2 Minute Medicine Rewind September 13, 2021 

Effect of screen time on recovery from concussion

1. In a single-center trial, decreased screen time during an acute concussion recovery period shortened the duration of concussive symptoms in a pediatric population. 

Evidence Rating Level: 1 (Excellent) 

Children and adolescents have the highest incidence of concussion, comprising many visits to the emergency department. There are varied guidelines on cognitive and physical restrictions after sustaining a concussion. Many guidelines caution against screen time; however, no research study has specifically assessed the effect of screen time on concussive symptoms. Therefore, this randomized control trial sought to examine the effect of screen time on time until symptom recovery in first 10 days after injury. A total of 125 patients were randomized into two groups, where the control group was permitted to engage in screen time during first 48 hours of recovery and the intervention group was asked to abstain from screen time during this period. There were 66 participants in the control group (mean(SD) age= 17.1(4.0) years; 56.1% male) and 59 participants in the intervention group (mean(SD) age= 16.9 (3.3) years; 45.8% male). The primary outcome measured was days to recovery which was defined as a Post-Concussive Symptom Scale (PCSS) score of 3 points or less. The study found that female participants (HR, 0.34; 95% CI, 0.19-0.60) and participants in the screen time permitted group (HR, 0.51; 95% CI, 0.29-0.90) were less likely to recover over the study period than their male and screen-time abstinent counterparts. The screen time permitted group had a significantly longer median time to recovery compared to screen time abstinent group (8.0 days [IQR, 3.0 to >10.0 days] vs 3.5 days [IQR, 2.0 to >10.0 days], respectively; P = 0.03). Secondary outcomes included amount of screen and sleep time, the day of return to school or work, day of return to exercise, and daily PCSS scores. There were no significant differences amongst the groups for secondary outcomes. Overall, the study concluded that abstaining from screen time for 48 hours after a concussion results in shorter duration of symptoms. However, future multi-center studies are needed to further support these conclusions. Additionally, future studies should examine the results of abstaining from screen time for a longer duration. 


Recent cannabis use and myocardial infarction in young adults: a cross-sectional study

1. In a cohort of young adults from the United States, there was an association between recent cannabis use and history of myocardial infarction. 

Evidence Rating Level: 2 (Good) 

Cannabis is a commonly used recreational drug which has recently been legalized in Canada. Despite increased use of cannabis, especially amongst the young adult population, there is limited knowledge on its health effects. Specifically, there are limited studies examining the association between cannabis consumption and cardiovascular diseases. Therefore, this retrospective cross-sectional study aimed to assess the prevalence of recent cannabis use and its association with a history of myocardial infraction (MI) in young adults. It made use of data from the Behavioural Risk Factor Surveillance System survey conducted by the Centers for Disease Control and Prevention. The exposure was recent cannabis used, defined as using the substance 1 or more times in the past 30 days. The frequency of cannabis use was also measured. From 33,173 young adult participants, 4610 reported recent cannabis use (17.5%; 95% CI, 16.8% to 18.2%). Most cannabis users reported frequent use, defined as more than 4 times in the past 30 days (70.5%l; 95% CI, 68.3%–72.7%). Smoking cannabis was the most prevalent primary method of consumption (76.3%; 95% CI, 74.3%–78.4%). The primary outcome was defined as a self-reported history of myocardial infarction. A history of MI was reported by 61 of 4,610 (1.3%) cannabis users and 240 of 28,563 (0.8%) non-users (adjusted OR, 2.07; 95% CI, 1.12 – 3.82). Additionally, history of MI was associated with more frequent cannabis use (adjusted OR, 2.31; 95% CI, 1.18 – 4.50). These results were sustained after adjusting for hypertension and hypercholesterolemia. Therefore, the study concluded increased odds of history of MI amongst young adults with recent cannabis use. However, the largest limitation of the study was that they were unable to differentiate whether the MI occurred before or after the adults began using cannabis. Therefore, future prospective studies with improved validity and study design are needed to support this association. 


Effect of a randomized interventional school-based vision program on academic performance of students in grades 3 to 7

1. In this trial, students in grades 3 to 7 who received eyeglasses through a school-based vision program achieved better reading scores and had improved academic achievement. 

Evidence Rating Level: 1 (Excellent) 

The number of school-age children with uncorrected visual impairment is substantial, especially in high-poverty neighbourhoods. Visual impairment has been found to be associated with a negative impact on academic success. School-based vision programs (SBVP) offer students an opportunity to receive a thorough assessment and access to eyeglasses to mitigate these impacts. However, there has been no research examining the academic impact of SBVPs. Therefore, this study aimed to evaluate the impact of a SBVP in Baltimore on student academic achievement in English language arts (reading) and mathematics. There were 127 schools included in the study and they were stratified based various characteristics such as school type and special education status. Schools in each stratum were then randomized into one of three cohorts in a 1:1:1 ratio. Cohorts 1 (42 schools), 2 (42 schools), and 3 (43 schools) received interventions in first, second, and third program years, respectively. The intervention services included vision screenings, eye examinations, and eyeglasses, if needed. Program effect size (ES) was defined as the difference in score on a particular academic test between the intervention and control groups. The primary outcome was measured by comparing cohort 1 (intervention) with cohorts 2 and 3 (controls) at the end of the first program year, as well as comparing cohort 2 (intervention) and cohort 3 (control) at the end of the second program year. The study found that at year one, there was a positive impact on reading scores (ES, 0.09; P=0.02). No positive impact was observed for mathematics at one year. At two years, a positive intervention impact was reported on reading scores (ES, 0.08; P=0.23) and mathematics scores (ES, 0.08; P=0.20), however these results were not statistically significant. Overall, the study concluded that there was a positive impact of an SBPV on academic performance in reading, however, the results were not sustained for 2 years. Future studies should investigate reasons for the diminishing impact of SBPVs to further inform healthcare policies. 


 Association of ECT with risks of all-cause mortality and suicide in older Medicare patients

1. In a cohort of older adults with mood disorders in the United States, electroconvulsive therapy (ECT) was associated with lower all-cause mortality and short-term protective effects on suicide risk. 

Evidence Rating Level: 2 (Good) 

Studies show that individuals suffering from mood disorders are at a greater risk for premature mortality. Similarly, rates of suicide are higher amongst this population. Electroconvulsive therapy (ECT) is a possible intervention that may reduce all-cause mortality and suicide in patients suffering from psychiatric disorders. However, the results from various research studies have been inconsistent. Therefore, this retrospective cohort study aimed to evaluate the effect of ECT on all-cause mortality and suicide in older adults on Medicare. It utilized data from the Medicare fee-for-service claims database. The study matched ECT patients with those who did not receive ECT in a 1:3 ratio based on various characteristics. The study included 10,460 patients who received ECT and 31,160 who did not receive ECT. Exposure was defined as having had one or more ECT treatments during index hospitalization. The primary outcomes assessed were all-cause mortality and suicide death. The study demonstrated that compared with the control group, the ECT group had significantly all-cause mortality for up to 1 year (hazard ratio, 0.61; 95% CI, 0.56-0.66). However, over the 1-year follow-up, there was no significant difference between the groups in rate of suicide death. Therefore, the study concluded that ECT may offer benefit for all-cause mortality, yet it did not influence suicide death. Future studies should therefore further evaluate the effects of ECT beyond 12 months and preferably through randomized controlled study design. 


Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial

1. In this trial, a patient-education booklet was effective in reducing the proportion of low back pain patients who underwent imaging examinations over 12 months.

Evidence Rating Level: 1 (Excellent) 

Although one of the most common presenting complaints, low back pain management and diagnostic imaging are often inconsistent with guidelines. For instance, studies have demonstrated that patients often undergo inappropriate imaging for the evaluation of low back pain. Therefore, this study aimed to assess the effectiveness of a patient-education booklet in reducing the proportion of patients presenting with LBP who undergo imaging. It was a cluster-randomized trial design that included 418 LBP patients, 212 in the intervention group (mean age (SD) = 41.1 (12.8) years, 60.8% female) and 203 in the control group (mean age (SD) = 44.6 (12.6) years, 67.0% female). There were no statistically significant differences amongst the groups in terms of characteristics such as physical activity levels, smoking, osteoarthritis, and other factors that could confound the results. The intervention was the use of patient education booklet in addition to usual care as part of the appointment, whereas the control received just the usual care. The primary outcomes measured was the proportion of patients presenting with LBP who underwent imaging during the first 3 months. The study demonstrated that although the education booklet reduced the proportion of LBP patients who underwent imaging at 3 months, the results were not statistically significant (OR, 0.57; 95% CI, 0.27-1.22; p = 0.147). The secondary outcomes measured were the proportion of LBP patients who underwent imaging over 12 months, type of imaging obtained over 3- and 12-month follow-ups, the number of LBP-related sick leaves and number of LBP-related healthcare appointments during the 3- and 12-month follow-up. It was found that individuals in the intervention group received significantly less imaging over 12 months compared to control group (OR, 0.50; 95% Cl 0.30-0.83; p = 0.008). Additionally, the intervention group had significantly decreased sick-leave days over the 3 and 12 month follow ups (RR, 0.47; 95% CI, 0.26-0.83; p = 0.01 and RR, 0.36; 95% Cl, 0.18-0.72; p = 0.004, respectively). There were no statistically significant differences between the groups in other secondary outcomes. Therefore, the study concluded that although the patient education booklet did not have an impact on imaging in the 3-month follow-up, it did change imaging received over 12 months and had an impact on sick leaves taken by patients. Future studies should be conducted to evaluate potential reasons for discrepancy between the 3- and 12-month follow-up data. 

Image: PD

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