David B. Coppel

Secondary prevention with college drinkers: Evaluation of an alcohol skills training program.

This study evaluated secondary prevention approaches for young adults (N = 36, mean age 23 years) at risk for alcohol problems. Subjects were randomly assigned to cognitive-behavioral alcohol skills training, a didactic alcohol information program, or assessment only. The skills program included training in blood alcohol level estimation, limit setting, and relapse prevention skills. All subjects maintained daily drinking records during the 8-week intervention and for 1 week at each follow-up. Repeated measures MANOVA found a significant reduction over 1-year follow-up in self-reported alcohol consumption for the total sample. For all drinking measures, the directional findings consistently favored skills training. Despite overall reductions, most subjects continued to report occasional heavy drinking.

A Randomized Study of Carbon Dioxide Management during Hypothermic Cardiopulmonary Bypass

Eighty-six patients undergoing coronary artery bypass graft (n = 63) or intracardiac (n = 23) surgery were randomly assigned with respect to the target value for PaCO2 during cardiopulmonary bypass. In 44 patients the target PaCO2 was 40 mmHg, measured at the standard electrode temperature of 37 degrees C, while in 42 patients the target PaCO2 was 40 mmHg, corrected to the patients rectal temperature (lowest value reached: mean 30.1, SD 1.9 degrees C). Other salient features of bypass management include use of bubble oxygenators without arterial filtration, flows of 1.8-2.4 l.min-1.m-2, mean hematocrit of 23%, and mean arterial blood pressure of approximately 70 mmHg, achieved by infusion of phenylephrine or sodium nitroprusside. Neuropsychologic function was assessed with series of tests administered on the day prior to surgery, just before discharge from the hospital (mean 8.0, SD 5.8 days postoperatively, n = 82), and again 7 months later (mean 220.7, SD 54.4 days postoperatively, n = 75). The scores at 8 days showed wide variability and generalized impairment unrelated to the PaCO2 group or to hypotension during cardiopulmonary bypass. At 7 months no significant difference was observed in neuropsychologic performance between the PaCO2 groups. Regarding cardiac outcome, there were no significant differences between groups in the appearance of new Q-waves on the electrocardiogram, the postoperative creatine kinase-MB fraction, the need for inotropic or intraaortic balloon pump support, or the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO2 management during cardiopulmonary bypass at moderate hypothermia has no clinically significant effect on either neurobehavioral or cardiac outcome.

Behavioral assessment in youth sports: coaching behaviors and children's attitudes

To define the characteristics and dimensional patterning of coaching behaviors, 15,449 behaviors of 31 youth basketball coaches were coded in terms of a 10-category system. Post-season attitude and self-esteem data were obtained from players on 23 teams and were related to the behavioral measures. Compared with rates of reinforcement, encouragement, and technical instruction, punitive responses occurred relatively infrequently. Factor analysis of the coaching behaviors indicated that supportive and punitive behavioral dimensions were orthogonal or statistically independent of one another rather than opposite ends of the same dimension. Punitive and instructional categories were part of the same behavior cluster. The relationship between coaching behaviors and the various player attitudes were highly specific in nature. Coaching behaviors accounted for about half of the variance in post-season attitudes toward the coach and the sport, but for significantly less variance in measures of team solidarity and self-esteem. Surprisingly, the rate of positive reinforcement was unrelated to any of the attitudinal measures. Punishment was negatively related to liking for the coach. In general, technical instruction categories were the strongest predictors of basketball player attitudes.

Social support as a multifaceted concept: Examination of important dimensions for adjustment

Four commonly used operationalizations of the social support concept: network contact frequency, satisfaction with support (including nine dimensions), perceived availability of support, and use of support, were related to two measures of psychological adjustment (Beck Depression Inventory and Symptom Checklist-90) and to one measure of physical adjustment (Cornell Medical Index). Subjects were 68 45- to 85-year-old, highly stressed care-givers to spouses with Alzheimers disease. Results indicate that of the four operationalizations, Satisfaction with Support was the only significant predictor of depression and general psychopathology. The set of four support variables showed the strongest relationship to depression level, next strongest to general psychopathology, and least to physical health. The satisfaction with nine social support dimensions related differentially to the types of adjustment. Results suggest the importance of specificity (sample, support operationalization, dimensions, adjustment measures) in social support research.

Attention deficit hyperactivity disorder and the athlete: an American Medical Society for Sports Medicine position statement.

Attention deficit hyperactivity disorder (ADHD) is an important issue for the physician taking care of athletes since ADHD is common in the athletic population, and comorbid issues affect athletes of all ages. The health care provider taking care of athletes should be familiar with making the diagnosis of ADHD, the management of ADHD, and how treatment medications impact exercise and performance. In this statement, the term “Team Physician” is used in reference to all healthcare providers that take care of athletes. These providers should understand the side effects of medications, regulatory issues regarding stimulant medications, and indications for additional testing. This position statement is not intended to be a comprehensive review of ADHD, but rather a directed review of the core issues related to the athlete with ADHD.

Sleep apnea syndrome: Symptomatology, associated features, and neurocognitive correlates

This article reviews the essential features, types, prevalence, pathophysiology, and neuropsychological correlates associated with the sleep apnea syndrome. Persons who experience the intermittent hypoxia and fragmented sleep characteristic of the sleep apnea syndrome tend to exhibit moderate symptoms of diffuse cognitive dysfunction as well as multiple emotional and psychosocial sequela. It is concluded that more research is required in order to elucidate the relationship between the hypoxic parameters and neurocognitive deficits seen in the sleep apnea syndrome, and that neuropsychological assessment might represent a means whereby the effectiveness of various treatments for sleep apnea may be evaluated.

The influence of pediatric autonomic dysfunction on recovery after concussion

INTRODUCTION In the United States, the reported incidence of recreation-related or sports-related concussions among children and adults is approximately 3.8 million. Common symptoms include headache, dizziness, and nausea, as well as functional impairments in concentration, memory, and processing. In most cases, there are no abnormalities by neuroimaging and the symptoms resolve within 1 to 2 weeks. Post-concussion management involves physical, cognitive, and emotional rest. Once free of symptoms, a graded increase in exertion is recommended, with return to sport once asymptomatic at all stages. Premature return to athletic participation increases the risk for post-concussive syndrome (PCS). The pediatric athlete deserves unique attention because the child’s brain may be more developmentally vulnerable. Symptom assessment must be age appropriate, and parents and teachers serve as important advocates to monitor a child’s recovery within both school and social realms. Underlying medical conditions may also influence the time to recovery. We present a gymnast whose post-concussive symptoms were compounded by undiagnosed autonomic dysfunction (AD), which once addressed facilitated her recovery and return to sport.

Acquisition of stimulus-outcome and response-outcome expectancies as a function of locus of control

An attempt was made to integrate the expectancy models of Bolles and Rotter by assessing the role of generalized expectancies in the acquisition of situation-specific expectancies. The relationship between locus of control and the detection of specific stimulus-outcome (S-S*) and response-outcome (R-S*) contingencies was investigated by assessing awareness of S-S* and R-S* contingencies in a laboratory analogue study. As predicted, a significant interaction was found between locus of control and the nature of the expectancy to be acquired. Internals acquired the R-S* expectancy more rapidly than the S-S* expectancy, whereas externals showed relatively faster acquisition of the S-S* than of the R-S* expectancy. Internals attributed success on the tasks to skill to a greater degree than did externals, and also expressed greater confidence that their hypotheses about the contingencies were correct. Some applications of the results to social learning and psychopathology, assessment, and treatment are discussed.

Concussion Evaluation Methods Among Washington State High School Football Coaches and Athletic Trainers

To evaluate awareness of concussion assessment methods and to determine whether there are differences among Washington State high school football coaches and athletic trainers in urban versus rural school districts.

Tools for Assessing Central Nervous System Injury in the Cardiac Surgery Patient

Despite improvements in surgical, anesthetic, and perfusion techniques in recent years, central nervous system (CNS) complications remain “a principal cause of the morbidity after open-heart surgery” [1]. Just as the improvement in cardiac outcome owes much to the growth in the number and sophistication of the tools to measure cardiac function, having better tools to assess brain function will contribute to development of new ways of avoiding CNS damage due to cardiopulmonary bypass (CPB). The importance to the CNS of oxygenator design, perfusion flow, pressure, arterial filtering, carbon dioxide tension, pharmacologic protection, and other factors can only be evaluated if proper measuring tools are available to the investigators.