Frequent mild head injury promotes trigeminal sensitivity concomitant with microglial proliferation, astrocytosis, and increased neuropeptide levels in the trigeminal pain system.

BACKGROUND: Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms. METHODS: In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry. RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI group with the highest injury frequency showed the greatest reduction in trigeminal thresholds along with greatest increased levels of calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis. Repetitive CHI resulted in astrogliosis in the central trigeminal system, increased GFAP protein levels in the sensory barrel cortex, and an increased number of microglia cells in the trigeminal nucleus caudalis. CONCLUSIONS: Headache behavior in rats is dependent on the injury frequency and recovery interval between mild head injuries. A worsening of headache behavior after repetitive mild head injuries was concomitant with increases in CGRP levels, the presence of astrocytosis, and microglia proliferation in the central trigeminal pathway. Signaling between neurons and proliferating microglia in the trigeminal pain system may contribute to the initiation of acute headache after concussion or other traumatic brain injuries

New Zealand bicycle helmet law - do the costs outweigh the benefits?

Objectives: This paper examines the cost effectiveness of the compulsory bicycle helmet wearing low (HWL) introduced in New Zealand on 1 January 1994. The societal perspective of costs is used for the purchase of helmets and the value of injuries averted. This is augmented with healthcare costs averted from reduced head injuries. Methods: Three age groups were examined: cyclists aged 5-12 years, 13-18 years, and greater than or equal to19 years. The number of head and non-head injuries averted were obtained from epidemiological studies. Estimates of the numbers of cyclists and the costs of helmets are used to derive the total spending on new bicycle helmets. Healthcare costs were obtained from national hospitalisation database, and the value of injuries averted was obtained directly from a willingness-to-pay survey undertaken by the Land Transport Safety Authority. Cost effectiveness ratios, benefit:cost ratios, and the value of net benefits were estimated. Results: The net benefit (benefit:cost ratios) of the HWL for the 5-12, 13-18, and greater than or equal to19 year age groups was $0.3m (2.6), -$0.2m (0.8), and -$1.5m (0.7) (in NZ$, 2000 prices; NZ $1.00 = US$0.47 = UK pound0.31 approx). These results were most sensitive to the cost and life of helmets, helmet wearing rates before the HWL, and the effectiveness of helmets in preventing head injuries. Conclusions: The HWL was cost saving in the youngest age group but large costs from the law were imposed on adult (greater than or equal to19 years) cyclists

Head Injuries

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Head Injuries and the Hearing Screening Inventory

Head trauma can lead to problems with the ear and auditory pathway. These problems can involve tympanic membrane perforation, fragments in squamous epithelium, damage to the ossicles, or ischemia of the cochlear nerve. It is common for behavioral checklists, for concussion or head injuries, to include an item about hearing difficulty. In the present study, 152 introductory psychology students completed a survey in which they indicated if they had ever had a concussion or sustained a head injury. Approximately one-third (35.53%) of the sample had a history of head trauma. The Hearing Screening Inventory was also part of the survey. Overall, participants who had a previous head injury reported more hearing difficulties than participants with no previous head injury (t(150) = 2.15, p \u3c .02). Although this difference had a moderate effect size (d = .37), it suggests that hearing difficulties may linger since participation was not limited to those having a recent head injury but was open to anyone who had a head injury at any point in time. An examination of specific hearing difficulties revealed that the difference between the two groups was based almost exclusively on their ability to distinguish target sounds from background noises. Specifically, the ability to understand words in music (t(150) = 2.36, p \u3c .01; d = .40) and to isolate an individual speaking from background conversations (t(150) = 2.44, p \u3c .01; d = .41) differentiated the two groups. This finding is consistent with Hoover, Souza and Gallun (2017) who also found that head injury can impair target and noise processing

Retrospective analysis of chronic injuries in recreational and competitive surfers:Injury location, type, and mechanism

Only two studies have reported on chronic musculoskeletal surfing injuries. They found over half of the injuries were non-musculoskeletal, but did not consider mechanisms of injury. This study identified the location, type, and mechanisms of chronic injury in Australian recreational and competitive surfers using a crosssectional retrospective observational design. A total of 1,348 participants (91.3% males, 43.1% competitive surfers) reported 1,068 chronic injuries, 883 of which were classified as major. Lower back (23.2%), shoulder (22.4%), and knee (12.1%) regions had the most chronic injuries. Competitive surfers had significantly (p \u3c .05) more lower back, ankle/foot, and head/face injuries than recreational surfers. Injuries were mostly musculoskeletal with only 7.8% being of non-musculoskeletal origin. Prolonged paddling was the highest frequency (21.1%) for mechanism of injury followed by turning maneuvers (14.8%). The study results contribute to the limited research on chronic surfing injuries

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: A systematic review and meta-analysis of cohort studies

BackgroundIn 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers.MethodsCohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger's test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309).ResultsEleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I-2=99.7; P=0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR=0.56, 95% CI=0.37 to 0.84), abdominal injuries (RR=0.87; 95% CI=0.78 to 0.98) and, spinal injuries (RR=0.56, 95% CI=0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR=0.49; 95% CI=0.22 to 1.08), neck injuries (RR=0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR=1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR=0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers.ConclusionIn sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type

Head Injuries in Professional Football (Soccer)

Introduction: Head injuries in sports may have been an underestimated health risk for many years. However, they potentially bear the risk of serious long-term sequelae with a potential impact on the athletes’ activities of daily living, sports, or career. Although the incidence of head injuries in professional football (soccer) is relatively low in comparison to so-called high-risk sports such as American football, rugby, boxing, or ice hockey, absolute numbers are substantial because of the high popularity of this sport and the large number of players. In 2006, a first step towards head injury prevention in football was made by altering a rule: henceforth intentional elbow to head contacts had to be punished by a red card. This action determined one of the three aims of this thesis: i) to present incidence rates of head injuries including their time trends and injury mechanisms; ii) to identify circumstances of head injury incidents, the behavior of referees, and their decisions; and iii) to investigate the effect of the rule change on the reduction of head injuries in professional male football. Methods: i) To investigate the time trends of head injuries, an analysis of head injuries in the 1st German Bundesliga was generated comprising the 11 consecutive seasons (2006/07 to 2016/17) following the rule change. The head injury database was based on continuously published data from the German football magazine “kicker Sportmagazin®” and other media sources. Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) were calculated. Time trends were analysed via linear regression. ii) To identify circumstances of head injury incidents, the video analyses of all head injuries from 13 consecutive seasons (2000/01 to 2012/13) were screened. iii) To provide a description of injury mechanisms of head injuries and the effect of the rule change, the database of all head injuries comprising seasons 2000/01 to 2012/13 were screened and the equal number of seasons before and after the rule change were compared. Head injury mechanisms were analysed from video recordings. IRs and 95% CI as well as incidence rate ratios (IRR) to assess differences in injury rates six seasons before and six seasons after the rule change were calculated. Results: i) During the 11 consecutive seasons, 238 head injuries occurred during matches (IR 1.77 per 1000 match hours). There were no significant seasonal changes (expressed as annual average year-to-year change) in IRs over the 11-year period for total head injuries, facial and head fractures, head and face lacerations and abrasions, and head contusions. The average year-toyear increase for concussion was 6.4%. There were no seasonal changes in head injury mechanisms over the study period. ii) Most head injury incidents involved two players. Those players who suffered a subsequent head injury predominantly jumped (60%), headed the ball (36%), and ran forwards (20%), whereas the non-injured players mainly jumped (64%), headed the ball (27%), and raised the elbow to the head (23%). Free ball situations (two players challenging/dueling for the ball) caused the largest proportion of the head injuries (81%). iii) 356 head injuries were recorded (IR 2.22 per 1000 match hours) in 13 consecutive seasons. Contact with another player resulted in the greatest proportion of head injuries, especially head to head (34%) and elbow to head (17%) contacts. After the rule change the total number of head injuries was reduced by 29%. The subcategories head and face lacerations and abrasions declined by 42%, concussions by 29%, head contusions by 18% and facial and head fractures by 16%. Discussion/Conclusion: The first study in this thesis revealed that the subcategory concussion increased slightly over the (2006/07 to 2016/17) seasons, which could be the result of increasing match dynamics and/or a raised awareness for this injury type among team physicians and players. Total head injuries and the other subcategories remained reasonably stable over 11 consecutive seasons. The second study showed that heading duels are particularly associated with head injuries and could be target of future prevention strategies. The third study provided evidence that the incidence rates for total number of head injuries and their respective subcategories were lower in the six seasons after the rule change compared to the equal number of seasons before. Therefore, rule changes in football appear to be effective in reducing the occurrence of head injuries. To summarize, the increasing number of concussions requires action. Ongoing monitoring and surveying of head injuries allows practitioners to keep track of head injuries. For future research, the development of preventative measures to avoid potential (serious) health consequences of head injuries is warranted

Pattern of Head Injuries in Western Hilly Region of Nepal: A Hospital-based Cross-sectional Study

Introduction: Subtle or gross structural changes of scalp, skull and its contents due to application of direct or indirect external force are known as head injuries. Head being the most vulnerable and prominent part of body, injuries to it cause major mortality and morbidity globally. This study focussed to find the pattern of traumatic head injuries in patients presented to Lumbini Medical College Teaching Hospital, Palpa, Nepal. Methods: The data was collected from 252 patients (164 males and 88 females) with head injuries attending Emergency or out-patient department of Neurosurgery of the institute. All patients with traumatic head injuries (scalp injury, skull fracture, intracranial haemorrhage and brain injury) were included in the study and brought dead patients and patients with non-traumatic brain lesions were excluded. Results: Among the various modes of head injuries, the most frequent was road traffic accidents accounting 125 (49.60%) cases and fall from height 108 (42.86%) cases was second to it followed by physical assault 12 (4.76%) and others 7(2.78%). Manner of injuries were unintentional in 238 (94.44%) of cases. Among males, intentional injuries were present in 5 (2.98%) cases and among females, 9 (10.72%) cases presented with intentional injuries. In 105 (41.67%) of the cases, head injuries were associated with injuries to the other body parts as well. Conclusion: The most common cause of head injury was found to be road traffic accident followed by fall from height. Intentional injuries were more common in females when compared to males

Epidemiology of Acute Injuries in Surfing: Type, Location, Mechanism, Severity, and Incidence: A Systematic Review

Prospective and retrospective studies have examined traumatic injuries within competitive and recreational surfers worldwide using online surveys and health care facility (HCF; e.g., hospital, emergency department, medical record) data. However, few studies have provided a synthesis of all available literature. The purpose of this study was to obtain, critique and synthesise all literature specific to acute surfing injuries, and evaluate differences in injury type, mechanism and location between HCF and survey data. A systematic literature review design was used to identify relevant articles from three major databases. Peer-reviewed epidemiological studies of musculoskeletal surfing injuries were included. A modified AXIS tool was used for critical appraisal, and objective data was extracted and synthesized by lead researchers. Overall frequencies for injury location, type and mechanism were calculated from raw injury data. A total of 19 cross-sectional articles of fair to good quality (Modified AXIS 54.2–83.3%) were included in this study; 17 were National Health and Medical Research Council (NHMRC) level III-2 (retrospective) and two were level II (prospective). Articles examined competitive, recreational and combined populations. Injury data from Australia, Brazil, UK, USA, Portugal, Japan, Norway, and worldwide were represented. Skin (46.0%; HCF 50.1%, survey 43.8%) and being struck by own surfboard (38.6%; HCF 73.4%, survey 36.7%) were the most common injury type and mechanism. Head, face and neck injuries were most common in HCF (43.1%) versus lower limb injuries (36.4%) in survey data. Incidence proportion was highest in aerialists (0.48). Incidence rate (number of injuries per 1000 h) ranged from 0.74 in Australian surfers (Melbourne) to 6.6 in international contest surfers from medical record data. This review highlights the prevalence of skin, board-related, head, face and neck, and lower limb surfing injuries across available literature. Proposed use of protective equipment and foam-based surfboards in dangerous or crowded surf locations may reduce injury risk