Pain, impairment, medication use and health-related quality of life of retired professional rugby players.

Background: Rugby is a physically demanding sport with a high injury rate. Professional male rugby players have a notably greater risk of sustaining injuries that require hospitalisation or surgery than male athletes from non-contact sports. Retired elite male rugby players experience physical and mental health conditions as well as varying levels of pain, negatively impacting their quality of life. Retired rugby players could use medication or substances as a coping mechanism to deal with chronic pain and a lower quality of life. However, research is scarce on how retired rugby players manage pain and how this affects their quality of life. Objectives: This study aimed to understand joint pain and impairment, mental and physical quality of life, and pain medication use in retired professional male rugby players. Methods: A cross-sectional study was conducted using a questionnaire completed by retired professional male rugby players. Joint pain and impairment were explored through three questions, health-related quality of life was assessed through the PROMIS-GH, and medication use was explored through 12 questions. Results: Retired rugby players (N=142) reported higher scores than matched controls (N=49) for joint pain and impairment, including significantly higher scores for joint impairments for activities of daily living (p=0.047). The global mental health scores of retired rugby players were significantly lower compared to matched controls (p=0.043) and the global physical health scores were also lower in retired rugby players. Most retired rugby players reported not using prescription pain medication (75%) or over-the-counter pain medication (56%). Conclusion: Professional rugby careers have a considerable impact on the joint health and overall well-being of retired players, resulting in unique challenges. The findings of this study emphasise the need for specific after-career support for challenges faced by retired rugby players.

The challenge of adults with phenylketonuria who have been lost to care; a single center's attempt to reach those diagnosed with PKU over 60 years of newborn screening.

Background: Those diagnosed with PKU in the early years of newborn screening (NBS) were often discharged from clinic in childhood. Long-term lost to clinic patients may be impacted by untreated PKU and uninformed about current recommendations. We aimed to contact adults away from clinic for 5-50+ years, share current recommendations, offer clinical care, and elicit factors underlying not returning to clinic. Methods: Former patients were identified and offered a virtual meeting with a physician and dietitian for structured interview and education about current guidelines and treatments. Results: We identified 53 eligible patients who had PKU and had not returned to clinic in ≥5 years. Of those 53, 27 were successfully contacted, 16 completed the educational intervention, and 5/16 returned to clinic. Reasons for having been away from clinic included discharge from clinic in childhood and inadequate insurance coverage. Experiences varied and some denied negative impacts after diet discontinuation. Individuals expressed a desire for convenient treatments that aligned with overall health goals. Most participants who completed the educational intervention expressed interest in returning to clinic; however, most did not return within the timeframe of the project. All 27 individuals successfully contacted agreed to be re-contacted with future updates or research opportunities. Discussion: We successfully contacted half of individuals identified as having been lost to clinic follow-up long-term. Limitations included inability to make initial contact, and unwillingness to re-engage by some we reached. Those who agreed to participation desired ongoing PKU clinic and community connection. This experience will inform our process to engage current patients and re-engage those currently lost to care.

Headers and concussions in elite female and male football: a pilot study.

Background: Heading is a risk factor for neurogenerative disease in football. However, the exposure to heading in elite football training is understudied. Objectives: The primary purpose of this study was to determine the exposure to headers in elite men's and women's football and to describe the effects of the headers on ocular markers. Methods: Exposure to headers was observed over three days of women's and men's football. The number of headers at each session was determined through video analysis, and the G-force was determined via an impact tracker. Ocular markers were assessed at the start and end of the three days, and the results were compared to determine if there were any changes. Self-reported exposure to heading was recorded after each session and compared to the number of headers observed through video analysis, to assess the validity of players' self-reporting. Results: Female players made an average of 11 headers per player per session. Ninety percent of the headers were below 10G, and none were above 80G. Male players made an average of three headers per player per session, with 74% of the headers recording a G-force above 10G and 3% above 80G. No meaningful changes were observed post-session in the ocular markers, and no concussions were observed. Neither cohort was able to accurately self-report exposure to headers. Conclusion: Longitudinal studies should be designed and conducted across different levels of play in both women and men's football as a prerequisite to develop evidence-based measures to prevent or mitigate the potential risks associated with headers and concussions in elite football.

Dendritic cell deficiencies in pediatric acute lymphoblastic leukemia patients.

Acute lymphoblastic leukemia (ALL) cells are particularly poor at generating anti-leukemia immunity, despite residing in lymphoid organs. To assess a potential role of dendritic cells (DC) in poor anti-leukemia immunity, we analyzed peripheral blood DC in 55 pediatric ALL patients at the time of initial diagnosis and 19 age-matched healthy controls. Dendritic cells were identified by their expression of HLA-DR, lack of B, T, NK, and monocyte markers, and expression of CD11c (myeloid DC(mDC)) or BDCA-2 (plasmacytoid DC(pDC)) using flow cytometry. We found that in children with B-lineage ALL, numbers of both mDC and pDC were significantly reduced (P = 0.0001). In contrast, T-lineage ALL patients showed normal pDC and significantly elevated mDC (P = 0.003) levels, with normal expression of HLA-DR and co-stimulatory molecules. A decrease in DC could not be explained by general impairment of myelopoiesis, as we could not demonstrate a correlation of DC numbers with granulocyte/monocyte numbers in patients with B-lineage ALL. However, aberrant expression of myeloid surface markers on leukemic blasts was frequent in patients lacking myeloid DC indicating a potential block of DC differentiation. Thus, depletion of DC in B-lineage ALL patients may contribute to poor anti-leukemia immune responses.

Providing health information to the general public: a survey of current practices in academic health sciences libraries.

A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC-accredited medical schools in the United States and Canada to determine level of access and services provided to the general public. For purposes of this study, "general public" was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers. One hundred five (71%) libraries responded. Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public. Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries. A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee. Most allowed the public to use some or all library computers. Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele.

Public health professionals in the Midwest: a profile of connectivity and information technology skills.

OBJECTIVES: The aim of this study was to assess Internet connections and information technology skills of public health workers in the Midwest. METHODS: A questionnaire was mailed to 713 local health departments (LHDs) in the ten states of the Greater Midwest Region. RESULTS: Three hundred forty-four LHDs (48%) responded. Overall, 85% own a computer that would allow Internet access. Half provide Internet access to some or all staff. Of these, two-thirds use e-mail and half search the Web. One-half are linked to the State Health Department, and 30% are linked to other local health departments. Over half use CDC-Wonder; less than 20% search MEDLINE. Two-thirds of the respondents expressed an interest in MEDLINE training, and three-fourths are interested in learning more about the Internet. Sixty-nine percent of respondents planned to enhance electronic communication capacity within the next year. CONCLUSIONS: Public health practitioners need timely, convenient access to information to aid them in improving the health of the American public. A majority of public health departments in the Midwest are technically capable of connecting to the Internet. This technological capability, combined with an expressed desire by public health agencies to have workers become computer literate, suggests an important role for health sciences librarians.

Laparoscopic service economic considerations.

Laparoscopic surgery has revolutionized the outpatient surgery industry by increasing the types of surgical cases that can be performed on an outpatient or extended recovery basis. This article examines the economics surrounding laparoscopic surgery by discussing operational considerations as they relate to the surgical delivery of care. Methodologies for basic analysis of the financial impact of instituting or upgrading laparoscopic capabilities are presented for the physician's understanding of how technology affects an ever-shrinking base of reimbursement. Proposals by the Health Care Financing Administration in redesigning reimbursement for outpatient surgery services provided to Medicare beneficiaries are critically important in health care delivery because the growth in the over 65 group will soon be touched by the first of the baby-boomers. Finally, examples of various studies examining the significant direct costs for benchmarking and the advantages of laparoscopy as a surgical technique are presented.

Collection development and outsourcing in academic health sciences libraries: a survey of current practices.

Academic health sciences libraries in the United States and Canada were surveyed regarding collection development trends, including their effect on approval plan and blanket order use, and use of outsourcing over the past four years. Results of the survey indicate that serials market forces, budgetary constraints, and growth in electronic resources purchasing have resulted in a decline in the acquisition of print items. As a result, approval plan use is being curtailed in many academic health sciences libraries. Although use of blanket orders is more stable, fewer than one-third of academic health sciences libraries report using them currently. The decline of print collections suggests that libraries should explore cooperative collection development of print materials to ensure access and preservation. The decline of approval plan use and the need for cooperative collection development may require additional effort for sound collection development. Libraries were also surveyed about their use of outsourcing. Some libraries reported outsourcing cataloging and shelf preparation of books, but none reported using outsourcing for resource selection. The reason given most often for outsourcing was that it resulted in cost savings. As expected, economic factors are driving both collection development and outsourcing practices.

Assessing and enhancing medical students' computer skills: a two-year experience.

In 1984, the Association of American Medical Colleges (AAMC) issued recommendations for the reform of medical education. One recommendation was that information sciences be incorporated into the medical curriculum. In fall 1996, a survey was conducted to learn more about computer use by medical students at the Rockford regional site of the University of Illinois at Chicago College of Medicine. The purpose of the survey was to gather information not only about computer skills, but also about overall comfort level in using computers and about expectations for enhancing computer skills while attending medical school. Over a two year period, 208 students representing four classes received this survey in their e-mail. Non-respondents received a follow-up print copy in their student mailboxes. Results, based on a 60% response rate, showed a majority of Rockford students entered medical school with good skills in using e-mail and word processing, but many lacked the skills necessary to search the medical literature or to use computer-assisted instructional programs. Overall, 80% of students expected to learn more about computers while attending medical school. Results contributed to an increased effort to integrate computer applications into the medical curriculum and to use computers as a means of communicating with students.

The impact of consumer health information provided by libraries: the Delaware experience.

In the past two decades, consumer health libraries have proliferated in response to the changing health care environment and consumer demand. While this growth of consumer health resources and services has been extensively described in the literature, there is little documentation about the impact and value of providing consumer health information. This paper explores the issues of impact and value as examined in a retrospective study of consumers who received health information from the Delaware Academy of Medicine's Consumer Health Library during 1995. In this study, 270 adults were mailed a questionnaire that focused on whether the information influenced decisions, actions, anxiety levels, and patient-provider communication. The questionnaire also addressed the value of such library service in terms of likelihood of repeat use, recommendation to others, and willingness to pay. The results, based on a return rate of 86.7%, identified effects of library-supplied consumer health information that extend beyond the anticipated acquisition of knowledge to specific actions and effects on anxiety. The value of consumer health library information service was shown by the extremely high percentage of probable repeat use and recommendation to others, the willingness of 83.8% of the respondents to pay for such service, and the copious comments volunteered by the respondents.

Consumer health information partnerships: the health science library and multitype library system.

The University of Illinois Library of the Health Sciences at Rockford (LHS-Rockford) long has honored a commitment to serving the health information needs of the greater Rockford community. Utilization data collected over the past five years indicate that approximately 50% of reference transactions involve persons not affiliated with the university. In early 1994, LHS-Rockford submitted a proposal to the Northern Illinois Library System (NILS), a multitype system spanning twelve counties in northwestern Illinois, asking to serve as a resource library for improving medical and health information services provided by the 138 NILS member libraries. The NILS funded this pilot project as part of an effort to implement a new strategic plan, which encouraged member libraries to form networks to provide reference back-up service. LHS-Rockford acquired InfoTrac's Health Reference Center, a consumer health information database, and set up a dedicated workstation near the information and circulation desk. Referral guidelines were established and the project was promoted among NILS member libraries. Activities were documented in order to track project success in terms of referrals and outcomes. The demonstration project was very successful, and it proves public consumers seeking health information can benefit greatly from this type of cooperative arrangement.

Cost reductions Part 2: an organizational culture perspective.

Part One of this series described how an Operations Improvement process, computer simulation, and a focus on the dollars per patient day or unit of service ($PPD) can enhance a hospital's cost-reduction efforts. Part Two will address the organizational culture issues that can hamper or support nursing's cost-reduction efforts.

Cost reductions. Part 1: An operations improvement process.

Today's nursing leaders are commonly expected to reduce labor costs. This two-part series provides a framework for achieving significant cost reductions in the nursing labor budget. Part One describes a process that has been used to identify and implement cost savings in varied hospital settings. Part Two will address organizational culture issues that can hamper or support cost savings.