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.

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.

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.

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.

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.

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).

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.

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.

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.

Attention and executive control in varsity athletes engaging in strategic and static sports.

Examining non-sport-related cognitive tasks of attention and executive control in skilled athletes may provide insight into the acquisition of highly specific skills developed in experts as well as help identify successful performance in sport. Through a cross-sectional design, this study examined performance on aspects of attention and executive control among varsity athletes playing soccer (strategic sport) or track & field (static sport) using a computerized test of attention and executive control. Ninety-seven university athletes participating in soccer (n = 50) or track and field (n = 47) were included in the study. Domains of attention and executive control were examined using the Attention Network Test-Interactions (ANT-I). Mean reaction time (RT) and intra-individual variability (IIV) were compared between groups as measures of performance speed and performance stability respectively. Soccer players demonstrated overall faster RTs (p = 0.0499; ηp2 = .04) and higher response accuracy (p = .021, d = .48) on the ANT-I compared to track and field athletes. Faster RTs were observed for soccer players when presented with an alerting tone (p = .029, d = .45), valid orienting cue (p = .019, d = .49) and incongruent flanker (p = .031, d = .45). No significant group differences were observed in IIV (p = .083, d = .36). Athletes engaging in strategic sports (i.e., soccer) demonstrated faster performance under test conditions that required higher vigilance and conflict resolution. These findings suggest that engagement in strategic sports is associated with enhanced performance on non-sport-related cognitive tasks of attention and executive control.

Investigation of baseline attention, executive control, and performance variability in female varsity athletes.

To examine attention, executive control, and performance variability in healthy varsity athletes and identify unique resting-state functional connectivity (rsFC) patterns associated with measures of speed, stability, and attention. A sample of 29 female university varsity athletes completed cognitive testing using the Attention Network Test- Interactions (ANT-I) and underwent resting-state functional MRI (rsfMRI) scans. Performance was characterized by examining mean reaction time (RT), variability in performance (ISD), and attention network scores on the ANT-I. RsfMRI data were analyzed using an independent component analysis (ICA) in the frontoparietal (FPN), dorsal attention (DAN), default mode, (DMN), salience (SN), and sensorimotor (SMN) networks. Group-level analyses using the performance variables of interest were conducted. Athletes' performance on the ANT-I revealed a main effect of orienting and executive control (ps<0.001; partial η2 = 0.68 and 0.89, respectively), with performance facilitated (i.e., faster RT) when athletes were presented with valid cues and congruent flankers. Alerting, orienting, and executive control performance were associated with differences in rsFC within the SN, DMN, and FPN, respectively. Slower RTs were associated with greater rsFC between DAN and bilateral postcentral gyri (p<.001), whereas more stable performance was associated with greater FC between the SMN and the left precuneus (p<.05). Consistent with prior studies, we observed that efficiency in alerting, orienting, and executive control aspects of attention was associated with differences in rsFC in regions associated with the SN, DMS, and FPN. In addition, we observed differential patterns of rsFC for overall speed and variability of performance.

Systematic Review of the Long-Term Neuroimaging Correlates of Mild Traumatic Brain Injury and Repetitive Head Injuries.

Objective: To systematically review the literature on the long-term neuroimaging findings (≥10 years from exposure) for exposure in adulthood to mild traumatic brain injury (mTBI) and repetitive head impacts (RHIs) using neuroimaging across all available populations. Data sources: Four electronic databases: MEDLINE, SPORTDiscus, PsycINFO, and EMBASE. Study selection: All articles were original research and published in English. Studies examined adults with remote exposure to mTBI and/or RHIs from ten or more years ago in addition to any associated neuroimaging findings. Data extraction: Parameters mainly included participants' population, age, years since head injury, race, sex, education level, and any neuroimaging findings. Scores for the level of evidence and risk of bias were calculated independently by two authors. Results: 5,521 studies were reviewed, of which 34 met inclusion criteria and were included in this study. The majority of adults in these studies showed positive neuroimaging findings one or more decades following mTBI/RHI exposure. This was consistent across study populations (i.e., veterans, athletes, and the general population). There was evidence for altered protein deposition patterns, micro- and macro-structural, functional, neurochemical, and blood flow-related differences in the brain for those with remote mTBI/RHI exposure. Conclusion: Findings from these studies suggest that past mTBI/RHI exposure may be associated with neuroimaging findings. However, given the methodological constraints related to relatively small sample sizes and the heterogeneity in injury types/exposure and imaging techniques used, conclusions drawn from this review are limited. Well-designed longitudinal studies with multimodal imaging and in-depth health and demographic information will be required to better understand the potential for having positive neuroimaging findings following remote mTBI/RHI.

Substance use is associated with worse mental health and altered resting state functional connectivity in female university athletes at baseline: A pilot study.

University athletes are at high risk for both substance use and mental health problems. This study examined associations between substance use, mental health symptoms, and the resting state functional connectivity (rsFC) of key neural regions involved in self-monitoring and emotional regulation in a sample of female varsity athletes. 31 female university athletes completed measures of substance use, mental health symptoms, and underwent functional MRI scans during the pre-season. Athletes who were substance users had higher symptoms of depression than non-users (p = 0.04; Hedge's g = 0.81). RsFC differences were observed between users and non-users in orbital frontal cortex (OFC) and bilateral hippocampal seeds, and negative associations between depression symptoms and rsFC in the left hippocampus and posterior cingulate cortex were observed in cannabis users. In female athletes, substance use is associated with greater self-reported depression symptoms and altered rsFC in self-monitoring and emotional regulation regions of the brain.

Parent knowledge of and attitudes towards youth sport-related concussion and associations with child and parent factors.

Aim: This cross-sectional study aimed to better understand parental knowledge and attitudes regarding pediatric sport-related concussions, and association with parent/child biopsychosocial factors. Methods: A community sample of ninety families (n = 140 children) were included. Parental concussion knowledge and attitudes, concussion history, sport participation and social risk status score (SRS) were collected. Results: Parents scored an average of 76% accuracy on factual concussion knowledge, with 74% confidence in responses. Parents endorsed a favorable attitude toward concussion reporting and management. Low SRS had higher perceived accuracy of knowledge than medium or high SRS (p = 0.003). SRS influenced over-and-underestimations of factual knowledge (p = .04). Age at first sport and sport contact level influenced factual and perceived concussion knowledge. Conclusion: These findings identify common gaps in concussion knowledge in parents.

White Matter Abnormalities in Retired Professional Rugby League Players with a History of Concussion.

The topic of potential long-term neurological consequences from having multiple concussions during a career in collision sports is controversial. We sought to investigate white matter microstructure using diffusion tensor imaging (DTI) in retired professional Australian National Rugby League (NRL) players (n = 11) with a history of multiple self-reported concussions compared with age- and education-matched controls (n = 13) who have had no history of brain trauma. Diffusion-weighted images were acquired with a Siemens 3T scanner. All participants completed a clinical interview. There were no significant differences between groups on measures of depression, anxiety, stress, or post-concussion symptoms; however, NRL players scored significantly higher on the alcohol use disorder identification test (AUDIT). Voxelwise analyses of DTI measures were performed using tract-based spatial statistics (TBSS) with age and AUDIT scores included as covariates. TBSS revealed significantly reduced fractional anisotropy (FA), and increased radial diffusivity (RD), axial diffusivity (AD), and trace (TR) in white matter regions of recently retired NRL players compared with controls. FA was significantly reduced in the right superior longitudinal fasciculus and right corticospinal tract while TR, RD, and AD were increased in these regions, as well as the corpus callosum, forceps major, right uncinate fasciculus, and left corticospinal tract. In summary, DTI in a small cohort of recently retired professional NRL players with a history of multiple concussions showed differences in white matter microstructure compared with age- and education-matched controls with no history of brain trauma.

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.

Influence of Anxiety on Baseline Cognitive Testing and Symptom Reporting in Adolescent Student Athletes.

Anxiety symptoms are commonly endorsed by student athletes. This study examined the possible influence of anxiety on baseline cognitive testing and symptom reporting in a large sample of adolescent student athletes. Participants were 37,945 adolescent student athletes from the state of Maine who completed baseline testing using ImPACT®. ImPACT includes an evaluation of cognitive functioning and a questionnaire assessing the presence and severity of common post-concussion symptoms. Participants were divided into high and low anxiety groups based on endorsement of anxiety-like symptoms. Student athletes in the high anxiety group were more likely to be girls and to have a greater lifetime history of treatment for mental health problems and headaches (ps < 0.001). The high anxiety group scored slightly lower on cognitive tests (Cohen ds = 0.15-0.26) and reported a much greater amount of baseline pre-season symptoms (Cohen d = 3.38). More than eight of 10 youth in the high anxiety group (82.7%) met International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) symptom criteria for at least a mild form of the postconcussional syndrome compared with less than two of 10 (18.4%) in the low anxiety group. Students in the high anxiety group had slightly lower scores on neurocognitive testing, but the differences were not practically meaningful; however, they endorsed dramatically more physical, cognitive, and emotional symptoms. Anxiety can mimic the ICD-10 postconcussional syndrome in adolescent student athletes at baseline, when they have not been injured.

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.

Task-related functional magnetic resonance imaging activations in patients with acute and subacute mild traumatic brain injury: A coordinate-based meta-analysis.

Task-based functional magnetic resonance imaging (fMRI) has been used to examine neuroanatomical and functional changes following mild traumatic brain injury (mTBI). Prior studies have lacked consistency in identifying common regions of altered neural activity during cognitive tasks. This may be partly due to differences in task paradigm, patient heterogeneity, and methods of fMRI analysis. We conducted a meta-analysis using an activation likelihood estimation (ALE) method to identify regions of differential brain activation in patients with mTBI compared to healthy controls. We included experiments that performed scans from acute to subacute time points post-injury. The seven included studies recruited a total sample of 174 patients with mTBIs and 139 control participants. The results of our coordinate based meta-analysis revealed a single cluster of reduced activation within the right middle frontal gyrus (MFG) that differentiated mTBI from healthy controls. We conclude that the cognitive impairments in memory and attention typically reported in mTBI patients may be associated with a deficit in the right MFG, which impacts the recruitment of neural networks important for attentional control.