Reference Values for the Headache Impact Test-6 Questionnaire.

OBJECTIVE: To determine reference values for the Headache Impact Test-6 (HIT-6) in a young, physically active cohort and to examine the influence of sex, concussion history, headache history, and competitive sport level on HIT-6 scores. DESIGN: Cross-sectional. SETTING: United States Service Academy. PARTICIPANTS: United States Service Academy cadets (N=2678) completed an HIT-6 questionnaire as part of their annual concussion baseline assessment. Cadets with a recent concussion were excluded from baseline testing. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Reference values were calculated and stratified by sex, concussion history, headache history, and competitive sport level. Mann-Whitney U and Kruskal-Wallis tests were used to examine the effect of sex, concussion history, headache history, and competitive sport level on HIT-6 scores (P<.05). RESULTS: Of the 3599 cadets baselined, 2687 cadets (23% female) agreed to participate in the study and completed the HIT-6. Female participants reported significantly worse HIT-6 scores compared with male participants both with (P<.001) and without (P<.001) a concussion history. In both sexes, participants with a headache history reported worse scores than those with no headache/concussion history and a concussion history (all P<.005). Female cadets who participated in intramural athletics reported worse HIT-6 scores at baseline than female intercollegiate athletes (P=.003). CONCLUSIONS: This is the first study to stratify HIT-6 data by sex, concussion history, headache history, and sport level in a collegiate population at risk for concussions. Sex and headache history appear to influence HIT-6 scores and should be given special consideration when interpreting health-related quality of life deficits due to headache.

Evaluating the mental health and well-being of Canadian healthcare workers during the COVID-19 outbreak.

During the COVID-19 pandemic, healthcare systems have been under extreme levels of stress due to increases in patient distress and patient deaths. While additional research and public health funding initiatives can alleviate these systemic issues, it is also important to consider the ongoing mental health and well-being of professionals working in healthcare. By surveying healthcare workers working in Canada during the COVID-19 pandemic, we found that there was an elevated level of depressive symptomatology in that population. We also found that when employees were provided with accurate and timely information about the pandemic, and additional protective measures in the workplace, they were less likely to report negative effects on well-being. We recommend that healthcare employers take these steps, as well as providing targeted mental health interventions, in order to maintain the mental health of their employees, which in turn will provide better healthcare at the population level.

Reference values for the Balance Error Scoring System as measured by the Tekscan MobileMat™ in a physically active population.

OBJECTIVES: The Balance Error Scoring System (BESS) is commonly used to measure postural stability; however, it has demonstrated inconsistent reliability values when administered by humans. The Tekscan MobileMat™ was developed to automate the assessment of BESS errors and eliminate rater subjectivity. The objective of this study was to report reference values for the BESS, as measured by the MobileMat™, and examine the effect of sex, concussion history, and competitive sport level on BESS performance. METHODS: Four hundred and forty participants performed the BESS on the MobileMat™. Participants were asked to maintain each stance with their eyes closed for 20 s. The MobileMat™ was used to quantify the number of errors. RESULTS: Concussion history (p = 0.279-0.979) and competitive sport level (p = 0.422-0.979) did not affect BESS performance. Males performed significantly better than females for the single-limb foam stance (p = 0.032). No sex differences were detected for the other BESS stances or BESS total score (p = 0.067-0.744). CONCLUSIONS: Previously reported reference values in collegiate athletes and adolescents were slightly higher thus highlighting the value in establishing population norms and in developing new technologies to objectively quantify BESS performance. Furthermore, sex, concussion history, and competitive sport level do not appear to influence BESS performance as measured by the MobileMat™.

Operant discrimination of relative frequency ratios in black-capped chickadee song.

The two-note fee bee song of the black-capped chickadee (Poecile atricapillus) is sung at many different absolute frequencies, but the relative frequencies, or "pitch ratios", between the start and end of the fee note (glissando) and the fee and the bee notes (inter-note interval) are preserved with each pitch-shift. Ability to perceive these ratios and their relative salience varies with sex of the bird and setting: while both sexes appear to perceive changes in the inter-note interval, males appear to attend to the glissando in the field, and females appear to attend to both ratios. In this study, we compared directly whether male and female chickadees could discriminate between normal fee bee songs and songs that had one or both of the pitch ratios altered, and whether birds attended to one type of alteration over another. Both sexes learned to discriminate normal from altered songs; songs lacking an inter-note interval were more easily discriminated than songs with only the glissando removed. Females performed slightly better than males, including in the most difficult task with the stimuli lacking the glissando. Our study illustrates the value of using perceptual tasks to directly compare performance between the sexes and to demonstrate the difference between perception of and attention to acoustic features of vocal communication.

The relationships among nature connectedness, climate anxiety, climate action, climate knowledge, and mental health.

Introduction: Climate change is a source of global concern that has both direct and general impacts on mental health. A recent study conducted following severe bushfires in Australia demonstrated relationships among nature connectedness, climate action, climate worry, and mental health; for example, nature connectedness was associated with climate worry, which in turn was associated with psychological distress. Methods: The present study sought to replicate those findings while building on them in two important ways: on those findings in two ways: first, test similar relationships in a different geographical context that has been mostly spared from direct impacts by acute climate events; second, we take into consideration an additional factor, climate knowledge, which has been linked to relevant factors such as climate anxiety. Results: The results of a survey completed by 327 adults revealed a similar relationship between nature connectedness and climate anxiety, and between that and psychological distress. Further mirroring those previous findings, nature connectedness was associated with both individual and collective climate action, but the relationships between them and psychological distress differed. Discussion: The proposed model was a better fit to the collected data among those with high levels of climate change knowledge than those with low levels, suggesting that such knowledge influences how the above factors relate to each other.

Influence of Graft Type on Lower Extremity Functional Test Performance and Failure Rate After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Both autografts and allografts are used to reconstruct the anterior cruciate ligament (ACL) after injury; however, it is unclear whether graft source affects lower extremity functional test performance or failure rate in an active military population. OBJECTIVE: To compare lower extremity functional test performance and graft failure rates between ACL grafts [allograft, hamstring, bone-patellar tendon-bone (BTB)]. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 2. METHODS: Ninety-eight cadets entering a US Service Academy with a history of unilateral ACL reconstruction (ACLR) agreed to participate. Before basic training, participants completed 4 lower extremity functional tests. Active injury surveillance was conducted within the study cohort to identify all subsequent graft failures. RESULTS: Cadets with hamstring autografts outperformed the BTB and allograft groups on the Lower Quarter Y-Balance Test-Posteromedial direction and single-leg hop test, respectively. No differences were detected by graft type for the other functional tests. The incidence of subsequent ipsilateral graft failures in patients with autograft was 8.11%. No failures were observed in the allograft group during the follow-up period. After controlling for sex, joint hypermobility, and time since injury and surgery, the risk of graft failure was 9.8 times higher for patients with a hamstring autograft than with a BTB (P = 0.045). CONCLUSION: After ACLR, graft type appears to influence some single-limb measures of lower extremity function and the risk of subsequent failure. Hamstring autografts demonstrated better functional performance but increased risk of graft failure. CLINICAL RELEVANCE: Surgeons need to weigh the pros and cons of all graft options in relation to the patient's lifestyle. Regardless of graft type, individuals with an ACLR may require additional rehabilitation to regain neuromuscular control during dynamic single-limb tasks and mitigate graft failure.

Remember the past, plan for the future: How interactions between risk perception and behavior during the COVID-19 pandemic can inform future Canadian public health policy.

The ongoing COVID-19 pandemic necessitated the implementation of numerous temporary public health policies, including social distancing, masking, and movement limitations. These types of measures require most citizens to follow them to be effective at a population level. This study examined population adherence to emergency public health measures using early data collected in the Spring of 2020, when all Canadian jurisdictions were under relatively strict measures. In total, 1,369 participants completed an online questionnaire package to assess adherence, perceptions of government response, and perceptions of COVID-19 risk. Results indicated that most Canadians were pleased with the government's handling of the early phases of the pandemic and immediately engaged new public health mandates. Willingness to change behaviors was unrelated to satisfaction with the government response. Similarly, behavioral adherence was also unrelated to satisfaction with government, or personal risk perceptions; however, adherence to public health guidelines was related to elevated psychological distress. As the pandemic continues, public health officials must balance the mental health of the population with the physical health concerns posed by COVID-19 when applying public health mandates.

The Influence of Self-Reported Tobacco Use on Baseline Concussion Assessments.

INTRODUCTION: Baseline symptom, balance, and neurocognitive scores have become an integral piece of the concussion management process. Factors such as sleep, learning disorders, fitness level, and sex have been linked to differences in performance on baseline assessments; however, it is unclear how tobacco use may affect these scores. The objective of this study was to compare baseline concussion assessment scores between service academy cadets who use and do not use tobacco. METHODS: Cadets completed a standard battery of concussion baseline assessments per standard of care and were classified into two groups: tobacco users (n = 1,232) and nonusers (n = 5,922). Dependent variables included scores on the Balance Error Scoring System, Standardized Assessment of Concussion, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory-18, and Brief Sensation Seeking Scale (BSSS). Separate Mann-Whitney U-tests were used to compare all baseline assessment scores between groups with an adjusted P-value < 0.004. RESULTS: Cadets that used tobacco performed significantly worse on the impulse control (P < 0.001) section of the ImPACT, reported greater ImPACT symptom severity scores (P < 0.001), and were more likely to take risks as measured by the BSSS (P < 0.001). No differences were detected for Balance Error Scoring System, Standardized Assessment of Concussion, Brief Symptom Inventory-18, and Sport Concussion Assessment Tool-3 symptom scores, verbal memory, visual memory, visual-motor speed, or reaction time on the ImPACT (P > 0.004). CONCLUSIONS: Tobacco users performed significantly worse than tobacco nonusers on the impulse control section of the ImPACT, reported greater symptom severity scores on the ImPACT, and were more likely to take risks as measured by the BSSS. Despite statistical significance, these results should be interpreted with caution, as the overall effect sizes were very small. Future research should examine the influence of tobacco use on recovery post-concussion.

Factors Associated With Delayed Concussion Reporting by United States Service Academy Cadets.

CONTEXT: Approximately half of individuals who sustain a concussion do not immediately report their injuries. Motivators for not reporting include thinking the suspected concussion was not a serious injury and wanting to continue participating in activity. Additionally, military personnel have concerns about how concussions may affect their careers. However, delayed reporting can prolong neurobehavioral recovery. Understanding the frequency of delayed reporting and contributing factors will aid in identifying individuals who may be more likely to delay reporting. OBJECTIVE: To describe the frequency of delayed concussion reporting by service academy cadets and determine if sex, injury setting, sport level, or medical history is capable of predicting delayed reporting. DESIGN: Cohort study. SETTING: Service academies. PATIENTS OR OTHER PARTICIPANTS: A total of 316 patients with concussions were observed from January 2014 to August 2016. MAIN OUTCOME MEASURE(S): All cadets completed an annual concussion baseline collection of demographic, medical history, and sports participation information. Delayed concussion reporting served as the outcome variable. Predictor variables were sex, injury setting, and sport level, as well as concussion, headache, and learning disorder history. Frequencies were calculated to describe the proportion of participants who delayed reporting. Univariable and multivariable logistic regression models were used to assess if the predictor variables were associated with delayed concussion reporting. Odds ratios (ORs) and 95% confidence intervals were calculated for all variables included in the final model. RESULTS: Of the patients with concussion, 51% were classified as delayed reporting. In univariable models, females (OR = 1.70) and National Collegiate Athletic Association cadet-athletes (OR = 1.98) were more likely to delay reporting than males and intramural cadet-athletes, respectively. The multivariable model yielded similar findings. CONCLUSIONS: Roughly half of the cadets who sustained a concussion failed to immediately report their injury. Specifically, our data suggested that female cadets, cadets injured outside of competition, and highly competitive cadet-athletes were almost twice as likely to delay reporting as others.

Vocal production and playback of altered song do not affect ZENK expression in black-capped chickadees (Poecile atricapillus).

The two-note fee bee song of the black-capped chickadee (Poecile atricapillus) is sung at many different absolute frequencies, but the relative frequencies between the start and end of the fee note (the glissando) and between the fee and the bee notes (the inter-note ratio) are preserved regardless of absolute frequency. If these relative frequencies are experimentally manipulated, birds exhibit reduced behavioural responses to playback of altered songs both in field studies and laboratory studies. Interestingly, males appear to be sensitive to alterations in the glissando, while females appear to be sensitive to alterations in both the glissando and the inter-note ratio. In this study, we sought to determine whether the behaviour of male and female chickadees corresponds to differences in zenk protein immunoreactivity (ZENK-ir) in auditory perceptual regions following playback of fee bee songs with typical and altered pitch ratios. Overall, there was a small but significant sex difference in ZENK-ir (females>males), but altering relative frequencies did not reduce ZENK-ir compared to typical song. Birds did vocalize less in response to playback of songs that lacked an inter-note interval, but amount of singing fee bee song, chick-a-dee calls, or gargles was not correlated with ZENK-ir in perceptual regions (caudomedial nidopallium, NCM and caudomedial mesopallium, CMM) or in HVC, which is part of the song system. Our results confirm that ZENK-ir in NCM and CMM is not involved in fine-grain perceptual discrimination, however it did not support the idea that increased vocalizing increases ZENK-ir in HVC.

Cholecystokinin and endogenous opioid peptides: interactive influence on pain, cognition, and emotion.

It is well documented that stressful life experiences contribute to the etiology of human mood disorders. Cholecystokinin (CCK) is a neuropeptide found in high concentrations throughout the central nervous system, where it is involved in numerous physiological functions. A role for CCK in the induction and persistence of anxiety and major depression appears to be conspicuous. While increased CCK has been associated with motivational loss, anxiety and panic attacks, an increase in mesocorticolimbic opioid availability has been associated with coping and mood elevation. The close neuroanatomical distribution of CCK with opioid peptides in the limbic system suggests that there may be an opioid-CCK link in the modulation and expression of anxiety or stressor-related behaviors. In effect, while CCK induces relatively protracted behavioral disturbances in both animal and human subjects following stressor applications, opioid receptor activation may change the course of psychopathology. The antagonistic interaction of CCK and opioid peptides is evident in psychological disturbances as well as stress-induced analgesia. There appears to be an intricate balance between the memory-enhancing and anxiety-provoking effects of CCK on one hand, and the amnesic and anxiolytic effects of opioid peptides on the other hand. Potential anxiogenic and mnemonic influences of site-specific mesocorticolimbic CCK and opioid peptide availability, the relative contributions of specific CCK and opioid receptors, as well as the time course underlying neuronal substrates of long-term behavioral disturbances as a result of stressor manipulations, are discussed.

Intracerebroventricular D-Pen2, D-Pen5-enkephalin administration soon after stressor imposition influences behavioral responsivity to a subsequent stressor encounter in CD-1 mice.

Endogenous opioid peptide systems diminish stress-induced autonomic nervous system, neuroendocrine (hypothalamic-pituitary-adrenal axis) and behavioral responses, attenuating a collection of physiological symptoms basic to emotional and affective states. Neurogenic stressors may incite specific central changes in opioid peptide availability as well as changes in mu and delta-opioid receptor function. The present investigation evaluated the proactive influence of an intracerebroventricular injection of the opioid receptor agonist D-Pen2, D-Pen5-enkephalin (DPDPE) (0 microg, 0.005 microg, 1.0 microg or 2.5 microg) on locomotor behavior of mice following uncontrollable footshock (Shock) or novel shock chamber exposure (No Shock). It was expected that DPDPE administration following Shock on Day 1 would restore locomotor activity up to 1 week and prevent shock-associated behavior of mice encountering a brief session of footshock 18 days later. Exposure to Shock reduced horizontal locomotor and vertical locomotor (rearing) activity of mice while 2.5 microg DPDPE restored behavior. Eighteen days following Shock and DPDPE challenge, mice were exposed to either an abbreviated session of footshock (Mild Stress) or the shock chamber (Cues). Mice in the No Shock and Shock groups administered 2.5 microg DPDPE on Day 1 did not exhibit any locomotor deficits in response to Mild Stress on Day 18. Mice in the Shock group administered 0.005 microg DPDPE on Day 1, did not exhibit exaggerated rearing deficits following ensuing Mild Stressor encounter relative to mice reexposed to Cues on Day 18. Taken together, these data show that (a) footshock differentially affects rearing and locomotor activity, (b) DPDPE administration increases locomotor activity for up to 1 week following footshock and DPDPE administration, (c) reexposure to Mild Stress affects rearing and locomotor performance differently depending on previous stressor history and DPDPE dose, (d) DPDPE affords long-lasting protection to previously non-stressed mice against the deleterious effects of subsequent mild stress on locomotor activity, while a low dose of DPDE is sufficient to prevent shock-induced sensitization of rearing deficits, 18 days following original stressor and drug presentation. Finally, our investigation demonstrates that DPDPE administration alters the behavioral impact of future stressful encounters and emphasizes the importance of investigating opioid mechanisms in chronic stress disorders.

Zenk expression in auditory regions changes with breeding condition in male Black-capped chickadees (Poecile atricapillus).

Black-capped chickadees (Poecile atricapillus) produce different vocalizations at different times of year: the fee-bee song is produced by males primarily in spring, whereas the chick-a-dee call is produced year-round but most frequently in the fall and winter. We wanted to determine if neural response to playback in auditory regions of the songbird brain varied with season in parallel to production. We captured adult male black-capped chickadees from the wild in either breeding condition or non-breeding condition and within 24-48 h of bringing them into the laboratory setting, played them recordings of either conspecific vocalizations (fee-bee songs or chick-a-dee calls), heterospecific vocalizations (Song Sparrow, Melospiza melodia, song), or silence. We then measured ZENK protein immunoreactivity (Zenk-ir) in caudomedial nidopallium (NCM) and caudomedial mesopallium (CMM), two regions important for perception of conspecific vocalizations. We found that, overall, non-breeding birds had greater Zenk-ir than breeding birds. In addition, we found that birds in non-breeding condition had significantly greater Zenk-ir to heterospecific song than birds in breeding condition, but this difference was not seen in birds that heard conspecific songs or calls. Finally, in NCMd chickadees had greater response to playback of conspecific vocalizations (when combining song and call groups) than playback of heterospecific vocalizations but only while in breeding condition. Our results qualify the claim that Zenk-ir is biased toward conspecific vocalizations, and indicate that specificity of neural response varies with season. Variation could be a result of increased production and perceptual demand in spring, or hormonal changes in breeding birds, possibly because chickadees display vocal plasticity in chick-a-dee calls in the fall, requiring a degree of neural plasticity across seasons.