Multifactorial examination of sex-differences in head injuries and concussions among collegiate soccer players: NCAA ISS, 2004–2009

Background While head injuries and concussions are major concerns among soccer players, the multifactorial nature of head injury observations in this group remains relatively undefined. We aim to extend previous analyses and examine sex-differences in the incidence of head injuries, odds of head injuries within an injured sample, and severity of head injuries, among collegiate soccer players between 2004 and 2009. Methods Data collected within the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) between the years of 2004 and 2009, were analyzed in this study. Unadjusted rate ratios (RR), compared incidence rates between categories of sex, injury mechanism, setting and competition level. We also examined sex-differences in head injury incidence rates, across categories of the other covariates. Multivariable logistic regression and negative binomial regression modeling tested the relation between sex and head injury corollaries, while controlling for contact, setting, and competition level. Results Between 2004 and 2009, head injuries accounted for approximately 11% of all soccer-related injuries reported within the NCAA-ISS. The rate of head injuries among women was higher than among men (RR = 1.23, 95% CI = [1.08, 1.41]). The rate of head injuries due to player-to-player contact was comparable between women and men (RR = 0.95, 95% CI = [0.81, 1.11]). Whereas, the rate of injury due to contact with apparatus (ball/goal) was nearly 2.5 times higher (RR = 2.46, 95% CI = [1.76, 3.44]) and the rate due to contact with a playing surface was over two times higher (RR = 2.29, 95% CI = [1.34, 3.91]) in women than in men. In our multifactorial models, we also observed that the association between sex and head injury corollaries varied by injury mechanism. Conclusions Sex-differences in the incidence, odds (given an injury), and severity (concussion diagnosis, time-loss) of head injuries varied by injury mechanism (player-to-player contact vs. all other mechanisms) in this sample

Multifactorial Examination of Sex-differences in Head Injuries and Concussions Among Collegiate Soccer Players: NCAA ISS, 2004-2009.

BACKGROUND: While head injuries and concussions are major concerns among soccer players, the multifactorial nature of head injury observations in this group remains relatively undefined. We aim to extend previous analyses and examine sex-differences in the incidence of head injuries, odds of head injuries within an injured sample, and severity of head injuries, among collegiate soccer players between 2004 and 2009. METHODS: Data collected within the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) between the years of 2004 and 2009, were analyzed in this study. Unadjusted rate ratios (RR), compared incidence rates between categories of sex, injury mechanism, setting and competition level. We also examined sex-differences in head injury incidence rates, across categories of the other covariates. Multivariable logistic regression and negative binomial regression modeling tested the relation between sex and head injury corollaries, while controlling for contact, setting, and competition level. RESULTS: Between 2004 and 2009, head injuries accounted for approximately 11% of all soccer-related injuries reported within the NCAA-ISS. The rate of head injuries among women was higher than among men (RR = 1.23, 95% CI = [1.08, 1.41]). The rate of head injuries due to player-to-player contact was comparable between women and men (RR = 0.95, 95% CI = [0.81, 1.11]). Whereas, the rate of injury due to contact with apparatus (ball/goal) was nearly 2.5 times higher (RR = 2.46, 95% CI = [1.76, 3.44]) and the rate due to contact with a playing surface was over two times higher (RR = 2.29, 95% CI = [1.34, 3.91]) in women than in men. In our multifactorial models, we also observed that the association between sex and head injury corollaries varied by injury mechanism. CONCLUSIONS: Sex-differences in the incidence, odds (given an injury), and severity (concussion diagnosis, time-loss) of head injuries varied by injury mechanism (player-to-player contact vs. all other mechanisms) in this sample

Transition Experiences of Former Collegiate Women’s Soccer Athletes

Athlete transition from American collegiate sport participation, to non-sport careers or professional sport, has been a topic of contemporary sport science research but it is still not well understood, especially in female athlete populations. Informed by extant transition theory, the current study purpose was to describe the transition experiences of former women’s collegiate soccer athletes, including both positive and negative contributing factors. Using a deductive conceptual content analysis, results showcase both positive (i.e., social support, career goals, recreational sport play) and negative (i.e., lack of a team/support, lack of soccer/competition, lack of direction) contributors to the post-collegiate sport transition for female soccer athletes sampled. The importance of athletic identity and potential transition resources were identified. Specifically, participants endorsed career guidance, physical activity/exercise, mentorship programming, and mental health resources as potentially helpful to future athletes. Study findings expanded upon relevant transition theory and former female athlete research. Our study results may inform future research and program development efforts aimed at former female collegiate athletes from soccer and other sports

Reporting of Concussion Symptoms By a Nationwide Survey of United States Parents of Middle School Children

This cross-sectional study assessed concussion symptom knowledge of parents of middle school (MS) children (aged 10–15 years) through a free-response item that solicited concussion symptoms and compared findings to a pre-validated scale-based measure. A self-administered online questionnaire was sent to a panel of randomly selected United States residents who were recruited by a third-party company, aged ≥ 18 years, and identified as parents of MS children. Via a free-response item, parents listed what they believed were concussion symptoms. Multiple sections later, parents identified potential concussion symptoms via a scale measure, which featured 25 items (22 actual symptoms, three distractor symptoms) with three response options: yes, no, maybe. Free-response item responses were coded into specific symptoms. The 1062 eligible parents that provided complete data commonly identified the symptoms of dizziness (90.2%), blurred vision (87.4%), and balance problems (86.4%) on the scale-based measure. However, these and other symptoms were less commonly identified via the free-response item (dizziness: 44.4%; blurred vision: 16.5%; balance problems: 3.5%). Concussion symptoms commonly reported via the scale-based measure were reported less frequently within the free-response item. Future research must explore strategies to help clinicians working with parents and their children to measure and assess concussion symptom reporting and knowledge

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

Evaluating methods for utilizing time loss data in sports settings using a sample of U.S. collegiate soccer-related injury observations

Background: Time loss has featured heavily in assessments of sports-related injury severity. Typically, it is measured as a count of days lost to injury and analyzed using ordinal cut points. We argue that a refinement of methods for the analysis of time loss which acknowledges the role of severity, is advantageous. We propose to instead model time loss with count or survival regression and adopt the view that it is a manifestation of injury severity, which is a latent variable. Inclusion of a random intercept in the model enables representation of latent injury severity as an unobservable predictor of time loss and admits an interesting, clinically relevant interpretation of observable covariate effects as being ‘severity-adjusted.’ Methods: Using a sample of U.S. collegiate soccer-related injury observations, we fit random effects Poisson and Weibull Regression models to perform ‘severity-adjusted’ evaluations of time loss. Results: Injury site, injury mechanism and injury history emerged as the strongest predictors in our sample. In comparing random effects and fixed effects models, we noted that the incorporation of the random effect attenuated associations between most observed covariates and time loss, and model fit statistics revealed that the random effects models improved model fit over the fixed effects models

Sex-Differences and Interactions in Head Injuries and Concussions among Collegiate Soccer Players: NCAA ISP, 2004-2009

Introduction: Some of the highest rates of head injuries and concussion among all contact/collision sports are observed in soccer; yet, the multifactorial determinants of head injuries among players remain relatively undefined. We extend previous analyses and examine sex-differences in the rate and the severity (concussion and lost days of participation) of head injuries among collegiate soccer players between 2004 and 2009. Methods: Data were analyzed from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). Multivariable logistic regression and negative binomial regression modeling tested the relation between sex and head injury outcomes, while controlling for contact, setting, and competition level, as well as their joint effects. Results: Between 2004 and 2009, the sex-specific rate of soccer-related head injuries was 0.87 per 1000 AEs in women and 0.71 per 1000 AEs in men (RR = 1.23, 95% CI = [1.08, 1.41]). The rate of head injuries due to player-to-player contact was comparable between women and men (RR=0.95, 95% CI=[0.81, 1.11]); however, the rate of injury due to contact with apparatus (ball/goal) was nearly 2 ½ -fold higher (RR=2.46, 95% CI = [1.76, 3.44]) and the rate due to contact with a playing surface was over two-fold higher (RR=2.29, 95% CI = [1.34, 3.91]) in women than in men. We also observed a significant joint effect between sex and contact in our regression models. Conclusions: Among female players, head contact with a ball, a goal post, or the playing surface may be especially deleterious compared with head contact with another player