Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19–3.91; MI, 2.10,1.17–3.76; CES-D, 3.08,1.65–5.76; AES, 2.39,1.32–4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76–0.97) and CES-D (OR, 95% CI: 0.85, 0.74–0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.

OBJECTIVE:To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN: Mailed survey. SETTING:Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS:Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS:A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. he shift in health care delivery toward the ambulatory setting has increased the need for broadly trained primary care physicians who can provide comprehensive care. 1-3 However, surveys of practicing general internists indicate deficiencies in their training for a variety of common ambulatory procedures, 4-9 raising the question whether general internists can provide common components of ambulatory care without referral. In response to this perceived need to improve ambulatory training, the Internal Medicine Residency Review Committee (RRC) guidelines, 10 effective July 1998, increased residents' training time in the ambulatory setting, and the American Board of Internal Medicine and others have published recommendations for residency training in ambulatory skills. [10][11][12][13][14][15][16][17][18] Nonetheless, a consensus regarding specific requirements for training in ambulatory procedures has not emerged, and it is not clear who should teach these procedures. CONCLUSIONS:Though academic general internists supervise the majority of resident ambulatory training, they may not be prepared to teach common ambulatory procedures. 19,20 This may be due to inadequate training and experience with these procedures, limited time spent in the ambulatory setting, or the common practice in academic settings of referring patients to readily available specialists. With this in mind, we conducted this study to assess the confidence of academic general internal medicine and aca-

OBJECTIVE:To investigate patients' preferences for care by general internists and specialists for common medical conditions. DESIGN: Telephone interview.SETTING: A convenience sample of general internal medicine practices at 10 eastern academic medical centers.PATIENT/PARTICIPANTS: A probability sample of 314 participants who had at least one visit with their primary care physician during the preceding 2 years. MEASUREMENTS AND MAIN RESULTS:Items addressed patients' attitudes concerning continuity of care, preferences for care by general internists or specialists for common medical problems, and perceptions about the competency of general internists and specialists to manage these problems. Continuity was important to participants, with 63% reporting they preferred having one doctor. Respondents were willing to wait 3 or 4 days to see their regular doctor (85%) and wanted their doctor to see them in the emergency department (77%) and monitor their care while in the hospital (94%). A majority ( Ͼ 60%) preferred care from their regular doctor for a variety of new conditions. Though respondents valued continuity, 84% felt it was important to be able to seek medical care from any type of physician without a referral, and 74% responded that if they needed to see a specialist, they were willing to pay out-ofpocket to do so. Although most participants (98%) thought their regular doctor was able to take care of usual medical problems, the majority thought that specialists were better able to care for allergies (79%) and better able to prescribe medications for depression (65%) and low-back pain (72%). CONCLUSIONS:Participants preferred to see their general internist despite their perceptions that specialists were more competent in caring for the conditions we examined. However, they wanted unrestricted access to specialists to supplement care provided by general internists.

No abstract

No abstract