Post-Traumatic Growth and Resilience Among Medical Students After the March 2011 Disaster in Fukushima, Japan.

In March of 2011, an earthquake, tsunami, and nuclear accident struck northern Japan causing profound damage to the surrounding area and lasting effects to all those who lived there. Fukushima Medical University (FMU), the closest hospital that remained open during the disaster, was greatly impacted and its students rallied to help the cause. Many of them were directly affected as their neighborhoods were ruined and family and friends were injured or killed. Our study sought to better understand how this disaster impacted their posttraumatic growth and resilience in the wake of the disaster and today, 8 years later. There were three goals of this study. First, we aimed to replicate previous research that showed positive effects of disaster volunteerism on medical students' posttraumatic growth. Second, we sought to better understand the role of resilience in the wellbeing of these students. Finally, we wanted to explore the advantages to our newly created 10-Factor Resilience Behavioral Scale, which we used alongside the Davidson Trauma Scale (DTS), Posttraumatic Growth Inventory (PTGI-X), and Connor-Davidson Resilience Scale (CD-RISC). Overall, 579 responses were collected (response rate of 71.9%). Volunteers continued to show greater PTG as well as greater overall resilience. Furthermore, there were positive correlations between students' feelings of confusion, anger, sadness, guilt or anxiety and their sense of resilience, both at the time of the disaster and in the most recent month, suggesting that within Japanese culture difficult emotions may promote resilient behaviors and actions.

The Effects of Altitude on Concussion Incidence in the 2013-2017 National Hockey League Seasons.

Background and objective The high incidence of traumatic brain injuries during contact sports has necessitated the need for further research pertaining to their implications and possible mitigation. Despite increasing attention to sports-related concussions, there is still a striking lack of detail pertaining to the environmental factors that contribute to their occurrence. One environmental condition that has yet to be considered is altitude. Altitude cannot be readily adjusted, yet can still impact quality of play and concussion incidence. The current body of published evidence evaluating environmental effects on concussion is divided on the degree to which altitude mitigates concussion incidence. We aim to systematically compare the prevalence of concussions that occur at high and low altitude utilizing 1000 feet (304.8 meters) as a cut-off marker for high altitude. Our research also takes a novel approach utilizing average games missed as a proxy for concussion severity. We hope to use this analysis to shed light on the implication of altitude on concussion incidence. Methods Individual player data on concussion incidence were retrospectively acquired for the 2013-2017 National Hockey League (NHL) seasons utilizing FOX Sports Injury tracker. NHL season schedules were acquired through the online source "Hockey Reference." In order to establish cutoff criteria for high vs low altitude we adopted 1000 feet (304.8 meters) as high-low altitude cutoff. We also evaluated our data utilizing a previously published high-low altitude cutoff of 644 feet (196.3 meters). Specific altitudes of each NHL arena were derived from "elevationmap.net". One caveat to our data collection was the striking lack of publicly available data pertaining to the concussions sustained by each NHL team. Data was analyzed utilizing SAS programing. Results Out of the 5281 games included in our data set, we documented a total of 133 concussions which occurred in 125 games through the 2013-2017 NHL seasons. We noted an increase in concussion reporting in the most recent 2016-2017 NHL season compared to the previous 2013-2016 seasons. Effect of altitude variance on concussion rate was evaluated utilizing 644 and 1000 ft as the low-high altitude split. We defined each variance by where the team is based at compared to where the game was played. This produced four distinct categories: 1) low-low altitude, 2) low-high altitude, 3) high-low altitude, and 4) high-high altitude. We noted a significant difference in concussion rate when teams based at high altitude above 1000 ft travel to play at low altitude; this trend was non-significant at 644 ft. The results of the average games missed analysis demonstrated that teams that play above 1000 feet had fewer games missed per concussion compared to teams that are based at a low altitude. Conclusions Though underreported in the total number of concussions in the 2013-2017 NHL seasons, our data suggests that teams who are based at a high altitude (>1000ft) experience a reduction in mean concussion rate when traveling to play at a lower altitude. Our data also indicated a reduction in average games missed post-concussion for teams based at a higher altitude. It is our goal that our findings here contribute to the larger discussion about concussion incidence and can be applied to other sports leagues and activities to mitigate their dangerous effects.

Effects of Game Characteristics and Player Positions on Concussion Incidence and Severity in Professional Football.

BACKGROUND: Increasing efforts have been made to reduce the incidence and severity of concussion in high-contact sports. Despite these efforts, a relative lack of knowledge is available regarding modulating factors affecting concussion injury. PURPOSE: To analyze the potential influence of game characteristics and outcomes on concussion incidence and severity in professional football. STUDY DESIGN: Descriptive epidemiology study. METHODS: PBS Frontline Concussion Watch was used to collect concussion injury data from regular-season games of 32 National Football League (NFL) teams from 2012 to 2015. Game characteristic variables such as rushing and passing attempts, turnovers, and margin of victory were collected from ESPN. Analysis included descriptive statistics, analysis of variance, t tests, and correlation tests. RESULTS: Away teams demonstrated a significantly greater concussion incidence per game than home teams. Losing teams had a significantly greater concussion incidence per game than winning teams. Being both the away team and the losing team appeared to have an additive effect. The home-versus-away and win-versus-loss effects were significant for offensive but not defensive positions. Within individual positions, significantly greater concussion incidence was associated with tight ends, running backs, wide receivers, and cornerbacks. When running versus passing positions were compared, passing positions (wide receiver, tight end, cornerback, safety) had significantly greater concussion incidence. A total of 626 games were missed as a result of reported concussions. Away teams had significantly more games missed due to concussion when they lost. Play time did not significantly differ before or after concussion injury. Other game characteristic variables did not significantly affect concussion frequency or intensity. CONCLUSION: Position, game location, and game outcome affect concussion incidence for professional football players. In a subset of analyses, the number of games missed aligned with concussion incidence, but this appeared to be an imperfect measure. These findings highlight new factors that may modulate concussion incidence and merit further study on how they may influence concussion evaluation.

Does the Environment Influence the Frequency of Concussion Incidence in Professional Football?

Background Sports-related concussion is a major cause of mild traumatic brain injury (mTBI). It is possible that environmental factors, such as temperature, humidity, and stadium's altitude, may influence the overall incidence of concussions during a game. Purpose To examine the impact of environmental factors, such as temperature, humidity, barometric pressure, and dew point, on concussion incidence. Methods Public Broadcasting Service (PBS) FRONTLINE Concussion Watch was used to collect injury data on 32 NFL teams during regular season games from 2012 to 2015. Weather data points were collected from Weather Underground. Concussion incidence per game, the probability of a concussion during a game, and a difference in mean game-day temperature, humidity, dew point, and barometric pressure between concussion and concussion-free games were calculated. Our analysis included t-tests, analysis of variance (ANOVA), multivariate correlation tests, and logistic and Poisson regression.  Results Overall, 564 concussions were reported. There were 411 games with concussions and 549 games without concussions. We observed a significant decrease in concussion incidence with increasing temperature, both when the temperature was divided into 20oF increments or into quartiles (p = 0.005 and p = 0.002, respectively). We identified a statistically significant lower mean-game day temperature in concussion games compared to concussion-free games (p < 0.0006). We also observed a significant decrease in the incidence of concussion per game with increasing dew point. There was no significant difference in concussion incidence in barometric pressure and humidity. The logistic regression model predicted a decrease in the probability of a concussion in games with higher temperatures and dew points. Conclusions National Football League (NFL) players experienced an increased risk of concussion during football games played in colder temperatures and at lower dew points. Further research on environmental effects on concussions may aid in improving player safety in football leagues.