Background: The use of teletherapy has exponentially increased in the context of the ongoing COVID-19 pandemic. Studies on teletherapy documented substantial benefits of accessibility and convenience even before the start of the pandemic. Although recent studies show that this modality of therapy delivery is here to stay, few have studied who will most benefit from this trend. Objective: In this paper, we report predictors of continued teletherapy usage in a sample of licensed mental health professionals in the United States during a time period when pandemic-related restrictions began diminishing. As such, it is one of the first studies to examine factors related to continued benefits of teletherapy postpandemic. Methods: Participation from licensed mental health professionals was sought on listservs of national organizations of multiple mental health organizations. Data were collected via an anonymous link to a survey on Qualtrics between January 2021 and April 2021. Participants responded to questions on therapist demographics, practice setting, experiences of shifting to teletherapy, perspectives on continued use of teletherapy, and their client characteristics. Findings related to client characteristics that predicted continued teletherapy usage are presented here. Results: A total of 186 individuals consented to participate in the survey, with a final sample of 114 with complete data. A majority of participants identified as female (92/114, 80.7%), White (94/114, 82.5%), and having a master's degree (75/114, 65.5%) from a nationally accredited program (106/114, 93%). Data were analyzed using heteroskedastic regression modeling with client-related factors as predictors. Two models were run with and without distance travelled by clients as a control variable. Model estimates from both models showed that continued use of teletherapy postpandemic was predicted by the following factors: higher percentage of clients from rural areas, younger and older adult clients, clients with Medicare, and clients with marginalized gender and religious/spiritual identities. Significantly, having a higher percentage of clients from lower socioeconomic status, a higher percentage of those with Medicaid coverage, and a higher percentage of couples and families as clients predicted decreased use of teletherapy postpandemic. Conclusions: Findings from the study suggest that while some groups of clients are more likely to continue to receive benefits of teletherapy, vulnerable groups such as those in lower socioeconomic conditions, Medicaid beneficiaries, and those who seek couple and family therapy may be less likely to be served by it. These differences point to a need to address factors driving telehealth care disparities such as access to technology, housing, and childcare issues, as well as the need for continued training for licensed professionals.

Background: Given the sudden shift to telemedicine during the early COVID-19 pandemic, we conducted a survey of practicing physicians’ experience with telehealth during the prepandemic and early pandemic periods. Our survey estimates that most patient visits in the United States during the early COVID-19 pandemic period were conducted via telehealth. Given this magnitude and the potential benefits and challenges of telehealth for the US health care system, in this paper, we obtain, summarize, and analyze telehealth views and experiences of US-based practicing-physicians. Objective: The aim of this study was to examine the extent of shift toward telehealth training and care provision during the early pandemic from the US-based practicing physicians’ perspective. We also sought to determine the short- and long-term implications of this shift on the quality, access, and mode of US health care delivery. Methods: We conducted a purposive, snowball-sampled survey of US practicing-physicians. A total of 148 physician completed the survey. Data were collected from July 17, 2020, through September 4, 2020. Results: Sample training intensity scaled 21-fold during the early pandemic period, and patient-care visits conducted via telehealth increased, on average, from 13.1% directly before the pandemic to 59.7% during the early pandemic period. Surveyed physician respondents reported that telehealth patient visits and face-to-face patient visits are comparable in quality. The difference was not statistically significant based on a nonparametric sign test (P=.11). Moreover, physicians feel that telehealth care should continue to play a larger role (44.9% of total visits) in postpandemic health care in the United States. Our survey findings suggest a high market concentration in telehealth software, which is a market structural characteristic that may have implications on the cost and access of telehealth. The results varied markedly by physician employer type. Conclusions: During the shift toward telehealth, there has been a considerable discovery among physicians regarding US telehealth physicians. Physicians are now better prepared to undertake telehealth care from a training perspective. They are favorable toward a permanently expanded telehealth role, with potential for enhanced health care access, and the realization of enhanced access may depend on market structural characteristics of telehealth software platforms.

Background: The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players. Objective: This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player. Methods: We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile. Results: We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively. Conclusions: Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating.

Background: A growing body of research suggests that American football players are exposed to higher cumulative head impact risk as competition level rises. Related literature finds that head impacts absorbed by youth, adolescent, and emerging adult players are associated with elevated risk of long-term health problems (e.g., neurodegenerative disease onset). Most National Football League (NFL) players enter the League as emerging adults (18–24 years old), a period of continued cognitive and overall physical development. However, no prior research has studied the effect of age-at-entry on long-term NFL player health. Hypothesis/Purpose: This study assesses whether early NFL player age-at-entry is associated with increased risk of early all-cause mortality, controlling for player position, BMI, year-of-entry, birth year, and NFL Draft round (expected ability upon League entry). Study Design: This retrospective cohort study included 9049 players who entered the NFL from 1970–2017 and subsequently played at least one game. The variables whether deceased, age-at-death, age-at-entry, and controls were collected from Pro Football Reference website, a leading data site for American football that has been used extensively in the literature. Data collection began on 13 July 2017, and follow-up ended on 1 July 2018. Statistical analysis was performed from 10 March 2020 to 3 August 2020. Data was validated by checking a large sub-sample of data points against alternative sources such as NFL.com and NFLsavant.com. Methods: Cox proportional hazards regression models were used to examine variation in death hazard by NFL player age-at-entry, conditional upon a full set of controls. Results: Conditional on controls, Cox regression results indicate that a one-year increase in age-at-entry was significantly associated with a 14% decreased hazard-of-death (H.R., 0.86; 95% CI, 0.74–0.98). Among relatively young entering players, the increased hazard appears to be concentrated in the first quartile of players by age at League entry (20.2 to 22.3 years). Players not in this quartile exhibited a decreased hazard-of-death (H.R., 0.74; 95% CI, 0.57–0.97) compared with players who entered at a relatively young (first quartile) age. Conclusion: An earlier age-at-entry is associated with an increased hazard-of-death among NFL players. Currently, the NFL regulates age-at-entry only indirectly by requiring players to be 3 years removed from high school before becoming NFL Draft-eligible. Implementing a minimum age at entry for NFL players of 22 years and 4 months at beginning of season is expected to result in reduced mortality. What is known about this subject? There are no prior studies on the effects of NFL player age-at-entry on early mortality risk. What this study adds to existing knowledge: This study determines whether entering the NFL at an age of physical and physiological development is related to early mortality risk.

This systematic review examines risk factors for injuries in college football. We reviewed published manuscripts of original studies (1979 -2021) that examined risk factors of injuries among National Collegiate Athletic Association (NCAA) football players. The risk factors for NCAA football related injuries are interrelated and multifactorial inlcuding player characteristics and attributes (such as player position, history of injuries, fatigue, and muscle imbalancey), training factors (like insufficient recovery, high-intensity workloads), and game-related factors (including increased exposure to contact and high-friction surfaces).