Daryl A. Rosenbaum

Abnormal white matter integrity related to head impact exposure in a season of high school varsity football.

The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITS™) during all practices and games. All players received pre- and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWELinear), rotational (RWERotational), and combined components (RWECP), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, CL, CP, and CS, respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearmans rank correlation coefficient. None of the players analyzed experienced clinical concussion (N=24). Regression analysis revealed a statistically significant linear relationship between RWECP and FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWECP and RWELinear) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury.

Work organization and musculoskeletal health: clinical findings from immigrant Latino poultry processing and other manual workers.

Objective: To determine the potential role of differential exposure to work organization hazards in musculoskeletal disorders among immigrant Latino workers. Method: Self-reported work organization data were obtained from immigrant Latino workers in poultry processing and nonpoultry, manual occupations (N = 742). Clinical evaluations for epicondylitis, rotator cuff syndrome, and back pain were obtained from a subsample (n = 518). Results: Several work organization hazards (eg, low job control, high psychological demands) were elevated among poultry processing workers. Job control predicted epicondylitis (odds ratio [OR] = 0.77) and rotator cuff syndrome (OR = 0.79); psychological demand predicted rotator cuff syndrome (OR = 1.30) and back pain (OR = 1.24); awkward posture and repeated movements predicted all three outcomes; and management safety commitment predicted rotator cuff syndrome (OR = 1.65) and back pain (OR = 1.81). Discussion: Immigrant poultry processing workers are exposed to greater work organization hazards that may contribute to occupational health disparities.

Musculoskeletal and neurological injuries associated with work organization among immigrant latino women manual workers in North Carolina

BACKGROUND This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries. METHODS Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics. RESULTS Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS. CONCLUSIONS Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.

Assessment of Cardiovascular Risk in Collegiate Football Players and Nonathletes

Abstract Collegiate American football players may be at risk for cardiovascular disease. Objective: To compare cardiovascular disease risk factors and cardiovascular structure and function parameters of football players, stratified by position, to a group of sedentary, nonathletes. Participants: Twenty-six collegiate football players and 13 nonathletes participated in this study. Methods: Blood pressures, anthropometrics, and blood chemistries were obtained and analyzed using standardized procedures. Resting echocardiography was used to evaluate cardiac morphology and function. Brachial artery flow-mediated dilation was assessed using high-resolution ultrasonography. Results: The prevalence of the metabolic syndrome was significantly higher amongst the linemen compared to the skill-position players (46% versus 0%, p < .05). Mildly abnormal wall thickness was noted in 20% of the football players. No significant differences in vascular function were observed between the groups. Conclusions: The increased prevalence of the metabolic syndrome and its components in the collegiate linemen may increase cardiovascular disease risk.

Employer Differences in Upper-Body Musculoskeletal Disorders and Pain Among Immigrant Latino Poultry Processing Workers

ABSTRACT Between-employer differences in working conditions may lead to variable injury rates. The objective of this paper is to assess the difference in the prevalence of epicondylitis, rotator cuff syndrome, and low back pain among immigrant Latino poultry workers at plants of three different employers. Data were collected from a cross-sectional study among 286 poultry processing workers. Community-based sampling was used to recruit participants in western North Carolina. Rotator cuff syndrome (26.7%) and low back pain (27.9%) were more prevalent among employees of one specific employer. Multivariate analysis showed significant associations of low back pain and rotator cuff syndrome with age, task performed in the processing line, and employer. Employer is a major predictor of musculoskeletal disorders and pain. Line speed and work pace may account for these differences and provide an opportunity for regulation and intervention to protect the health of workers.

Learnings From the Pilot Implementation of Mobile Medical Milestones Application.

BACKGROUND Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs. OBJECTIVE We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool. METHODS Residents and faculty completed presurveys and postsurveys about the tool and the evaluation process in their program. Program directors were interviewed individually. Interviews and open-ended survey responses were analyzed and coded using the constant comparative method, and responses were tabulated under themes. RESULTS Common perceptions included increased data collection, enhanced efficiency, and increased perceived quality of the information gathered with the M3App. Residents appreciated the timely, high-quality feedback they received. Faculty reported becoming more comfortable with the tool over time, and a more favorable evaluation of the tool was associated with higher utilization. Program directors reported improvements in faculty knowledge of the milestones and resident satisfaction with feedback. CONCLUSIONS Faculty and residents credited the M3App with improving the quality and efficiency of resident feedback. Residents appreciated the frequency, proximity, and specificity of feedback, and faculty reported the app improved their familiarity with the milestones. Implementation challenges included lack of a physician champion and competing demands on faculty time.

Issues Encountered by Physicians During International Travel With Youth National Soccer Teams

Background: Little information is available to guide the selection, preparation, and support of a traveling team physician. Purpose: To determine the types of injuries and medical problems, as well as general team health and performance issues, encountered by physicians traveling internationally with youth national soccer teams. Study Design: Descriptive epidemiology. Methods: Physicians assigned to travel abroad with the under-17 men’s and women’s US national soccer teams during a 2-year period documented all encounters with team and staff members. Physicians also documented consultations related to team health and performance issues. Results: The 108 cases (5.71 per 10 days) were evenly divided between injuries (n = 54) and noninjuries (n = 54). Players sought care at a higher rate than did staff (2.28 vs 1.09 per 100 person days). Mean severity for all player cases was 5.19 days missed (injuries, 10.48; noninjuries, 0.23). Nearly 69% of injuries involved the lower extremities: strains, sprains, and contusions accounted for 74.1% of injuries. Gastrointestinal, dermatologic, and otolaryngologic complaints accounted for 77.8% of noninjuries. Medications were administered in 71% of cases, with analgesics, cough and cold remedies, antibiotics, and gastrointestinal agents accounting for the majority. The leading team health and performance concerns were nutrition/hydration, conditioning, prevention, and doping control. Conclusion: Physicians traveling internationally with youth soccer teams manage an equal proportion of musculoskeletal and medical problems using simple medications.

Estimation of Injury Simulation in International Women's Football

This study attempted to determine the frequency of apparent injury incidents in womens international football and estimate what proportion was authentic. Broadcast recordings of 47 games from 2 tournaments were reviewed to identify incidents in which a player behaved as if injured. Apparent injuries were considered definite if a player withdrew from participation within 5 minutes or if bleeding was visible. Remaining incidents were considered questionable. A total of 270 apparent injuries were observed at a rate of 5.74/game compared with 11.26/game previously reported in mens football. The definite injury rate was only 0.78/game vs. 4.96/game for questionable injuries. Definite injuries were associated with on-field treatment (P < 0.010), stretcher (P < 0.010), and second half (P = 0.022), while questionable injuries were associated with fouls (P = 0.036), contact (P < 0.010), and being tackled (P = 0.025). Questionable injuries were not associated with the final third of a half or with team success.

Presence of Athletic Trainers in a Youth Football Organization: A Single Institution's Experience

The experience presented in this report could inform other youth football organizations about the challenges and benefits of implementing an athletic trainer at the youth level. The authors report their experience with having an athletic trainer present at practices and game days for one youth football organization (ages 6 to 13) with more than 170 players during two consecutive seasons. [Athletic Training & Sports Health Care.

Examining the association between musculoskeletal injuries and carpal tunnel syndrome in manual laborers.

Introduction: The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population‐based study. Methods: Latino manual laborers were recruited as part of a study of work‐related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies. Results: A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance. Conclusions: Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31–35, 2016