Kelly Sarmiento

Kelly Sarmiento
U.S. Department of Health and Human Services | HHS · Centers for Disease Control and Prevention (CDC)

About

73
Publications
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Introduction
Featured research
Article
Full-text available
Head impacts in American football may lead to brain injuries called concussions. To study head impacts in young people who play American football, we collected data using sensors in mouthguards worn by young American football players. The sensors counted the number of hits and bumps to the head (head impacts) that players of American tackle and flag football got during the football season. We found that tackle football players had about 15 times more head impacts during a game or practice than flag football players had, and 23 times more hard head impacts. Learning more about head impacts in young American football players can help scientists find ways to lower the chances of concussions and other injuries. That way, kids can enjoy the benefits of sports while keeping their brains safe.
Article
Full-text available
Background Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. Hypothesis Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes. Study Design Cohort study. Level of Evidence Level 4. Methods Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes. Results There were 186,239 head impacts recorded during the study. Tackle football athletes were 14.67 (95% CI 9.75-21.95) times more likely to sustain a head impact during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15 g (17.95-18.34) and 52.55 g (51.06-54.09) for a tackle football athlete and 16.84 g (15.57-18.21) and 33.51 g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40 g) per athletic exposure compared with a flag football athlete. Conclusion This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes. Clinical Relevance These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes.
Article
Full-text available
Background : There is evidence to suggest that traumatic brain injuries (TBI) are increasing in the United States. It is important to examine predictors of TBI outcomes to formulate better prevention and care strategies. Research Design : National Trauma Data Bank (NTDB) data from 2016 were used to report the percentage of TBI by age, sex, race/ethnicity, health insurance status, intent/mechanism of injury, Glasgow Coma Scale (GCS), disposition at emergency department, and trauma center level. Logistic regression models were run to estimate the adjusted odds ratios of patient and facility characteristics on length of hospital stay and in-hospital mortality (analyzed in 2020). Results : There were 236,873 patients with TBI in the NTDB in 2016. Most patients with a TBI were male, non-Hispanic white, and had sustained a TBI due to an unintentional injury. After adjusting for other factors, individuals age 0-17, those who self-pay, and those with intentional injuries had increased odds of a shorter hospital stay. Older individuals, non-Hispanic black or Hispanic patients, those who had sustained an intentional injury, and those who were not seen in a Level I trauma center had higher odds of mortality following their TBI. Conclusions : Public health professionals’ promotion of fall and other TBI prevention efforts and the development of strategies to improve access to Level I trauma centers, may decrease adverse TBI health outcomes. This may be especially important for older adults and other vulnerable populations.
Article
BACKGROUND Evidence suggests that those who have sustained a traumatic brain injury (TBI) are at increased risk of adverse behaviors and health indicators, such as certain chronic physical and mental health conditions. However, little is known about the prevalence of these behaviors and health indicators among these individuals, information that could help decrease their risk of developing such conditions.METHODS Data (N = 4733) from the 2018 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to determine the prevalence of behaviors and health indicators among individuals who report having a lifetime history of TBI with loss of consciousness (LOC).RESULTS North Carolinians who report a lifetime history of TBI with LOC were at increased risk of reporting a range of 3 negative health behaviors: less than always seatbelt use (adjusted odds ratio [AOR] = 1.7; 95% confidence interval [CI] = 1.2-2.4), HIV risk behaviors (AOR = 1.7; 95% CI = 1.1-2.6), and reporting less than 7 hours of sleep (AOR = 1.5; 95% CI = 1.2-1.8); more difficulty obtaining health care (not seeing a doctor due to health care cost in the past 12 months [AOR = 1.3; 95% CI = 1.0-1.8]; not getting a routine medical check-up in the past 12 months [AOR = 1.5; 95% CI = 1.2-2.0]); worse self-reported health (fair or poor general health [AOR = 1.8; 95% CI = 1.4-2.3]); and reporting fair or poor mental health (AOR = 2.1; 95% CI = 1.6-2.8) compared with individuals who did not report a history of TBI.LIMITATIONS There are several limitations to the study, such as the sample being biased toward more severe brain injuries. Additionally, because the data in the BRFSS are retrospective and cross-sectional, it is not possible to determine temporality and causality between TBI history and the behaviors and health indicators examined.CONCLUSION Despite these limitations, this paper is one of the first to directly examine the association between history of TBI with LOC and a range of current behaviors and health care utilization. Assessing positive and negative behaviors and health indicators can help identify and tailor evidence-based interventions for those who have a history of TBI.
Article
Background: Compared with civilians, service members and veterans who have a history of traumatic brain injury (TBI) are more likely to experience poorer physical and mental health. To investigate this further, this article examines the association between self-reported history of TBI with loss of consciousness and living with 1 or more current disabilities (ie, serious difficulty with hearing, vision, cognition, or mobility; any difficulty with self-care or independent living) for both veterans and nonveterans. Methods: A cross-sectional study using data from the North Carolina Behavioral Risk Factor Surveillance System for 4733 veterans and nonveterans aged 18 years and older. Results: Approximately 34.7% of veterans residing in North Carolina reported having a lifetime history of TBI compared with 23.6% of nonveterans. Veterans reporting a lifetime history of TBI had a 1.4 times greater risk of also reporting living with a current disability (adjusted prevalence ratio = 1.4; 95% confidence interval, 1.2-1.8) compared with nonveterans. The most common types of disabilities reported were mobility, cognitive, and hearing. Conclusions: Compared with nonveterans, veterans who reported a lifetime history of TBI had an increased risk of reporting a current disability. Future studies, such as longitudinal studies, may further explore this to inform the development of interventions.

Publications

Publications (73)
Article
BACKGROUND Evidence suggests that those who have sustained a traumatic brain injury (TBI) are at increased risk of adverse behaviors and health indicators, such as certain chronic physical and mental health conditions. However, little is known about the prevalence of these behaviors and health indicators among these individuals, information that co...
Article
Background: Compared with civilians, service members and veterans who have a history of traumatic brain injury (TBI) are more likely to experience poorer physical and mental health. To investigate this further, this article examines the association between self-reported history of TBI with loss of consciousness and living with 1 or more current di...
Article
BACKGROUND To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K-12 schools in Utah. METHODS Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011-2012 to 2018-2019. SIRS is a unique online system that tracks injuries that...
Article
BACKGROUND Little is known about the effectiveness of school district concussion policies on reducing the concussion prevalence among students. METHODS Data from the 2016 School Health Policies and Practices Study and 2017 Youth Risk Behavior Survey for 10 school districts were linked. The outcome variable was having a sports- or physical activity...
Article
Study objective A better understanding of differences in traumatic brain injury incidence by geography may help inform resource needs for local communities. This paper presents estimates on traumatic brain injury–related hospitalizations and deaths by urban and rural county of residence. Methods To estimate the incidence of traumatic brain injury–...
Article
Full-text available
Head impacts in American football may lead to brain injuries called concussions. To study head impacts in young people who play American football, we collected data using sensors in mouthguards worn by young American football players. The sensors counted the number of hits and bumps to the head (head impacts) that players of American tackle and fla...
Article
Traumatic brain injuries (TBIs) have contributed to approximately one million deaths in the United States over the last 2 decades (1). CDC analyzed National Vital Statistics System (NVSS) mortality data for a 3-year period (2016-2018) to examine numbers and rates of TBI-related deaths, the percentage difference between each state's rate and the ove...
Article
Information is limited about signs and symptoms experienced by individuals who self-report a concussion within surveys. The objective of this study was to assess the number and types of signs/symptoms adults experienced and whether or not medical attention was reported after sustaining a self-reported concussion in the past year. A sample of 3,624...
Article
Background Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited. Purpose To explore head impact exposure among youth tackle an...
Article
Bicycling leads to the highest number of sport and recreation-related emergency department (ED) visits for traumatic brain injuries (TBIs) in the United States (1). Because bicycling continues to grow in popularity,* primarily among U.S. adults, examining the strategies that mitigate the risk for TBI is important. CDC analyzed data from the Nationa...
Article
Background: Many healthcare providers do not consistently implement recommendations contained in clinical guidelines on mild traumatic brain injury (mTBI). As such, the Centers for Disease Control and Prevention (CDC) created the HEADS UP to Healthcare Providers online training to promote uptake of five key recommendations in the CDC Pediatric mTB...
Article
Full-text available
Background Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. Hypothesis Tackle football athletes will have a greater number and magnitude of head impacts...
Article
Objective: To assess adherence to 5 key recommendations in the Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury, this article presents results from the 2019 DocStyles survey. Study design: Cross-sectional, web-based survey of 653 healthcare providers. Results: Most healthcare provider...
Article
Full-text available
Background : There is evidence to suggest that traumatic brain injuries (TBI) are increasing in the United States. It is important to examine predictors of TBI outcomes to formulate better prevention and care strategies. Research Design : National Trauma Data Bank (NTDB) data from 2016 were used to report the percentage of TBI by age, sex, race/et...
Article
Background There is a dearth of information and guidance for healthcare providers on how to manage a patient’s return to driving following a mild traumatic brain injury (mTBI). Methods Using the 2020 DocStyles survey, 958 healthcare providers were surveyed about their diagnosis and management practices related to driving after an mTBI. Results Ap...
Article
Objective: To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by age group for 2014. Setting and participants: Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states. Design: Cross-se...
Article
Objective: To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates for 2014. Setting and participants: The Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators participating states. Design: Cross-sectional....
Article
Objective: To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by sex for 2014. Setting and participants: Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states. Design: Cross-sectiona...
Article
Background This study examined the association between sports- or physical activity–related concussions and having seriously considered attempting suicide, made a suicide plan, or attempted suicide (ie, suicidality), and tested potential moderators of the association. Hypothesis Risk factors such as persistent feelings of sadness or hopelessness,...
Article
Objective: Because of the growing concern about the potential effects of traumatic brain injuries (TBIs) on a child's developing brain and the potential impact of lifetime depression and risk behaviors associated with TBI, further exploration is warranted. Setting and participants: Data (N = 4917) from the 2017 North Carolina Behavioral Risk Fac...
Article
Full-text available
During 2010-2016, there were an average of 283,000 U.S. emergency department (ED) visits each year among children for sports and recreation-related traumatic brain injuries (SRR-TBIs); approximately 45% of these SRR-TBIs were associated with contact sports (1). Although most children with an SRR-TBI are asymptomatic within 4 weeks, there is growing...
Article
CDC's 2018 Guideline for current practices in pediatric mild traumatic brain injury (mTBI; also referred to as concussion herein) systematically identified the best up-to-date practices based on current evidence and, specifically, identified recommended practices regarding CT, MRI, and skull radiograph imaging. In this commentary, we discuss types...
Article
Objective: The American Indian/Alaska Native (AI/AN) population has a disproportionately high rate of traumatic brain injuries (TBIs). However, there is little known about incidence and common mechanisms of injury among AI/AN persons who seek care in an Indian Health Service (IHS) or tribally managed facility. Methods: Using the IHS National Pat...
Article
Background: Sports- and recreation-related concussions are a common injury among children. Sports officials (SOs) and athletic trainers (ATs) are integral to setting the stage for safe play and managing concussions when they occur, and significant numbers of both groups have completed the Centers for Disease Control and Prevention's HEADS UP onlin...
Conference Paper
Statement of Purpose Traumatic brain injury (TBI) mortality rates have been shown to be higher in rural versus urban areas. Variation by age and intent/mechanism of injury has not been assessed. Urban–rural TBI mortality rate differences were quantified by age and intent/mechanism of injury. Methods/Approach National Vital Statistics System mortal...
Article
Full-text available
Background: This paper sought to examine the frequency of self-reported sports- and recreation-related (SRR) concussion, as well as care-seeking behaviors and potential activity restrictions after concussions, in a sample of youth. Methods: A sample of 845 youth ages 12–17 years responded to the web-based YouthStyles survey in 2018. The survey meas...
Article
Due in part to concern about the potential long-term effects of concussion and repetitive head injuries in football, some programs have implemented tackling interventions. This paper explores youth football coaches’ perception of football safety and their experiences implementing these interventions aimed at athlete safety. Using a qualitative appr...
Article
Full-text available
To identify opportunities to improve coach-athlete communication, this study examined young athletes' perceptions and concerns about concussion, as well as their information needs. A qualitative data collection approach, based on the grounded theory methodology, was utilized. Six virtual focus groups were conducted with 17 male and female athletes’...
Article
Traumatic brain injury (TBI) affects the lives of millions of Americans each year (1). To describe the trends in TBI-related deaths among different racial/ethnic groups and by sex, CDC analyzed death data from the National Vital Statistics System (NVSS) over an 18-year period (2000-2017). Injuries were also categorized by intent, and unintentional...
Article
Introduction: Despite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emot...
Article
Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and t...
Article
Background For 15 years, the US Centers for Disease Control and Prevention’s (CDC) HEADS UP education campaign has focused on increasing awareness of concussion among children to reduce adverse outcomes from this injury. Objective To keep pace with the rapid expansion in media coverage, research, state laws and education efforts on concussion, the...
Article
Objective: Because of limitations in current national data sets, respondent self-report may be critical to obtaining concussion prevalence estimates. We examined whether self-report of lifetime concussion among adults varies with the provision of a concussion definition and by the content of that definition. Setting and participants: A convenien...
Article
Objective: The recently published Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury (mTBI) was developed following an extensive review of the scientific literature. Through this review, experts identified limitations in existing pediatric mTBI research related to study setting and generali...
Article
Full-text available
Background: Concussion, a commonly reported injury among young athletes, can lead to short- and long-term physical, cognitive, emotional, and sleep-related symptoms. Parents are in a unique position to help identify a possible concussion and to support an athlete's recovery. Methods: This qualitative study used a focus group methodology to explo...
Article
Purpose of review: In September 2018, the Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. Recent findings: Based on a systematic review of the evidence that covers research published over a 25-year span (1990-2015), the CD...
Article
Background: Concussions are common among youth athletes. Responsibility for the recognition and management of concussion is often put on coaches. To equip coaches with appropriate knowledge and skills, the US Centers for Disease Control and Prevention (CDC) launched the HEADS UP: Concussion in Youth Sports online training. Objectives: To determi...
Article
Full-text available
Traumatic brain injuries (TBIs), including concussions, are at the forefront of public concern about athletic injuries sustained by children. Caused by an impact to the head or body, a TBI can lead to emotional, physiologic, and cognitive sequelae in children (1). Physiologic factors (such as a child's developing nervous system and thinner cranial...
Article
Introduction: Concussions are a commonly reported injury in youth and high school sports and much of the responsibility related to concussion identification and response for young athletes is allocated to sports coaches. This paper presents findings on concussion-related education, access to resources, experiences, and attitudes among a large numb...
Article
The Centers for Disease Control and Prevention recently published an evidence-based guideline, "Diagnosis and Management of Mild Traumatic Brain Injury (mTBI) Among Children." The guideline has many applications for athletic trainers. The following commentary provides considerations for athletic trainers regarding the guideline in conjunction with...
Article
Background: Given the growing research on potential adverse outcomes related to concussion and other serious brain injuries and the increased susceptibility for concussion among youth athletes, primary prevention is vital to protect the health and safety of this population. Purpose: To summarize the current research on risk factors and primary conc...
Article
Introduction: Current research recommends that students returning to school after a concussion should receive a return to school plan that is tailored to their individual symptoms. School professionals play important roles in designing and implementing the supports outlined in return to school plans. Methods: This qualitative study explored midd...
Article
Objectives: The Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of pediatric mild traumatic brain injury (mTBI) in 2018. This commentary provides key practice takeaways for sports medicine providers outlined in the Guideline recommendations. Data sources: The CDC Pediatric mT...
Article
Introduction/Background: Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease thought to be caused by repeated head impacts and associated with deficits in cognition. Despite research and media attention, there is little science-based information available for the public. Also unclear is what the public and particularly parents of...
Article
Introduction: The Centers for Disease Control and Prevention (CDC) Pediatric Mild Traumatic Brain Injury (mTBI) Guideline was created to help standardize diagnosis, prognosis, and management and treatment of pediatric mTBI. This paper describes the process CDC used to develop educational tools, and a dissemination and implementation strategy, in s...
Article
Full-text available
IMPORTANCE Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing...
Article
Full-text available
Importance Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing...
Article
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withd...
Article
Objective: Explore healthcare providers’ experiences managing mTBI and better understand their use of mTBI assessment tools and guidelines. Cross-sectional Methods: A random sample of 1,760 healthcare providers responded to the web-based DocStyles survey between June 18 and 30, 2014. The sample included family/general practitioners, internists, ped...
Article
Full-text available
Background: Concussions are responsible for numerous emergency department visits and hospitalizations among children annually. However, there remains a great deal of confusion about how to prevent and manage concussions in youth. To teach children aged 6 to 8 years about concussion safety, the Centers for Disease Control and Prevention (CDC) creat...
Article
BACKGROUND In 2013, the National Academy of Sciences emphasized the need to develop, implement, and evaluate effective large‐scale educational strategies to improve the culture of concussion in youth and high school sports. In support of this recommendation, in this article we summarize research on factors that contribute to the culture of concussi...
Article
Introduction Primary care providers play a critical role in protecting older adult patients from one of the biggest threats to their health and independence—falls. A fall among an older adult patient cannot only be fatal or cause a devastating injury, but can also lead to problems that can effect a patient's overall quality of life. Methods In res...
Article
Background Children and adolescents account for an estimated 65% of emergency department visits for sports and recreation-related traumatic brain injuries, including concussions. Immediate identification and appropriate response to a concussion can help reduce the risk of short- or long-term health problems that can affect thinking, learning, behav...
Article
To describe the reach of the Heads Up "Concussion in Sports: What You Need to Know," online course and to assess knowledge change. Online. Individuals who have taken the free online course since its inception in May 2010 to July 2013. Descriptive, uncontrolled, before and after study design. Reach is measured by the number of unique participants an...
Article
The Journal of Safety Research has partnered with the Office of the Associate Director for Science, Division of Unintentional Injury Prevention in the National Center for Injury Prevention & Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research and...
Article
Purpose: Although much effort is underway by the Centers for Disease Control and Prevention (CDC) and other organizations to highlight the seriousness of traumatic brain injury, including concussions, among young athletes, little is known about how these athletes and their parents view this injury and how much they know about it. Methods: Online...
Article
Traumatic Brain Injury (TBI) is a public health problem in the United States. In 2009, approximately 3.5 million patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N=300,667) or were treated and released from emergency departments (EDs; N=2,077,350), outpatient departments (ODs; N=83,857), and offic...
Article
In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The Nat...
Article
Concussions remain a serious public health concern. It is important that persons involved in youth sports, particularly coaches, be made aware and educated on the signs and symptoms of concussion. This study assessed the perceptions of youth sport coaches who have received the Centers for Disease Control and Prevention's (CDC's) "Heads Up: Concussi...
Conference Paper
Background: Youth ages 518 years account for 65% of emergency department visits for sports and recreation-related TBIs. A TBI can cause short- or long-term problems affecting a student's memory, learning, and concentration. Thus, CDC developed Heads Up to Schools: Know Your Concussion ABCs to deliver concussion information to school professionals o...
Article
To reduce the number of sports-related concussions, the Centers for Disease Control and Prevention (CDC), with the support of partners and experts in the field, has developed a tool kit for high school coaches with practical, easy-to-use concussion-related information. This study explores the success of the tool kit in changing knowledge, attitudes...
Article
Falls are the leading cause of traumatic brain injury (TBI) among older adults aged 75 and older. Despite this burden, many older adults, their caregivers, and professionals are not aware of the importance of TBI as an outcome of falls among older adults. To address this important public health problem, the Centers for Disease Control and Preventio...
Article
Among older adults, both unintentional falls and traumatic brain injuries (TBI) result in significant morbidity and mortality; however, only limited national data on fall-related TBI are available. To examine the relationship between older adult falls and TBI deaths and hospitalizations, CDC analyzed 2005 data from the National Center for Health St...
Conference Paper
Approximately 1.6-3.8 million sports- and recreation-related traumatic brain injuries (TBIs) occur in the U.S. each year, and teenagers are one of the groups at highest risk. In order to address this need, the Centers for Disease Control and Prevention (CDC) created and distributed a national TBI education and awareness tool kit, Heads Up: Concussi...
Article
Sports-related concussions can happen to any athlete in any sport. Each year in the United States, an estimated 1.6-3.8 million sports and recreation-related traumatic brain injuries (TBIs) occur, most of which can be classifi ed as concussions. To help coaches prevent, recognize, and better manage sports-related concussions, the Centers for Diseas...
Article
Harlem Hospital Directly Observed Therapy (DOT) Program, New York City. To identify various pathways to tuberculosis (TB) diagnosis, and determine time to diagnosis and reasons for delay, to ensure rapid diagnosis of TB and prompt initiation of appropriate treatment. Cross-sectional survey of the help-seeking behavior of TB patients within 2 months...

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