68 years). We assessed a broad range of immune cell phenotypes to generate a composite score, IMM-AGE, to determine the degree of immune senescence. We found increased immunesenescence features in severe COVID-19 survivors compared to controls including: a reduced frequency and number of naïve CD4 and CD8 T cells (p < 0.0001); increased frequency of EMRA CD4 (p < 0.003) and CD8 T cells (p < 0.001); a higher frequency (p < 0.0001) and absolute numbers (p < 0.001) of CD28−ve CD57+ve senescent CD4 and CD8 T cells; higher frequency (p < 0.003) and absolute numbers (p < 0.02) of PD-1 expressing exhausted CD8 T cells; a two-fold increase in Th17 polarisation (p < 0.0001); higher frequency of memory B cells (p < 0.001) and increased frequency (p < 0.0001) and numbers (p < 0.001) of CD57+ve senescent NK cells. As a result, the IMM-AGE score was significantly higher in severe COVID-19 survivors than in controls (p < 0.001). Few differences were seen for those with moderate disease and none for mild disease. Regression analysis revealed the only pre-existing variable influencing the IMM-AGE score was South Asian ethnicity (β = 0.174, p = 0.043), with a major influence being disease severity (β = 0.188, p = 0.01). Conclusions: Our analyses reveal a state of enhanced immune ageing in survivors of severe COVID-19 and suggest this could be related to SARS-Cov-2 infection. Our data support the rationale for trials of anti-immune ageing interventions for improving clinical outcomes in these patients with severe disease