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From the NY Times: Tackle Football and Youth

Category : Information , Research , Safety

Athletes who began playing tackle football before the age of 12 had more behavioral and cognitive problems later in life than those who started playing after they turned 12, a new study released on Tuesday showed.

The findings, from a long-term study conducted by researchers at Boston University, are likely to add to the debate over when, or even if, children should be allowed to begin playing tackle football.

The results of the study by researchers at Boston University, published in the journal Nature’s Translational Psychiatry, was based on a sample of 214 former players, with an average age of 51. Of those, 43 played through high school, 103 played through college and the remaining 68 played in the N.F.L.

In phone interviews and online surveys, the researchers found that players in all three groups who participated in youth football before the age of 12 had a twofold “risk of problems with behavioral regulation, apathy and executive function” and a threefold risk of “clinically elevated depression scores.”

“The brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life,” Robert Stern, one of the authors of the study, said of the findings.

The study is consistent with earlier findings by Stern and others that looked specifically at N.F.L. retirees. That research found that retirees who started playing before 12 years old had diminished mental flexibility compared to those who began playing tackle football at 12 or older.

A growing number of scientists argue that because the human brain develops rapidly at young ages, especially between 10 and 12, children should not play tackle football until their teenage years.

Last year, doctors at Wake Forest School of Medicine used advanced magnetic resonance imaging technology to find that boys between the ages of 8 and 13 who played just one season of tackle football had diminished brain function in parts of their brains.

The N.F.L., which long denied that there was any link between the game and brain damage, has in recent years been promoting what it considers safer tackling techniques aimed at reducing head-to-head collisions.

More recently, the league has been promoting flag football as an even safer alternative, an implicit acknowledgment that parents are worried about the dangers of the sport and turning away from it.

Participation in tackle football by boys ages 6 to 12 has fallen by nearly 20 percent since 2009, though it rose 1.2 percent, to 1.23 million, in 2015, according to the Sports and Fitness Industry Association.

Schools across the country have shut their tackle football programs because of safety concerns and a shortage of players. Large numbers of children have shifted to other sports like flag football, soccer, baseball and lacrosse.

The new Boston University study looked only at behavioral changes, based on the phone and online surveys.

There was no examination of physical changes in the brain. (A separate study published by researchers at Boston University in July found that 110 out of 111 brains of deceased former N.F.L. players had chronic traumatic encephalopathy, a degenerative brain disease.)

Still, the findings are yet more evidence that have contributed to an existential crisis for the game, from youth leagues to the N.F.L. Pop Warner, the most established youth football organization in the country, has reduced the amount of contact in practice – where the majority of head hits occur – and changed game rules, including banning kickoffs, one of the most dangerous plays in the game.

Jon Butler, the executive director of Pop Warner, said in a statement that the sport has changed significantly for the better since the players in the Boston University study participated decades ago. He said the organization’s medical advisory committee will review the study and “compare it against the number of recent studies that contradict these findings.”

Pop Warner is facing a class-action lawsuit asserting that it knowingly put players in danger by ignoring the risks of head trauma.

Last year, the Ivy League decided to eliminate tackling at practices during the regular season. The Canadian Football League made a similar announcement last week.

USA Football, the governing body for the sport, is introducing a 7-on-7 version of football that includes measures, like players starting in a two-point stance, designed to reduce the risk of head hits.

Other groups, like Practice Like the Pros, suggest that only flag football be played through the sixth grade and a limited version of tackle football in 7th and 8th grades.

“The curiosity about head injuries and the correct age to play full contact is peaking,” said Terry O’Neil, the group’s founder. “Tackling is the culprit. Everybody associated with the game is worried about the participation numbers.”


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Meet the Pediatricians October 26, 2017

Category : Information , People

 

We will have a meet-the-pediatricians’ evening meeting at our Woodinville office on Thursday, October 26 at 6:30 PM with Dr. Nakahara and Dr. Anderson. 

 

These meetings are for those expecting a child, or potentially new patients to our practice. If you are interested, please call our office at (425) 483-5437 to register. Meeting will be limited to the first 10 families to sign up. Please note we must limit attendance to those who sign up. See more information about these meetings here.

 


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Meed the Pediatricians August 16, 2017-Woodinville

Category : Information

 

We will have a meet-the-pediatricians’ evening meeting on Wednesday, August 16 at 6:00 PM in our Woodinville office with Dr. Johnson and Dr. Kaneshiro.

These meetings are for those expecting a child, or potentially new patients to our practice. If you are interested, please call our office at (425) 483-5437 to register. Meeting will be limited to the first 10 families to sign up. Please note we must limit attendance to those who sign up. See more information about these meetings here.

 


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Meet the Pediatricians in Mill Creek – August 10, 2017

Category : Uncategorized

We will have a meet-the-pediatricians’ evening meeting in our Mill Creek office on Thursday, August 10 at 5:30 PM with Dr. Kaneshiro and Dr. Neuzil.

These meetings are for those expecting a child, or potentially new patients to our practice. If you are interested, please call our office at (425) 483-5437 to register. Meeting will be limited to the first 10 families to sign up. Please note we must limit attendance to those who sign up. See more information about these meetings here.


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Concussion studies in the news

Category : Information , Research , Safety

Study validates concussion assessment tools for children (published 7/26/17): http://www.aappublications.org/news/2017/07/26/Concussion072617

  • Woodinville Pediatrics uses the updated version of these tools, SCAT5 and Child SCAT5

General advice regarding concussion from the AAP: https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Concussions.aspx

Study of football players’ brains, including a majority of ex-NFL players (published 7/25/17):

  • NY Times article about this study:  https://www.nytimes.com/interactive/2017/07/25/sports/football/nfl-cte.html 
    • “It is no longer debatable whether or not there is a problem in football — there is a problem,” Dr. McKee said.
  • Source article: http://jamanetwork.com/journals/jama/fullarticle/2645104
    • Relevant comments from the study: “There is substantial evidence that CTE is a progressive, neurodegenerative disease. In this study, 107 participants (96%) had a progressive clinical course based on informant report. In addition, pathological severity of CTE was correlated with age at death (Table 3). However, a postmortem study evaluates brain pathology at only 1 time point and is by definition cross-sectional. In addition, the participants were not observed longitudinally during life. Although associations with age in cross-sectional samples can result from age-related progression within individuals, they can also arise from birth cohort effects, differential survival, or age-related differences in how individuals were selected into the study. Population-based prospective studies are needed to address the issue of progression of CTE pathology and age at symptom onset.The strengths of this study are that this is the largest CTE case series ever described to our knowledge, more than doubling the size of the 2013 report,6 and that all participants were exposed to a relatively similar type of repetitive head trauma while playing the same sport. In addition, the comprehensive neuropathological evaluation and retrospective clinical data collection were independently performed while blinded to the findings of the other investigators.This study had several limitations. First, a major limitation is ascertainment bias associated with participation in this brain donation program. Although the criteria for participation were based on exposure to repetitive head trauma rather than on clinical signs of brain trauma, public awareness of a possible link between repetitive head trauma and CTE may have motivated players and their families with symptoms and signs of brain injury to participate in this research. Therefore, caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample. Second, the VA-BU-CLF brain bank is not representative of the overall population of former players of American football; most players of American football have played only on youth or high school teams, but the majority of the brain bank donors in this study played at the college or professional level. Additionally, selection into brain banks is associated with dementia status, depression status, marital status, age, sex, race, and education.36 Third, this study lacked a comparison group that is representative of all individuals exposed to American football at the college or professional level, precluding estimation of the risk of participation in football and neuropathological outcomes.”

Association of Playing High School Football With Cognition and Mental Health Later in Life (published 7/3/2017)

http://jamanetwork.com/journals/jamaneurology/article-abstract/2635831

  • “For men who attended high school in the late 1950s, playing high school football did not appear to be a major risk factor for later-life cognitive impairment or depression”

Reassuring News About Football and Cognitive Decline? Not So Fast (published 7/3/2017)

http://jamanetwork.com/journals/jamaneurology/article-abstract/2635828

  • “Although the Wisconsin Longitudinal Study provides a rich data set, there is no information on concussion history per se. The study evaluates the overall effect on long-term outcomes of playing football vs not playing football, but it does not directly evaluate the association of football-related exposure to concussion or subconcussion injury…”

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