Concussions in the National Hockey League
Players who experienced a concussion playing hockey took more days to return to play if they had headache, low energy, amnesia or abnormalities on physical examination. Benson and colleagues found this by collecting information for 559 concussions in hockey players and following their recovery over time. The authors suggest a more precautionary approach to allowing players with these symptoms to return to play. See Research, page 905
Improved communication, exchange of ideas and cooperation between researchers of sport and non-sport concussion will enrich the overall knowledge and treatment of mild brain injuries. See Commentary, page 887
Oral contraceptives and the gallbladder
Newer formulations of oral contraceptive pills carry similar risks of gallbladder disease to older formulations. This finding is from an analysis of health data on more than 2.7 million women in the United States who were using various forms of combined oral contraceptive pill between 1997 and 2009. Although some statistically significant differences in the risk of gallbladder disease were found between formulations, these differences were small and unlikely to be of clinical significance, say the authors. See Research, page 899
Frailty matters at all ages
At any age, greater frailty is associated with higher mortality and greater use of health care services. Rockwood and colleagues constructed a frailty index based on responses to the National Population Health Survey and used it in following 14 713 respondents over 12 years, recording deaths and use of health services. Providers of health care services may have to move away from considering the impact of one disease at a time. See Research, page E487
Frailty is a combination of factors influencing a person’s physiologic state such that he or she may become more vulnerable to external stressors. Crome and Lally discuss Rock-wood’s model for assessing frailty, which proposes that certain deficits including those in areas of mental health or psychosocial issues increase a person’s risk of becoming frail. See Commentary, page 889
Conversion disorder
Although conversion disorder has long been viewed as the quintessential psychological disorder, Feinstein points out that advances in neuroscience are slowly changing this view. Functional magnetic resonance imaging shows that people with conversion disorder may have abnormal patterns of cerebral activation in which areas of the brain regulating emotion override activation of the motor and sensory areas. See Review, page 915
Bodychecking in youth ice hockey
Concussion is a common, serious injury in youth ice hockey, which affects, at one estimate, up to 25% of players. According to Johnson, legal bodychecking is a major cause of concussion, yet some Canadian provinces allow players as young as nine years old to engage in bodychecking. The way to reduce the rates of concussion is to eliminate bodychecking for all youth hockey players, except the elite, 16 years and older, as per the recommendations of the Canadian Academy of Sports and Exercise Medicine. See Analysis, page 921
Persistent epigastric pain
An 80-year-old man presented with a one-week history of constant epigastric pain and exertional left-sided chest pain. Myocardial infarction was diagnosed, but despite appropriate treatment, the epigastric pain persisted, indicating a second hidden problem. See Practice, page 925
Fish odour syndrome
Poor hygiene, vaginosis, gingivitis and urinary tract infection are relatively common causes of a fishy body odour. However, the 68-year-old woman described in this report had trimethylaminuria (fish odour syndrome) that was exacerbated by use of rosuvastatin. Psychosocial problems, including social isolation and suicidal tendencies, can be serious consequences of this condition, warn Li and colleagues. See Practice, page 929