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How dangerous is heading a soccer ball? Who's mandating the HPV vaccine in the US? And how many women are drinking while pregnant in Ireland, Australia, New Zealand, and the UK? This is Healthcare Triage News.

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Aaron: How dangerous is heading a soccer ball?  Which states are requiring the HPV vaccine in the United States?  And how many women are drinking while pregnant in Ireland, Australia, New Zealand, and the UK?  This is Healthcare Triage News.

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Our first study is from JAMA Pediatrics, an evidence-based discussion of heading the ball and concussions in high school soccer. This was a retrospective analysis collected in 2005-6 and 2013-14, through a nationally representative sample of high school students. Specifically, this work looked at high school soccer players. So look, we were watching the US women win the World Cup last week. My wife and I were just amazed at how effortlessly some of the players let the ball just smack into their heads. Doesn't that hurt? Isn't it dangerous? This study looked at the incidence and epidemiology of concussions during games and practices in high school soccer players. There were almost 1.4 million female athlete exposures over the study period, and there were 627 concussions. This means that there were 4.5 concussions per 10,000 athlete exposures. For boys, it was lower, with about 2.8 concussions per 10,000 athlete exposures. In both boys and girls, contact with other players was the most common mechanism for concussions. Heading was the most common activity, accounting for 31% of boy concussions and 25% of girl concussions. But still, contact with another player, not the ball, was the reason for most concussions, even while heading. Even if we were to ban heading, which ain't gonna happen, contact with other players causes the most concussions. Until they ban that, concussions will continue.

Next up from JAMA, state vaccination requirements for HPV and other vaccines for adolescents 1990-2015. In this study, researchers were looking at state mandates for vaccines, especially the HPV vaccine. You may remember that vaccine from one of our first and greatest episodes on it. So 29 states plus the District of Columbia, for example, have requirements for children and/or adolescents to be vaccinated against meningococcus. 47 plus DC have requirements for Hepatitis B. Fifty-one, or all of them, have requirements for varicella. Know how many have them for HPV? Three. Virginia and Washington D.C. have requirements, with lots of exceptions, right now. Rhode Island will join them in August. And it's not because HPV is new. By this point in each vaccine's history, or about eight years after routine administration was recommended, hepatitis was required in 36 states plus DC and varicella in 38 states plus DC. Why? No one is sure, I mean, it could be because boys were added later than girls, and that's confusing, it could be that it's adolescent-based and not infants, it could be because it requires three doses and it's harder to complete. Or it could be because in this case, we're vaccinating against a sexually transmitted infection. Regardless of the reason, we can do better.

Finally, from BMJ Open, prevalence and predictors of alcohol use during pregnancy, finding from international multicenter cohort studies. Basically researchers wanted to look at how different groups of people drink alcohol, especially pregnant women. The studies don't always agree. In Ireland, different databases gave different results. One study showed that 20% of pregnant women consumed alcohol, the other said 80%. In Australia, New Zealand, and the UK, drinking alcohol while pregnant ranged from 40% to 80% of women. So let's agree, it ain't rare. In Ireland, binge drinking occurred during pregnancy at 45% of women in one study. In the other, though, it was only 3%. Most drinking occurred during the first trimester, and dropped off after that. White women were the most likely to drink while pregnant, and so were younger women. The biggest predictor of drinking while pregnant was smoking, which is also probably not a good idea. Now, while it sounds like this is cause for panic, most of the women were drinking very small amounts of alcohol, and it's not clear how low levels affect a developing fetus. Because of that, most physicians recommend complete abstinence. That obviously isn't happening. Better messaging, and better data, are needed.

Healthcare Triage is supported in part by viewers like you through, a service that allows you to support the show through a monthly donation. We'd especially like to thank our honorary research associates, Cameron Alexander and Qadeem Salehmohamed. Thanks, Cameron and Qadeem. If you'd like to support the show, more information can be found at