BackgroundConcussion is a considerable public health problem in youth. However, identifying, understanding and implementing best evidence informed recovery guidelines may be challenging for families given the vast amount of information available in the public domains (e.g. Internet). The objective of this study was to develop, implement and evaluate the feasibility of an evidence-informed self-management education program for concussion recovery in youth.MethodsSynthesis of best evidence, principles of knowledge translation and exchange, and expert opinion were integrated within a self-management program framework to develop a comprehensive curriculum. The program was implemented and evaluated in a children’s rehabilitation hospital within a universal health care system. A retrospective secondary analysis of anonymous data from a program evaluation survey was used to evaluate program feasibility, to identify features of importance to program participants and to assess changes in participants’ knowledge.ResultsThe program, “Concussion & You” includes a comprehensive, evidence informed, population specific curriculum that teaches participants practical strategies for management of return to school and play, sleep, nutrition, relaxation and energy conservation. A ‘wheel of health’ is used to facilitate participants’ self-management action plan. Results from eighty-seven participant surveys indicate that the program is feasible and participant knowledge increased in all areas of the program with the highest changes reported in knowledge about sleep hygiene, rest and energy conservation.ConclusionFindings indicate that “Concussion & You” is a feasible program that is acceptable to youth and their families, and fills a health system service gap.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1664-3) contains supplementary material, which is available to authorized users.

ObjectivesTo analyse John Cunningham virus (JCV) serology in natalizumab treated patients over time and assess whether seroconversion was influenced by natalizumab treatment and prior immunosuppressive therapy.MethodsPatients treated with natalizumab for relapsing-remitting multiple sclerosis at six tertiary hospitals in Melbourne, Australia (n=960) were longitudinally assessed for change in JCV serostatus. Duration of exposure to natalizumab and exposure to prior immunosuppressive therapy was documented.ResultsTwo hundred and ninety-four patients (30.6%) had positive JCV serostatus when commencing natalizumab while 666 patients (69.4%) were JCV negative. JCV serostatus changed in 148 of 960 longitudinally followed patients (15.4%) over a mean observation period of 2.7 years. Durable positive seroconversion was seen in 81 of 666 initially JCV negative patients (12.2% over 2.7 years, 4.4% per year). Conversely, durable negative seroconversion was seen in 17 of 294 initially JCV positive patients (5.8% in 2.7 years, 2.1% per year). Fluctuating JCV serostatus was seen in 50 of 960 patients (5.2%). Durable positive seroconversion was more common early in therapy with natalizumab, with 31.9% occurring in the first year of exposure. Positive seroconversion rates were not increased in patients who had received prior treatment with methylprednisolone. No positive seroconversion events were documented in patients exposed to mitoxantrone.ConclusionsIn contrast to recently published data from colleagues in France and Germany, in our longitudinal cohort study rates of durable positive JCV seroconversion correlate closely with expected background rates of JCV seroconversion in the general population. In addition, JCV seroconversion and positive serostatus is not increased in patients with prior exposure to immunosuppressive agents. The low seroconversion rates seen after the first year of exposure suggests that less frequent JCV testing of natalizumab treated patients may be safe.