Screening for Anxiety and Depression Symptoms Using Concussion Symptom Scales Among Varsity Athletes.

OBJECTIVE: This study examined associations between Sport Concussion Assessment Tool-5 (SCAT-5) symptom reporting and gold-standard measures of anxiety and depression, and explored the utility SCAT-5 symptom subscales to identify anxiety and depression symptomology. DESIGN: Prospective cross-sectional study. SETTING: York University in Toronto, Canada. PARTICIPANTS: Preseason data were collected for varsity athletes (N = 296) aged between 17 and 25 years ( M = 20.01 years, SD = 1.69 years; 52% male). MAIN OUTCOME MEASURES: The SCAT-5 symptom evaluation scale was used to assess baseline symptoms. The Generalized Anxiety Disorder Index-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess symptoms of anxiety and depression, respectively. RESULTS: Endorsement of SCAT-5 symptoms of feeling anxious, sadness, irritability, and feeling more emotional had the strongest correlations with the GAD-7 ( r' s > 0.400; P' s < 0.001). Sadness, trouble falling asleep, concentration problems, feeling slowed down, anxious, irritability, mental fog, fatigue, and memory problems had the highest correlations with the PHQ-9 ( r' s >0 .400; P' s < 0.001). The Emotional subscale from the SCAT-5 predicted mild to severe anxiety on the GAD-7 ( P < 0.001). The Sleep, Cognitive, and Emotional subscales predicted mild to severe depression on the PHQ-9 ( P' s < 0.05). CONCLUSIONS: These findings provide better delineation of symptoms endorsed on the SCAT-5 symptoms that aid in identification of athletes with symptoms of anxiety or depression who may be at risk for developing a clinical disorder or experiencing persistent symptoms after a concussion.

Neurodevelopmental outcomes at 18 months of children diagnosed with CHD compared to children born very preterm.

OBJECTIVE: To compare neurodevelopmental outcomes and parent behaviour ratings of children born term with CHD to children born very preterm. METHODS: A clinical research sample of 181 children (CHD [n = 81]; very preterm [≤32 weeks; n = 100]) was assessed at 18 months. RESULTS: Children with CHD and born very preterm did not differ on Bayley-III cognitive, language, or motor composite scores, or on expressive or receptive language, or on fine motor scaled scores. Children with CHD had lower ross motor scaled scores compared to children born very preterm (p = 0.047). More children with CHD had impaired scores (<70 SS) on language composite (17%), expressive language (16%), and gross motor (14%) indices compared to children born very preterm (6%; 7%; 3%; ps < 0.05). No group differences were found on behaviours rated by parents on the Child Behaviour Checklist (1.5-5 years) or the proportion of children with scores above the clinical cutoff. English as a first language was associated with higher cognitive (p = 0.004) and language composite scores (p < 0.001). Lower median household income and English as a second language were associated with higher total behaviour problems (ps < 0.05). CONCLUSIONS: Children with CHD were more likely to display language and motor impairment compared to children born very preterm at 18 months. Outcomes were associated with language spoken in the home and household income.

Is Component-Specific Antibody Testing Sufficient to Replace the Oral Food Challenge in the Diagnostics of Peanut-Sensitized Children? A Proof-of-Concept Study.

(1) Peanut allergy is associated with high risk of anaphylaxis which could be prevented by oral immunotherapy. Patients eligible for immunotherapy are selected on the basis of a food challenge, although currently the assessment of antibodies against main peanut molecules (Ara h 1, 2, 3 and 6) is thought to be another option. (2) The current study assessed the relationship between the mentioned antibodies, challenge outcomes, skin tests and some other parameters in peanut-sensitized children. It involved 74 children, divided into two groups, based on their response to a food challenge. (3) Both groups differed in results of skin tests, levels of component-specific antibodies and peanut exposure history. The antibody levels were then used to calculate thresholds for prediction of challenge results or symptom severity. While the antibody-based challenge prediction revealed statistical significance, it failed in cases of severe symptoms. Furthermore, no significant correlation was observed between antibody levels, symptom-eliciting doses and the risk of severe anaphylaxis. Although in some patients it could result from interference with IgG4, the latter would not be a universal explanation of this phenomenon. (4) Despite some limitations, antibody-based screening may be an alternative to the food challenge, although its clinical relevance still requires further studies.

Adjusting to life after pediatric stroke: A qualitative study.

AIM: To examine adjustment after stroke in adolescence from the perspective of affected young people. METHOD: Fourteen participants (10 female) aged 13 to 25 years with a history of ischemic or hemorrhagic stroke in adolescence participated in one-on-one semi-structured interviews at the Hospital for Sick Children, Toronto, Canada. Interviews were audio-recorded and transcribed verbatim. Two independent coders conducted a reflexive thematic analysis. RESULTS: Five themes were identified as representative of adjustment after stroke: (1) 'Processing the story'; (2) 'Loss and challenges'; (3) 'I've changed'; (4) 'Keys to recovery'; and (5) 'Adjustment and acceptance'. INTERPRETATION: This qualitative study provides medical professionals with a personal, patient-driven lens through which to better understand the challenges of adjusting to life after pediatric stroke. Findings highlight the need to provide mental health support to patients to assist them in processing their stroke and adapting to long-lasting sequelae. WHAT THIS PAPER ADDS: Processing the onset event is a key component of adjustment to stroke. Feelings of anxiety, sadness, frustration, and self-consciousness impede adjustment to stroke. Young people may feel overwhelmed academically owing to neurocognitive deficits. Sequelae may rid young people of hobbies and passions, and alter plans for the future. To adjust to stroke, survivors draw on resilience, patience, determination, and social support.

Influence of Mild Traumatic Brain Injury History and Mental Health Status on Alcohol and Cannabis Use in University Athletes.

OBJECTIVE: This study examined the relationship between mild traumatic brain injury (mTBI) history, mental health, and sex with single and polysubstance use in university athletes. DESIGN: Observational study. SETTING: University in Ontario, Canada. PARTICIPANTS: Participants were identified from a dataset of 416 university athletes ages 18 to 21. Participants were classified based on their substance use habits and, 153 met criteria for the nonsubstance group, 195 for the alcohol use (AU) only group, and 64 polysubstance use group [ie, a combined substance use (AU+) group]. INDEPENDENT VARIABLES: Athletes received baseline assessments and completed self-reported questions regarding alcohol, cannabis, or other recreational substance use, the Patient Health Questionnaire-9, self-reported mTBI history, and self-reported anxiety, and/or panic disorder endorsement information. MAIN OUTCOME MEASURES: Comparison of mTBI history and mental health status between individuals in the alcohol only or polysubstance use group. RESULTS: Mild traumatic brain injury history was a significant predictor of AU ( P < 0.001) and AU+ ( P < 0.001). Anxiety endorsement was also a significant predictor of polysubstance use ( P < 0.001) and there was a small but nonsignificant association of polysubstance use in men ( P = 0.057). CONCLUSIONS: University athletes who experience mTBI are more likely to engage in single or polysubstance use and athletes who experience anxiety are more likely to engage in polysubstance use. Consideration of mTBI history and mental health may inform clinical concussion management for identifying potential high-risk behavior such as polysubstance use in university athletes and tailoring intervention strategies (eg, incorporating education about substance use).

Sensitization to nut allergens in children with food allergy and other atopic diseases - just a coexistence?

Introduction: Allergy to nuts, the most common food allergy in childhood, is considered as a significant health problem. Aim: To investigate sensitization to selected nuts in children with or without atopic allergy. Material and methods: Retrospective analysis involved records of 598 children, diagnosed with food allergy. Laboratory data concerned screening for sensitization to major allergens of hazelnut, peanut and walnut. Results: Approximately 77.8% of children with food allergy presented at least one concomitant atopic disease: allergic rhinitis (52.9%), atopic dermatitis (48%) or asthma (31.4%). Nearly one-third experienced at least one episode of anaphylaxis. The nut-specific antibodies were found in 67% of children. Among them, 56% were sensitized to hazelnut, and 54% to peanut. Sensitization to other nuts was less frequent (< 30%). Only 27% of patients were mono-sensitized, the remaining 73% were co-sensitized to two or three of tested nuts. Noteworthy, the occurrence of sensitization varied among age-related groups, and also depended on clinical diagnosis. In patients with sole food allergy the frequency of sensitization was highest in youngest children, whereas, when accompanied by other atopic disease, it was highest in schoolchildren. In children without food allergy, but with another atopic disease, the prevalence of sensitization was relatively low, without any specific pattern. Conclusions: The analysis of sensitization patterns may help to identify patients with an increased risk, and gives the opportunity to introduce more effective prophylaxis. However, since even the first exposure to nuts may be sufficient to trigger the anaphylaxis, this risk should be considered as a serious issue at any age.

Prevalence of nut allergen sensitization among children in central Poland.

Introduction: The diagnostics of plant-derived food allergy may be challenging. However, the recognition of sensitization patterns in defined populations, especially in children, is clinically relevant as it enables the use of secondary prophylaxis to prevent life-threatening complications. Aim: To investigate the rates and sensitization patterns to nut allergens in children from central Poland. Material and methods: The retrospective assessment concerned data of 598 children diagnosed in a single centre due to suspected food allergy. The analysis included the results of component-based multiparametric assay Allergy Explorer2 (ALEX2). Results: The sensitization to particular nut allergens varied among patients, depending on their age and nut type. The sensitization to any nut was found in 67% of children, whereas sensitization to hazelnut and peanut was the most common (56% and 55% of all children, respectively). Hazelnut sensitization was predominant in every age, and its prevalence increased with age, while peanut sensitization was detected in more than half of individuals from all groups, except for teenagers (44% of cases). Among hazelnut molecules sensitization to Cor a 1.04 was the most prevalent (74% of sensitized children), and for peanut allergens - Ara h 1 (65% of sensitized patients). The simultaneous sensitization to hazelnut, peanut and walnut (two or all of them) was found in almost half of the entire group. Conclusions: Component-based diagnostics enables differentiation between primary and cross-reactive sensitization to nut allergens and detects co-sensitization. The clinical relevance of the latter observation is remarkable as co-sensitization increases the risk of life-threatening reactions even in trace nut contamination.

Prevalence of major food allergens in skincare products for atopic dermatitis.

Introduction: Food allergy is a common concomitant disease in patients with atopic dermatitis. Sensitisation and subsequent development of food allergy might result from the application of skincare products containing food allergens, particularly when the skin barrier is impaired and inflamed. Emollients are the mainstay of the management of atopic dermatitis; however, the prevalence of food allergens in skincare products used for atopic dermatitis is unknown. Aim: To analyse the prevalence of major food allergens in skincare products for atopic dermatitis. Material and methods: Three major online cosmetic retailers in Poland were screened for atopic skincare products. The major food allergens under the mandatory allergen labelling regulation of the European Union were searched for using the INCI nomenclature of cosmetics ingredients. Results: We screened 396 skincare products, out of which 127 (32.1%) products contained at least one derivative of a major food allergen. The most common allergens were almonds, macadamia nuts, soya and cereals, followed by sesame and milk. There was no significant difference in the presence of food derivatives between leave-on and rinse-off skincare products, as well as between those intended for use by infants and children, and adults only. Conclusions: Our analysis revealed that major food allergens are prevalent in skincare products for eczema. Applying skincare products containing food derivatives on affected and inflamed skin can promote percutaneous sensitisation. Therefore, clinicians and patients with atopic dermatitis must be careful of products used for treating eczema that may contain derivatives of a major food allergen.

Acute Effects of Concussion in Adolescent Athletes With High Preseason Anxiety.

OBJECTIVE: To examine associations between pre-existing anxiety symptoms, and symptoms and cognitive functioning acutely following a suspected concussion. DESIGN: Nested case-control study. SETTING: High schools in Maine, USA. PARTICIPANTS: Participants were identified from a dataset of 46 920 student athletes ages 13 to 18 who received baseline preseason testing. A subset of 4732 underwent testing following a suspected concussion. Of those, 517 were assessed within 72 hours after their suspected concussion and met other inclusion criteria. Nineteen injured athletes endorsed anxiety-like symptoms on the Post-Concussion Symptom Scale (PCSS) during baseline testing and were placed in the high anxiety group. Each athlete was matched to 2 injured athletes who did not endorse high levels of anxiety-like symptoms (N = 57). MAIN OUTCOME MEASURES: Immediate Post-Concussion Assessment and Cognitive Testing cognitive composite scores, PCSS total score, and symptom endorsement. RESULTS: Cognitive composite scores were similar between groups across testing times ( = 0.004-0.032). The high anxiety group endorsed a greater number of symptoms than the low anxiety group ( = 0.452) and rated symptoms as more severe ( = 0.555) across testing times. Using a modified symptom score that excluded anxiety-like symptoms, a mixed analysis of variance indicated a group by injury interaction ( = 0.079); the high anxiety group reported greater increases in overall symptom severity following injury. CONCLUSIONS: Adolescent athletes who have an anxious profile at baseline are likely to experience greater symptom burden following injury. Consideration of pre-injury anxiety may inform clinical concussion management by tailoring intervention strategies (eg, incorporating mental health treatments) to facilitate concussion recovery.

Comparison of Second- and Third-Generation Parathyroid Hormone Test Results in Patients with Chronic Kidney Disease.

BACKGROUND In patients with chronic kidney disease (CKD), secondary hyperparathyroidism is assessed by measuring serum parathyroid hormone (PTH) levels. Well-established, recommended, second-generation intact parathyroid hormone (iPTH) tests are typical; rarely are more recent third-generation PTH 1-84 assays used. The agreement between results of the 2 tests in patients with CKD has not been sufficiently defined. MATERIAL AND METHODS This study aimed to compare Roche second- and third-generation PTH assays by establishing a quantitative relationship between the results of assays in patients with CKD and assessing degree of their correlation with kidney function and calcium-phosphate and bone metabolism parameters. In 205 patients with stages 3 to 5D CKD and 30 healthy controls, we measured levels of iPTH and PTH (1-84), creatinine, urea, cystatin C, calcium, inorganic phosphate, magnesium, alkaline phosphatase, bone alkaline phosphatase, osteocalcin, and ß-CrossLaps. RESULTS The third-generation PTH assay results were more than 40% lower than those obtained with the second-generation test in patients undergoing dialysis and approximately 30% lower in patients in the pre-dialysis period. PTH concentrations determined with both assays were almost to the same extent correlated with calcium-phosphate and bone metabolism parameters, and renal function indices. Formulas have been developed enabling 2-way conversion of PTH results determined with both the second- and third-generation PTH assays: For dialyzed patients, PTH (1-84)=0.5181iPTH+18.0595. Serum osteocalcin, ß-CrossLaps, and total calcium were independent predictors of PTH levels. CONCLUSIONS Correcting for the established quantitative differences, the second-and third-generation PTH tests can be used interchangeably, given the almost identical pathophysiological correlations of their results with calcium-phosphate and bone metabolism parameters.

Factors Associated With Self-Reported Concussion History in Middle School Athletes.

OBJECTIVE: Identifying personal characteristics associated with sustaining a concussion is of great interest, yet only a few have examined this in children. The purpose of this study was to examine the association between sex, neurodevelopmental disorders, health history, and lifetime history of self-reported concussion in 12- and 13-year-old athletes. DESIGN: Cross-sectional study. SETTING: Middle schools. PARTICIPANTS: Participants were 1744 twelve- and thirteen-year-old student athletes who completed preseason Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) testing, including a self-report questionnaire about previous concussions, developmental diagnoses, and previous medical treatment. INDEPENDENT VARIABLES: Age, sex, attention-deficit/hyperactivity disorder (ADHD), learning disabilities (LDs), and previous treatment for migraine. MAIN OUTCOME MEASURES: Self-reported history of concussion. RESULTS: A minority of athletes (13.7%) reported previous concussions (1 concussion, n = 181; 2 concussions, n = 41; and 3+ concussions, n = 17). A small proportion reported a history of ADHD (4.4%), LD (2.8%) or migraine treatment (4.0%). Higher rates of self-reported previous concussions were associated with male sex [16.9% vs 9.1%; χ(1) = 21.47, P < 0.001] and previous migraine treatment [31.9% vs 13.0%; χ(1) = 20.08, P < 0.001]. There were no differences in self-reported concussion history between 12- and 13-year olds (P = 0.18) and those with/without ADHD (P = 0.41) or LDs (P = 0.06). The overall logistic regression model was statistically significant [χ(5) = 42.01, P < 0.001] but explained only 4.3% of the variance. Previous treatment for migraine [P < 0.001, Exp(B) = 3.30] and male sex [P < 0.001, Exp(B) = 2.06] were independently associated with a self-reported concussion history, whereas age, LD, and ADHD were not (P's > 0.05). CONCLUSIONS: Male sex and previous migraine treatment were associated with higher rates of self-reported previous concussions in both independent and multivariate models in middle school athletes, whereas age, ADHD, and LDs were not.

Contribution of Perceived Cognitive Functioning to Quality of Life in Service Members and Veterans With Posttraumatic Stress Disorder.

Perceived cognitive impairment is a core clinical feature of posttraumatic stress disorder (PTSD) and may be an important determinant of quality of life (QOL) in those who suffer from this disorder. Using a clinical data repository, we evaluated this hypothesis in a cross-sectional sample of U.S. military service members and veterans who served after September 11, 2001, and were seeking mental health treatment at a tertiary outpatient clinic. A consecutive series of 117 patients with a clinical diagnosis of PTSD completed a battery of questionnaires at intake, including the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993), a 4-item Cognitive Symptom subscale of the Neurobehavioral Symptom Inventory (Cicerone & Kalmar, 1995), the Depression Anxiety Stress Scale-21 (Lovibond & Lovibond, 1995), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Endicott, Nee, Harrison, & Blumenthal, 1993). Cognitive symptom reporting was very high, even in the subgroup without a history of traumatic brain injury. In a regression analysis, cognitive symptom severity was independently associated with QOL (ß = -.204). This relationship was not explained by comorbid traumatic brain injury, but was restricted to patients with comorbid depression (ß = -.278 in the subgroup with an elevated Depression Anxiety Stress Scale-21 Depression subscale; n = 91). In conclusion, perceived cognitive impairment was common in this PTSD sample and helped to explain impairments in QOL, especially in patients with comorbid depression.

Video and clinical screening of national rugby league players suspected of sustaining concussion.

PRIMARY OBJECTIVE: This study reviewed the available sideline Sport Concussion Assessment Tool-Third Edition (SCAT3) performance of players who were removed from play using the 'concussion interchange rule' (CIR), the available video footage of these incidences, and associated return to play and concussion diagnosis decisions. RESEARCH DESIGN: Descriptive, observational case series. METHODS AND PROCEDURES: Data were collected from all NRL players who used the CIR during the 2014 season. MAIN OUTCOMES AND RESULTS: Complete SCAT3 and video analysis data were available for 38 (23%) of 167 uses of the concussion interchange rule, of which 20 (52.6%) players were medically diagnosed with concussion. Those with video evidence of unresponsiveness performed more poorly on the modified Balance Error Scoring System (M-BESS; p = .04; Cohen's d = .69) and reported greater symptoms (p = .03; d = .51). Similarly, players with a vacant stare reported greater symptoms (p = .05; d = .78). Those who demonstrated three signs (unresponsiveness, vacant stare and gait ataxia) performed more poorly on the M-BESS (p = .03; d = 1.4) and reported greater symptoms than those with no observable signs (p = .03; d = 1.4). CONCLUSIONS: The SCAT3 is sensitive to the acute effects of concussion in professional athletes; however, a minority of injured athletes might go undetected by this test.

MR Spectroscopy Findings in Retired Professional Rugby League Players.

The aim of this study was to examine brain neurometabolite concentrations in retired rugby league players who had a history of numerous self-reported concussions. Participants were 16 retired professional rugby league players (ages 30-45 years) with an extensive history of concussion and participation in contact sports, and 16 age- and education-matched controls who had no history of neurotrauma or participation in contact sports. All completed a clinical interview, psychological and cognitive testing, and magnetic resonance spectroscopy (MRS) investigation. MRS voxels were placed in posterior cingulate grey matter and parietal white matter. Neurometabolite concentrations were quantified using LCModel. It was hypothesized that retired athletes would differ on N-acetyl aspartate, myo-inositol, choline, glutamate, and glutathione. Retired players had significantly lower concentrations of grey matter glutathione (p=0.02, d=0.91). They did not significantly differ in concentrations of other neurometabolites. There were no significant differences between groups on measures of depression, anxiety, or cognitive functioning. The retired athletes reported significantly greater alcohol use (p<0.01; Cohen's d=1.49), and they had worse manual dexterity using their non-dominant hand (p=0.03; d=1.08). These preliminary findings suggest that MRS might be modestly sensitive to biochemical differences in athletes after their athletic careers have ended in the absence of clinical differences in cognitive performance and self-reported psychological functioning.

Altered functional connectivity and performance variability in relapsing-remitting multiple sclerosis.

BACKGROUND: Patients with multiple sclerosis (MS) demonstrate slower and more variable performance on attention and information processing speed tasks. Greater variability in cognitive task performance has been shown to be an important predictor of neurologic status and provides a unique measure of cognitive performance in MS patients. OBJECTIVES: This study investigated alterations in resting-state functional connectivity associated with within-person performance variability in MS patients. METHODS: Relapsing-remitting MS patients and matched healthy controls completed structural MRI and resting-state fMRI (rsfMRI) scans, as well as tests of information processing speed. Performance variability was calculated from reaction time tests of processing speed. rsfMRI connectivity was investigated within regions associated with the default mode network (DMN). Relations between performance variability and functional connectivity in the DMN within MS patients were evaluated. RESULTS: MS patients demonstrated greater reaction time performance variability compared to healthy controls (p<0.05). For MS patients, more stable performance on a complex processing speed task was associated with greater resting-state connectivity between the ventral medial prefrontal cortex and the frontal pole. CONCLUSIONS: Among MS patients, greater functional connectivity between medial prefrontal and frontal pole regions appears to facilitate performance stability on complex speed-dependent information processing tasks.

Indices of cognitive dysfunction in relapsing-remitting multiple sclerosis: intra-individual variability, processing speed, and attention network efficiency.

Impairments in attention and information processing speed are common in multiple sclerosis (MS) and may contribute to impairments of other cognitive abilities. This study examined attentional efficiency, information processing speed and intra-individual variability in response speed using the Attention Network Test-Interactions (ANT-I) in mildy-affected patients with MS. Thirty-one patients with relapsing-remitting MS and 30 age, sex, and education-matched controls completed the ANT-I, as well as the Paced Auditory Serial Attention Test (PASAT), as a standard clinical measure of information processing efficiency. As expected, patients with MS were slower in reaction time performance on the ANT-I and had poorer performance on the PASAT compared to controls. Patients with MS also demonstrated poorer efficiency in their executive control of attention on the ANT-I, suggesting difficulties with top-down allocation of attention. In addition, the MS group demonstrated greater intra-individual variability in the responses to the ANT-I even when their slower overall response time and other factors such as practice were accounted for. Intra-individual variability was found to best predict group membership compared to PASAT scores and other ANT-I scores. These results suggest that intra-individual variability may provide sensitive, unique and important information regarding cognitive functioning in early MS.

Predictors of participant retention in a guided online self-help program for university students: prospective cohort study.

BACKGROUND: Attrition is a persistent issue in online self-help programs, but limited research is available on reasons for attrition or successful methods for improving participant retention. One potential approach to understanding attrition and retention in such programs is to examine person-related variables (eg, beliefs and attitudes) that influence behavior. Theoretical models, such as the Theory of Planned Behavior, that describe conditions influencing human behavior may provide a useful framework for predicting participant retention in online-based program. OBJECTIVE: We examined predictors of participant retention in a guided online anxiety, depression, and stress self-help program for university students using the theory of planned behavior. We also explored whether age, symptom severity, and type of coaching (ie, email vs phone) affected participant retention. METHODS: 65 university students with mild to moderate depression, anxiety, and stress were enrolled in this prospective cohort study. Participants completed a questionnaire based on the theory of planned behavior prior to commencing the online-based program and the Depression Anxiety and Stress Scale (DASS) during the assessment module of the program. Participant retention was operationalized as the number of program modules completed. RESULTS: Perceived control over completing the online program significantly predicted intention to complete the program (F3,62=6.7; P=.001; adjusted R(2)=.2; standardized beta=.436, P=.001). Age (standardized beta=.319, P=.03) and perceived behavioral control (standardized beta=.295, P=.05) predicted the number of program modules completed (F3,61=3.20, P=.03, adjusted R(2) =.11). Initial level of distress (ie, symptom severity) did not predict participant retention (P=.55). Participants who chose phone-based coaching completed more program modules than participants who chose email-based coaching (Mann-Whitney's U=137; P=.004). CONCLUSIONS: Participants' age, level of perceived behavioral control, and choice of interaction (ie, phone-based or email-based coaching) were found to influence retention in this online-based program.

Altered Brain Functional Connectivity in Female Athletes Over the Course of a Season of Collision or Contact Sports.

University athletes are exposed to numerous impacts to the body and head, though the potential cumulative effects of such hits remain elusive. This study examined resting-state functional connectivity (rsFC) of brain networks in female varsity athletes over the course of a season. Nineteen female university athletes involved in collision (N = 12) and contact (N = 7) sports underwent functional magnetic resonance imaging scans at both pre- and post-season. A group-level independent component analysis (ICA) was used to investigate differences in rsFC over the course of a season and differences between contact and collision sport athletes. Decreased rsFC was observed over the course of the season between the default mode network (DMN) and regions in the frontal, parietal, and occipital lobe (p false discovery rate, ≤0.05) driven by differences in the contact group. There was also a main effect of group in the dorsal attention network (DAN) driven by differences between contact and collision groups at pre-season. Differences identified over the course of a season of play indicate largely decreased rsFC within the DMN, and level of contact was associated with differences in rsFC of the DAN. The association between exposure to repetitive head impacts (RHIs) and observed changes in network rsFC supplements the growing literature suggesting that even non-concussed athletes may be at risk for changes in brain functioning. However, the complexity of examining the direct effects of RHIs highlights the need to consider multiple factors, including mental health and sport-specific training and expertise, that may potentially be associated with neural changes.