Article Analysis

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The article summary will be 700 words (no less than 650 words and no more than 750 words), include 3 components, and be worth 15% of the course grade overall (60 points total).For this assignment, you will read an empirical study from a peer-reviewed journal article (on an Exerciserelated topic) and summarize it. The purpose of this assignment is to (a) apply course concepts when summarizing a peer-reviewed journal article and (b) demonstrate critical thinking and writing skills. Read carefully through the directions below as well as the grading rubric at the end to understand how to successfully complete the assignment.

Nine-Year Risk of Depression Diagnosis Increases With Increasing Self-Reported Concussions in Retired Professional Football Players Zachary Y. Kerr,*yz MPH, MA, Stephen W. Marshall,*yz PhD, Herndon P. Harding Jr,§ MD, and Kevin M. Guskiewicz,yz|| PhD, ATC Investigation performed at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Background: Concussions may accelerate the progression to long-term mental health outcomes such as depression in athletes. Purpose: To prospectively determine the effects of recurrent concussions on the clinical diagnosis of depression in a group of retired football players. Study Design: Cohort study; Level of evidence, 2. Methods: Members of the National Football League Retired Players Association responded to a baseline General Health Survey (GHS) in 2001. They also completed a follow-up survey in 2010. Both surveys asked about demographic information, number of concussions sustained during their professional football career, physical/mental health, and prevalence of diagnosed medical conditions. A physical component summary (Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being [SF-36 PCS]) was calculated from responses for physical health. The main exposure, the history of concussions during the professional playing career (self-report recalled in 2010), was stratified into 5 categories: 0 (referent), 1 to 2, 3 to 4, 5 to 9, and 101 concussions. The main outcome was a clinical diagnosis of depression between the baseline and follow-up GHS. Classic tabular methods computed crude risk ratios. Binomial regression with a Poisson residual and robust variance estimation to stabilize the fitting algorithm estimated adjusted risk ratios. x2 analyses identified associations and trends between concussion history and the 9-year risk of a depression diagnosis. Results: Of the 1044 respondents with complete data from the baseline and follow-up GHS, 106 (10.2%) reported being clinically diagnosed as depressed between the baseline and follow-up GHS. Approximately 65% of all respondents self-reported sustaining at least 1 concussion during their professional careers. The 9-year risk of a depression diagnosis increased with an increasing number of self-reported concussions, ranging from 3.0% in the ‘‘no concussions’’ group to 26.8% in the ‘‘101’’ group (linear trend: P \ .001). A strong dose-response relationship was observed even after controlling for confounders (years retired from professional football and 2001 SF-36 PCS). Retired athletes with a depression diagnosis also had a lower SF-36 PCS before diagnosis. The association between concussions and depression was independent of the relationship between decreased physical health and depression. Conclusion: Professional football players self-reporting concussions are at greater risk for having depressive episodes later in life compared with those retired players self-reporting no concussions. Keywords: mental health; injury; epidemiology; traumatic brain injury Annually, an estimated 1.7 million people sustain a traumatic brain injury (TBI) in the United States (US).10 For adolescents and young adults, sports contribute to a substantial proportion of TBI, particularly mild TBI or concussion.38 Studies of high school and collegiate football players particularly report high concussion rates (0.47 and 0.61 per 1000 athletic exposures, respectively).12 The concussion rate among professional football players in the National Football League (NFL) is also higher than most other sports, with 0.41 concussions per NFL game and with quarterbacks, wide receivers, tight ends, and defensive backs being most at risk.28 The public health significance of concussions is further highlighted by findings suggesting that repeated concussions may accelerate long-term mental health outcomes in athletes, particularly depression.7,8,17,23 It has been theorized that there is a dose response between head impact exposure and an increased risk for depression and dementia in later life. One hypothesis for such an accelerated onset is that the brain lesions caused by concussions may produce biochemical changes that increase the number of The American Journal of Sports Medicine, Vol. 40, No. 10 DOI: 10.1177/0363546512456193 Ó 2012 The Author(s) 2206 Vol. 40, No. 10, 2012 excitatory neurotransmitters and result in neuron loss and cell death.41 Such neuron loss may then serve as the mechanism for the onset of TBI-mediated depression. Understanding the causes of depression is important in public health terms, as depression is associated with significantly higher health care costs40 and a significant risk of functional decline.29 Depression can also affect one’s ability to function in multiple realms, including maintaining relationships, productivity at work, and self-care. The purpose of our study was to prospectively determine the 9-year risk of the diagnosis of depression in a group of former professional football players to ascertain the effects of recurrent concussions on the clinical diagnosis of depression. We were also interested in examining whether self-reported changes in physical health over the past decade differed between those with and without a depression diagnosis during the follow-up period. In previous cross-sectional analyses of the baseline data collected for this study,16 we found that the 2001 prevalence of a depression diagnosis increased as players reported more concussions during their professional careers. Compared with retired players with no history of concussions, retired players reporting 3 or more previous concussions were 3 times as likely to be diagnosed with depression; those with a history of 1 or 2 previous concussions were 1.5 times as likely to be diagnosed with depression. The association persisted after controlling for age, number of years since retirement, number of years played (in quartiles), physical component summary score on the Short Form 36 Measurement Model for Functional Assessment of Health and WellBeing (SF-36), and diagnosed comorbidities including osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. However, these findings have the limitation of utilizing cross-sectional baseline data, thus making it difficult to definitively establish a temporal association. MATERIALS AND METHODS We used a prospective cohort design for this study. The study cohort was composed of a diverse group of former professional football players, ranging from those who played before World War II to those who played into the late 1990s and early 2000s. We collected baseline data in 2001 and follow-up data in 2010. The instruments used to obtain concussions and other health data in this cohort are detailed below. Depression Increases With Concussions 2207 Study Design and Measures The baseline 2001 General Health Survey (GHS) of former NFL players was first sent to all living members of the NFL Retired Players Association (n = 3729) through the Center for the Study of Retired Athletes at the University of North Carolina at Chapel Hill. The GHS was initially mailed in May 2001, followed by a remailing to nonrespondents in August 2001 and February 2002. We then completed the questionnaire with additional nonrespondents through telephone follow-up. A total of 2536 (68.7%) retired athletes completed the 2001 GHS. In August 2010, we sent a followup GHS to 2102 former players who had completed the 2001 GHS and who were not lost to contact or deceased (n = 434). The 2010 GHS utilized the same measures as the 2001 GHS. We followed up with nonrespondents in October and December 2010. A total of 1316 former players (62.6%) completed and returned the 2010 GHS. A larger proportion of nonrespondents (35.5%) than respondents (20.8%) were nonwhite. Both the 2001 and 2010 GHS collected demographic information and data on musculoskeletal, cardiovascular, and neurological conditions that the former players experienced during and after their football career. Both instruments included questions about the number of concussions sustained during their professional football career (self-reported concussion history). Participants who completed the 2010 GHS were blinded to their responses from the 2001 GHS. Assessment of Diagnosed Medical Conditions Both the 2001 and 2010 GHS included questions about the prevalence of diagnosed medical conditions such as depression, osteoarthritis, coronary heart disease, stroke, cancer, and diabetes (see the Appendix, available in the online version of this article at http://ajs.sagepub.com/supplemental/). Respondents were asked, ‘‘Have you ever been told by a physician or health professional that you had/have any of the following medical conditions?’’ The 2001 and 2010 GHS also included the SF-36, which assesses health status and estimates how well a retired athlete functions with activities of daily living. From the SF-36, we calculated the physical component summary (PCS) score that is derived from questions related to physical functioning, role limitations due to physical health, bodily pain, and general health.42 || Address correspondence to Kevin M. Guskiewicz, PhD, ATC, University of North Carolina at Chapel Hill, CB #8700, Chapel Hill, NC 27599-8700 (e-mail: gus@email.unc.edu). *Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. y Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. z Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. § College of Medicine, Florida State University, Tallahassee, Florida. One or more of the authors has declared the following potential conflict of interest or source of funding: The Center for the Study of Retired Athletes and its associated studies are funded in part by the National Football League Players Association (NFLPA), National Football League (NFL) Charities, and several foundations and corporations such as the National Operating Committee on Standards for Athletic Equipment (NOCSAE), Medtronic Inc, and Martek Biosciences Inc. This study was not funded solely by any one of these entities. 2208 Kerr et al Assessment of Concussion Recall During Professional Career The 2001 and 2010 GHS defined a concussion as ‘‘an injury resulting from a blow to the head followed by a variety of symptoms that may include any of the following: headache, dizziness, loss of balance, blurred vision, seeing stars, feeling in a fog or slowed down, memory problems, poor concentration, nausea, or throwing-up.’’ Participants were reminded that they did not need to be ‘‘knocked out’’ or unconscious to sustain a concussion. They were asked to report the total number of recalled concussions during their professional career. We opted to limit recall to those during respondents’ professional careers because they would be more recent than concussions sustained previously (ie, during collegiate and high school participation), and moderate correlation was found between the number of concussions reported to have been sustained during one’s professional and collegiate career.15 Statistical Analyses To ascertain the 2001 to 2010 incidence of depression, we limited analysis to those former professional football players who had not reported having been previously diagnosed clinically as depressed at baseline. Of this sample, respondents were categorized by whether they reported being diagnosed with clinical depression as of the 2010 GHS. As a result, the nondepressed group consisted of those who had never been diagnosed with clinical depression, and the depressed group consisted of those who had been clinically diagnosed between both GHS assessments. We used standard x2 statistics and the Fisher exact test to compare the demographics of the depressed and nondepressed. We stratified self-reported concussion history data from 2010 into 5 categories: 0, 1 to 2, 3 to 4, 5 to 9, and 101 concussions. Zero concussions served as the referent group. x2 analyses were conducted to identify associations and trends between concussion history and the 9-year risk of a depression diagnosis. We used a 2-sample paired t test to compare the SF-36 mean scores and the changes from 2001 to 2010 in the SF-36 scores between those players with and without a depression diagnosis from 2001 to 2010. Crude risk ratios (RRs) were obtained with classic tabular methods. Adjusted RRs were estimated using binomial regression. To stabilize the fitting algorithm, we used Poisson residual and robust variance estimation.14,39,44 To develop our final model, over 25 covariates were considered, including age, race, years since retirement, number of years they played professional football, playing position (stratified into 3 categories based upon the number of impacts each position sustains5), steroid use, alcohol usage, smoking status, 2001 body mass index, single/coupled status, regular exercise, work status, disability status, 2001 SF-36 PCS, and diagnosed comorbidities as of 2001, including osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. Interaction (effect measure modification) was assessed between concussion history and the covariates. We then utilized forward selection model building, in which each covariate was singularly added to a model with self-reported The American Journal of Sports Medicine concussion history predicting the 9-year risk of a depression diagnosis. Percentage change in the size of the RRs for selfreported concussion history was computed as 100 3 (initial RR – adjusted RR)/initial RR.25,34 The covariate that produced the greatest absolute change was added to the model, and the process was repeated until no covariate changed the concussion history RRs by more than 10%. The resulting model included years since retirement and the 2001 SF-36 PCS. Level of significance for all analyses was set a priori at P \ .05. The Biomedical Institutional Review Board at the University of North Carolina at Chapel Hill approved all aspects of this study. RESULTS Of the 1316 former players returning the 2010 GHS, 138 were excluded from subsequent analysis for having been diagnosed as clinically depressed before the 2001 GHS (n = 132) or having missing data regarding the clinical diagnosis of depression in the 2001 GHS (n = 6). Twentyseven respondents had missing data related to having been diagnosed as clinically depressed as of the 2010 GHS. An additional 107 had missing data related to concussion history. These 134 respondents were excluded from subsequent analysis, leaving 1044 respondents. A number of demographic characteristics were similar among former players with and without a depression diagnosis between the 2001 and 2010 GHS (see the Appendix, available online). However, compared with former players not diagnosed with depression between the 2001 and 2010 GHS, former players diagnosed with depression between the 2001 and 2010 GHS were younger, were retired from professional football for a fewer number of years, had lower 2001 SF-36 PCS scores, and were more likely to be single. Between the 2001 and 2010 GHS, 106 (10.2%) reported being diagnosed as clinically depressed. Of these 106 respondents, 68 (64.2%) reported still suffering from depression in 2010, and 36 (34.0%) were currently being treated with antidepressant medications. Regardless of the effectiveness of treatment, we considered these 36 former players to have been diagnosed as clinically depressed. Of those 68 retirees with current symptoms of depression, 56 (82.4%) reported that the condition limits their activities of daily living to some degree. Of the 1044 respondents, 365 (35.0%) self-reported no concussions during their professional careers, 269 (25.8%) self-reported 1 to 2 concussions, 204 (19.5%) self-reported 3 to 4 concussions, 135 (12.9%) self-reported 5 to 9 concussions, and 71 (6.8%) self-reported 10 or more concussions (Table 1). The 9-year risk of a depression diagnosis increased with an increasing number of self-reported concussions, ranging from 3.0% in the ‘‘no concussion’’ group up to 26.8% in the ‘‘10 or more’’ group (Table 1). A linear dose-response relationship was observed (P \ .001). Because we were concerned this association could be confounded or modified by other factors, we conducted an additional analysis with multivariate binomial regression with robust variance and Poisson residuals. The effect of selfreported concussion history was not modified by any of the Vol. 40, No. 10, 2012 Depression Increases With Concussions 2209 TABLE 1 Crude and Adjusted Risk Ratios and 95% Confidence Intervals for the Association Between Self-Reported Concussion History and 2001-2010 Depression Diagnosis in a Cohort of Former Professional Football Playersa No. of Concussions Sustained During Professional Career 0 1-2 3-4 5-9 10 or more Total Players With 2001-2010 Clinical Diagnosis of Depression, n (%) 11 22 28 26 19 106 (3.0) (8.2) (13.7) (19.3) (26.8) (10.2) Total 365 269 204 135 71 1044 Crude RR (95% CI) 1 2.7 4.6 6.4 8.9 (reference) (1.3-5.5) (2.3-9.0) (3.2-12.6) (4.4-17.8) Adjusted RR (95% CI)b 1 2.3 3.3 4.1 5.8 (reference) (1.1-4.7) (1.7-6.7) (2.0-8.4) (2.8-12.2) a Excludes all cohort members who had not reported having been diagnosed previously with clinical depression on the 2001 General Health Survey. RR, risk ratio; CI, confidence interval. b Adjusted for years since retirement and the 2001 physical component summary on the Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being. TABLE 2 Comparison of 2001 and 2010 General Health Survey Physical Component Summary Scores by 2001-2010 Clinical Diagnosis of Depression in a Cohort of Former Professional Football Playersa Clinical Diagnosis of Depression in 2001-2010 Yes No P value 2001 GHS (95% CI) 2010 GHS (95% CI) Change (95% CI)b 42.0 (39.7 to 44.3) 47.2 (46.5 to 47.8) \.001 37.6 (35.5 to 39.8) 45.1 (44.4 to 45.8) \.001 –4.4 (–7.1 to –1.7) –2.3 (–2.9 to –1.7) .13 a Excludes all cohort members who had not reported having been diagnosed previously with clinical depression on the 2001 General Health Survey (GHS). CI, confidence interval. b Change = 2010 GHS – 2001 GHS. covariates, based on additive assumptions of joint effects. However, the 2001 SF-36 PCS and years retired from professional football were found to be confounders with the forward selection change-in-estimate model building approach. After controlling for these covariates, the RRs were still elevated but were a little closer to the null value (Table 1). In the final model, the 2001 SF-36 PCS and years since retirement were also important predictors of the 9-year risk of a depression diagnosis. Controlling for concussion history and years retired from professional football, the 9year risk of a depression diagnosis increased by 40% for every 10-point decrease in the 2001 SF-36 PCS (adjusted RR, 1.40; 95% confidence interval [CI], 1.19-1.64). Controlling for concussion history and the 2001 SF-36 PCS, the 9year risk of a depression diagnosis decreased 17% for every 10-year increase in the number of years retired from professional football (adjusted RR, 0.83; 95% CI, 0.70-1.00). The SF-36 PCS measure from the 2001 and 2010 GHS and the change in the SF-36 PCS score from the 2001 and 2010 GHS were compared between those with and without a 2001 to 2010 depression diagnosis (Table 2). Those with a 2001 to 2010 depression diagnosis had lower average 2001 and 2010 SF-36 PCS scores than those without a 2001 to 2010 depression diagnosis (P \ .001 for both tests). However, the CIs for the average drop in the SF-36 PCS from the 2001 GHS to the 2010 GHS overlapped, and the 2 groups were not statistically different on this measure (P = .13). DISCUSSION Our study, the first longitudinal study examining the incidence of a mental health outcome in a cohort of retired athletes, found an association between self-reported concussion history during the professional playing career and the 9-year risk of a depression diagnosis. This is consistent with cross-sectional findings published using the baseline data from our study,16 indicating that retired athletes self-reporting 3 or more concussions during their professional career were 3 times more likely (prevalence ratio of 3.1; 95% CI, 2.3-4.1) to report that they were diagnosed with depression and that those with a history of 1 or 2 concussions were 1.5 times more likely (prevalence ratio of 1.48; 95% CI, 1.08-2.02) to have been diagnosed with depression compared with retired athletes who selfreported no concussions. The current study, which incorporated longitudinal data, found larger effect estimates and a stronger dose-response relationship between concussion history and the 9-year risk of a depression diagnosis. Relative to the prior cross-sectional study, this prospective study provides stronger evidence of a possible causal relationship between concussive episodes in professional football players and mental health outcomes. The literature on linking prior concussions or TBI and depression has grown rapidly after investigation of the effects of blastinduced TBIs in Iraq service personnel.4,9,18 In football 2210 Kerr et al players, there is growing concern about ‘‘tauopathies’’—deposits of tau proteins within the brain—that are associated with repetitive head impacts and may eventually elucidate the linkage between head injury and depressive tendencies.24 Several potential mechanisms for this association have been suggested, including direct neuroanatomic and neurochemical changes after TBI that affect mood. People with a diagnosis of major depression have smaller hippocampal and amygdala volumes,36,37 structural and morphological changes in the prefrontal31 and orbitofrontal cortex,22 and basal ganglia structures.3 These structures are extensively interconnected and are believed to compose a ‘‘neuroanatomical circuit’’27 that may play a key role in mood regulation. It is currently unclear to what extent these TBI-related mechanisms are present in mild TBI (concussion) patients. Psychosocial correlates between TBI and depression have also been described. The depressed TBI patient most likely does not engage in activities that were once enjoyable, which may cause social isolation along with lowered self-image. Also, any TBI patient with pre-existing depression is likely to suffer from bouts of depression after a head injury.11 Measures of concussion history obtained via self-report data have limitations. Because self-reported concussion history is not an objectively documented exposure history, we cannot establish a true causal relationship. Nevertheless, self-reported concussion history is unlikely to be a major source of bias in this study. Kerr et al20 compared the cohort’s self-reported concussion data from the 2001 baseline and 2010 follow-up assessment, finding moderate reliability in the self-reported concussion measure. Given the 9-year window between the 2 administrations of the survey and the aging of the participants, the authors suggested that the previously observed associations between concussion and depression may be relatively robust to recall bias. Although 62% of players fell into the same data groupings on both administrations of the instrument, about a third reported more concussions in the 2010 GHS.20 Kerr et al20 suggested that recent media coverage of concussions may have enhanced player education regarding concussion identification and influenced player attitudes toward concussion awareness. Although there is concern that the changes in concussion recall may reflect a person’s deteriorating mental health, recent literature has reported selective preservation of older information in patients with Alzheimer disease–related dementia, suggesting that recollection of events involving prior injuries is likely in these retired athletes.35 At the same time, there have been recent findings suggesting a history of underreporting of concussions. In a recent sample of high school student-athletes, only 40% of concussions and 13% of ‘‘bell-ringers’’ were reported.32,33 Given the better education and knowledge of athletes and retired athletes regarding concussions, plus the history of underreporting, we believe that the 2010 GHS data are the more valid measure of concussion history, and it is possible that the strengthened association in the current study versus Guskiewicz et al16 may be attributable to a more accurate reporting of self-reported concussions in the 2010 GHS than in the original 2001 GHS. We also found that retired athletes with a new depression diagnosis since 2001 were more likely to report low The American Journal of Sports Medicine physical health scores. In addition, the difference between 2010 and 2001 SF-36 PCS scores in those with a depression diagnosis since 2001 was larger than those without a depression diagnosis. However, a lack of statistical precision, as evidenced by wide CIs, meant that the difference was not statistically significant. The SF-36 PCS– depression association was independent of the association between history of self-reported concussions and depression. It is probable that reduced physical functioning in the population is associated with a growing sense of hopelessness and less physical independence. It is plausible that this could be a trigger for the onset of depression, particularly in people who earned their living from their athletic ability and whose self-image was closely identified with physical prowess. In addition, the number of years retired from professional football was found to be a significant predictor of the 9-year risk of a depression diagnosis. Premature retirement (ie, retired because of concussions) could be associated with a lack of fulfillment of ambitions as well as financial problems, which lead to depression. However, we do not have information regarding the reason for retirement. Also, anecdotal reports of former professional athletes, combined with published reports of the general population, suggest that retired people often encounter a degree of disenchantment with retirement and struggle to transition to the retirement lifestyle.1,6,19 Our findings may indicate that the immediate postretirement period was the most vulnerable period for the retired athletes in our cohort. Limitations Like all research, the current study has its limitations. First, the effect estimates produced by the statistical model had wide CIs because of the finite number of cases of an incident self-reported depression diagnosis (n = 106). Further research is necessary to validate the current findings in other athlete populations. Also, depression diagnosis is dependent on athlete recall. People with a depression diagnosis have been shown to demonstrate difficulties with retrieval of specific autobiographical memories.21,26,30,43 Thus, our findings may be limited to some extent by a recall bias. However, we expect the retrieval of significant injury episodes such as concussions sustained during a professional football career to be more accurately recalled because of media-related and medical record anchors attached to such events. The method for each depression diagnosis for each retired player is also unknown. The utilization of different diagnosis procedures for depression (eg, DSM-III-R, Hamilton Depression Scale, NIMH diagnostic interview) may have contributed to a possible misclassification error. Also, cases involving single episodes of depression are often collapsed with cases involving recurrent episodes of depression. Such a collapse of data consequently prohibits further examination of depression, particularly recurrence or severity. Given the design of the study, there are also no comparable data available to our knowledge that allow us to compare our 9-year risk of a clinical diagnosis of depression to a population of adults of the same age in the US. Vol. 40, No. 10, 2012 Nonetheless, this study provides estimates of a unique population of former professional athletes. Last, because our sample consisted entirely of former professional football players, it is difficult to ascertain how generalizable the findings are to other athletes. Soccer, for example, has a high concussion incidence at the high school, collegiate, and professional levels,2,12,13 but there has been limited research to date on the long-term effects of concussions in soccer players. At the same time, our findings may not be generalizable to high school or college athletes who do not proceed to professional levels of game play, although there may be implications for counseling of younger athletes with a history of concussions. Furthermore, we did not examine subconcussive impacts in this study, so we cannot comment on any possible effects of subconcussive impacts. Future research must investigate the effects of recurrent concussions and subconcussive head impacts on the onset of neurodegenerative outcomes in additional populations of athletes who played professionally or solely at the amateur level. Depression Increases With Concussions 2211 4. 5. 6. 7. 8. 9. 10. 11. CONCLUSION Our findings suggest that professional football players with a history of career concussions are at an elevated risk for depressive episodes later in life compared with those retired players without a history of concussions. This risk increases with a greater number of concussions reported. The pathophysiology of recurrent concussions or repetitive subconcussive head impacts and the risk of depression remain unclear. 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Retrograde amnesia in dementia: comparison of HIV-associated dementia, Alzheimer’s The American Journal of Sports Medicine 36. 37. 38. 39. 40. 41. 42. 43. 44. disease, and Huntington’s disease. Neuropsychology. 2004;18(4):692-699. Sheline YI, Sanghavi M, Mintun MA, Gado MH. Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. J Neurosci. 1999;19(12):5034-5043. Sheline YI, Wang PW, Gado MH, Csernansky JG, Vannier MW. Hippocampal atrophy in recurrent major depression. Proc Natl Acad Sci U S A. 1996;93(9):3908-3913. Sosin DM, Sniezek JE, Thurman DJ. Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj. 1996;10(1):47-54. Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162(3):199-200. Unutzer J, Patrick DL, Simon G, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a 4year prospective study. JAMA. 1997;277(20):1618-1623. Vaidya VA, Terwilliger RM, Duman RS. Role of 5-HT2A receptors in the stress-induced down-regulation of brain-derived neurotrophic factor expression in rat hippocampus. Neurosci Lett. 1999;262(1):1-4. Ware JE Jr, Gandek B, Kosinski M, et al. The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):1167-1170. Williams JM, Scott J. Autobiographical memory in depression. Psychol Med. 1988;18(3):689-695. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702-706. For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav
NAME: Paper 2 – Final Draft – Rubric Points WRITING STYLE AND CONTENT Organizes paper in a way that is easy to follow. The three components are unique in content and are not repetitive of each other. Each individual component is organized and easy to follow. Word Count is met but not exceeded. Uses grammar, spelling, and punctuation appropriately. (5 or more errors will result in a 0) COMPONENT 1 /6 /7 (Approximately 225 Words) Summary includes all important details about the study in a concise way. (Purpose, /5 participants, instruments/measures, and results) The study details are described accurately without using any direct quotes from the study. Proper in-text citations for the study are used. COMPONENT 2 (Approximately 350 Words) The writer successfully uses “the formula” to apply specific research methods concepts to the study they are analyzing. In other words, they define each research-methods term in their own words (with an in-text citation from the textbook) and then explains how it applies to the study using specific examples from the study (with an in-text citation for the study). The writer discusses a sufficient amount of research methods topics from Weeks 3-6, in enough detail to demonstrate understanding of course material. The terms are defined/applied accurately. COMPONENT 3 (Approximately 125 Words) One to two practical applications are discussed in detail (in other words, the writer does not provide a long list of options). The practical application discussed applies back to the study findings and its participants. /5 /7 /7 /4 /4 FORMATING Title page, paper, reference page, and in-text citations are in correct APA formatting. /5 TOTAL /50 Comments, if needed. Please see the list of Paper 1 Comments Posted on iLearn: 1 2 3 4 5 6 7 8 9 10 Similarity Score (should be 15% or less): Note: Papers that are late, incomplete, emailed (i.e. not uploaded to TurnItIn), or have plagiarism concerns may result in a “0”.
Page 1 of 2 KIN 384: Research Methods in Kinesiology Article Assignment 2 – Assignment Sheet & Grading Rubric Introduction The article summary will be 700 words (no less than 650 words and no more than 750 words), include 3 components, and be worth 15% of the course grade overall (60 points total). For this assignment, you will read an empirical study from a peer-reviewed journal article (on an Exercise related topic) and summarize it. The purpose of this assignment is to (a) apply course concepts when summarizing a peer-reviewed journal article and (b) demonstrate critical thinking and writing skills. Read carefully through the directions below as well as the grading rubric at the end to understand how to successfully complete the assignment. Directions: 1. Select an article in the field of Kinesiology and obtain approval for the article by the professor. 2. Write a paper that includes the following three components: ▪ Component #1: Summarize the article (1-2 paragraphs/~225 words). Describe the key aspects of the study, including (a) purpose, (b) basic methods, (c) participants, (d) results (add instruments and measures if imperative). You should describe the study in your own words, rather than using the authors’ exact words (i.e., no direct quotes). We want to hear your understanding of the article. If you have written in your own words, your summary will not contain quotation marks. Make sure to cite the author(s) of the article to give them credit for their ideas and avoid plagiarism. o Tip: Below are links to resources about how to paraphrase from the Purdue Online Writing Lab (OWL): i. “Paraphrase: Write it in Your Own Words” https://owl.english.purdue.edu/owl/resource/619/1/ ii. “Quoting, Paraphrasing, and Summarizing” https://owl.english.purdue.edu/owl/resource/563/01/ iii. “Sample Essay for Summarizing, Paraphrasing, and Quoting” https://owl.english.purdue.edu/owl/resource/563/03/ o Tip: Be sure to state exactly what article you chose by using an APA formatted in-text citation. By simply saying “This study found that…”, it is not clear which article you are discussing. Per APA format, include the last names of the author(s) and the date the article was published, such as “Smith and Jones (2012) found that…” See the link below to understand the rules for citations because they are different depending on how many authors wrote the article. Remember you do not need to write out the entire title of the article because (a) it takes up too much space in text and (b) you will already have the title included in your reference list. i. “In-Text Citations: Author/Authors” https://owl.english.purdue.edu/owl/resource/560/03/ ▪ Component #2: Study Design and Internal/External Validity Concerns (2-3 paragraphs/~350 words). Use concepts from the textbook to describe the study design. After considering the study design and methodology, determine which threats to internal and external validity may apply and explain your rationale (focus on validity). When citing ideas from the textbook, be sure to describe the ideas in your own words and include an in-text citation (i.e., author and date of publication). Again, we want to hear your understanding of the concepts from the textbook, which can only be accomplished through your own writing. o Tip: To help stay organized, devote 1 paragraphs to focus on the design of the article and 2-3 separate paragraphs to focus on possible threats to internal and external validity. Page 2 of 2 ▪ Component #3: Identify practical applications (1-2 paragraphs/125 words). Describe how results from the study could be used by a specific kinesiology practitioner in the real world (i.e., translating research to practice). How does this research inform professionals working with patients, athletes, exercisers, etc.? o Tip: Pick a specific type of practitioner, a specific population, and explain how the findings may help in that situation. You may be able to think of many examples, but pick one and describe it well. 3. In addition to APA formatted in-text citations, include the APA reference for your article and your textbook at the end of your paper. Below is a list of the requirements you will need to align your paper with APA format. We highly recommend using this as a checklist before submitting your final paper. ✓ Title page (Not part of APA but include the overall word count for your paper on the title page; The word count includes the body of the paper only, not the title page or reference page) ✓ Reference page ✓ Double spaced ✓ 12-point font ✓ Times New Roman font ✓ 1” margins on all sides (Double check this because the default in MS Word for the L and R margins is 1.25”) ✓ Page numbers in upper right-hand corner of each page ✓ Running head on each page Below are a few websites and resources that are helpful for refreshing your APA usage: o “APA Format Citations – Sixth (6th) Edition” (video) https://www.youtube.com/watch?v=9pbUoNa5tyY o “APA Sample Paper – Purdue Online Writing Lab” https://owl.english.purdue.edu/media/pdf/20090212013008_560.pdf o “APA 6th Edition Corrected Quick-View Sample Pages” https://www.regent.edu/admin/stusrv/writingcenter/files/APA%206th%20Edition%20Quickview.pdf Due Dates and Turning in the Assignment: This assignment will be completed in multiple phases between Tuesday October 9th and Tuesday October 16th. • • Partial rough draft due on October 9th. Students will provide peer review in class. Final draft of paper due Wednesday, October 16th Grade Breakdown: Partial rough draft and peer review (10 pts), Finished paper (50 pts).

Tutor Answer

henryprofessor
School: Duke University

Attached.

Running head: ARTICLE ANALYSIS

1

Article Analysis
Name
Institution

ARTICLE ANALYSIS

2
Article Analysis

The study by Kerr, Marshall, Harding Jr., & Guskiewicz (2012) was meant to assess the
depression risk associated with recurrent concussions in a group of players who were retired. The
authors sought to determine the relationship between depression and the number of concussions
the retired players had incurred within a timeline of nine years. The participants were members
of the National Football League Retired Players Association and involved in the survey between
2001 and 2010. Depending on the number of concussions each of the retired players incurred,
they were placed into five major groups. A total of 1044 respondents were used for the study.
The primary study design used was a cohort research design is used since the researchers
divided the retired players into five categories or cohorts depending on the number of
concussions incurred. The main approach to recruiting respondents was through sending
questionnaires to retired NFL players and following up on those who did not respond via
telephone. This was to ensure a prospectively follow up on the participants for nine years and
evaluate them concerning depression. As the study was conducted the results from different
cohorts were measured and a relationship between concussions incurred and depression
determined. The researchers found that the risk of depression increased as the number of
concussions incurred increased (Kerr et al., 2012). However, no relationship was realized
between reduced physical activity and depression among the respondents.
Cohort study design was the main approach used in the study. Data collected in a
previous cross-sectional on this study indicated that the chances of retired players getting
depression increased with an increase in the number of concussions incurred. The authors
divided the participants into five cohorts depending on the number concussions incurred; 0,1-2,
3-4,5-9, 10 and more (Kerr et al., 2012). The data initially used was from the retired players who

ARTICLE ANALYSIS

3

completed the General Health Survey document (GHS). Later on, questionnaires were used to
collect information from the non-respondents through telephone follow up. The primary data that
was collected using both the GHS documents and the te...

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