Sports-related brain injury in the general population: An epidemiological study

Objectives To determine the incidence, nature and severity of all sports-related brain injuries in the general population. Design Population-based epidemiological incidence study. Methods Data on all traumatic brain injury events sustained during a sports-related activity were extracted from a dataset of all new traumatic brain injury cases (both fatal and non-fatal), identified over a one-year period in the Hamilton and Waikato districts of New Zealand. Prospective and retrospective case ascertainment methods from multiple sources were used. All age groups and levels of traumatic brain injury severity were included. Details of the registering injuries and recurrent injuries sustained over the subsequent year were obtained through medical/accident records and assessment interviews with participants. Results Of 1369 incident traumatic brain injury cases, 291 were identified as being sustained during a sports-related activity (21% of all traumatic brain injuries) equating to an incidence rate of 170 per 100,000 of the general population. Recurrent injuries occurred more frequently in adults (11%) than children (5%). Of the sports-related injuries 46% were classified as mild with a high risk of complications. Injuries were most frequently sustained during rugby, cycling and equestrian activities. It was revealed that up to 19% of traumatic brain injuries were not recorded in medical notes. Conclusions Given the high incidence of new and recurrent traumatic brain injury and the high risk of complications following injury, further sport specific injury prevention strategies are urgently needed to reduce the impact of traumatic brain injury and facilitate safer engagement in sports activities. The high levels of ‘missed’ traumatic brain injuries, highlights the importance in raising awareness of traumatic brain injury during sports-related activity in the general population

Funding Era Free Speech Theory: Applying Traditional Speech Protection to the Regulation of Anonymous Cyberspace

Abstract Background Blunt trauma is the most frequent mechanism of injury in multiple trauma, commonly resulting from road traffic collisions or falls. Two of the most frequent injuries in patients with multiple trauma are chest trauma and extremity fracture. Several trauma mouse models combine chest trauma and head injury, but no trauma mouse model to date includes the combination of long bone fractures and chest trauma. Outcome is essentially determined by the combination of these injuries. In this study, we attempted to establish a reproducible novel multiple trauma model in mice that combines blunt trauma, major injuries and simple practicability. Methods Ninety-six male C57BL/6 N mice (n = 8/group) were subjected to trauma for isolated femur fracture and a combination of femur fracture and chest injury. Serum samples of mice were obtained by heart puncture at defined time points of 0 h (hour), 6 h, 12 h, 24 h, 3 d (days), and 7 d. Results A tendency toward reduced weight and temperature was observed at 24 h after chest trauma and femur fracture. Blood analyses revealed a decrease in hemoglobin during the first 24 h after trauma. Some animals were killed by heart puncture immediately after chest contusion; these animals showed the most severe lung contusion and hemorrhage. The extent of structural lung injury varied in different mice but was evident in all animals. Representative H&E-stained (Haematoxylin and Eosin-stained) paraffin lung sections of mice with multiple trauma revealed hemorrhage and an inflammatory immune response. Plasma samples of mice with chest trauma and femur fracture showed an up-regulation of IL-1β (Interleukin-1β), IL-6, IL-10, IL-12p70 and TNF-α (Tumor necrosis factor- α) compared with the control group. Mice with femur fracture and chest trauma showed a significant up-regulation of IL-6 compared to group with isolated femur fracture. Conclusions The multiple trauma mouse model comprising chest trauma and femur fracture enables many analogies to clinical cases of multiple trauma in humans and demonstrates associated characteristic clinical and pathophysiological changes. This model is easy to perform, is economical and can be used for further research examining specific immunological questions

Minor injuries as a risk factor for venous thrombosis

BACKGROUND: Injuries increase the risk of venous thrombosis. So far, most research has focused on major injuries that are accompanied by other risk factors for venous thrombosis, such as plaster casts and surgery. We studied the association of venous thrombosis with common minor injuries, such as minor sural muscle ruptures and ankle sprains.\ud \ud METHODS: We performed a large, population-based, case-control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study), including consecutive patients with a first deep venous thrombosis of the leg or pulmonary embolism and control subjects. Participants with malignant neoplasms, those who underwent surgery, and those who had a plaster cast or extended bed rest were excluded.\ud \ud RESULTS: Of 2471 patients, 289 (11.7%), and of 3534 controls, 154 (4.4%) had a minor injury in the 3 months preceding the venous thrombosis (patients) or completion of the questionnaire (controls). Venous thrombosis was associated with previous minor injury (odds ratio adjusted for sex and age, 3.1; 95% confidence interval, 2.5-3.8). The association was strongest for injuries that occurred in the 4 weeks before thrombosis and was not apparent before 10 weeks. Thrombosis was more strongly associated with minor injuries located in the leg (odds ratio adjusted for sex and age, 5.1; 95% confidence interval, 3.9-6.7), while those located in other body parts were not associated. A 50-fold increased risk was found in factor V Leiden carriers with a leg injury compared with noncarriers without injury (odds ratio, 49.7; 95% confidence interval, 6.8-362.7).\ud \ud CONCLUSIONS: Minor injuries in the leg are associated with greater risk of venous thrombosis. Because minor injuries are common, they could be major contributors to the occurrence of venous thrombosis\u

Influence of voluntary standards and design modifications on trampoline injury in Victoria, Australia

© 2015 BMJ Publishing Group. All rights reserved. Purpose To examine the influence of the voluntary Australian trampoline standard (AS 4989-2006) and market-driven design modifications on relevant trampoline injuries. Methods Trend and intervention analysis on frequencies and proportions of hospital-treated trampoline-related injury in Victoria, Australia, extracted from the Victorian Emergency Minimum Dataset from 1 July 1999 to 30 June 2013. The injuries relevant to the AS were contact with spring and frame, and multipleuser injury. Falls from trampolines were relevant for netted trampolines, a market-driven modification. Results Frequency of all trampoline injuries increased by 11.4% (95% CI 10.0% to 11.7%) on average each year. Spring and frame, and fall injuries increased to a lesser extent (8.7%, 95% CI 6.9% to 9.8% and 7.3%, 95% CI 5.8% to 8.3%, respectively). Multiple-user injuries increased by 21.0% (95% CI 16.3% to 21.9%). As a proportion of all trampoline injuries, spring and frame injury and falls injury decreased, while multipleuser injuries increased. The intervention analysis showed no significant change in spring and frame injuries associated with the AS (p=0.17). A significant increase was found for multiple-user injuries (p=0.01), in particular for the 0-year to 4-year age group (p<0.0001), post 2007. Conclusions There was little evidence for an effect of the voluntary standard on spring and frame injury and none for multiple-user injury. Netted trampolines appear to be associated with a decrease in falls from trampolines but an increase in injuries to multiple users. A mandated trampoline safety standard and a safety campaign including warnings about multiple users is recommended. Continued monitoring of injury data will be required

Biomechanical Tolerance of Whole Lumbar Spines in Straightened Posture Subjected to Axial Acceleration

Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12‐L5) were dynamically loaded using a custom‐built drop tower. Twenty‐three specimens were tested at sub‐failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p \u3c 0.0001) injury predictors. Injury probability curves using parametric survival analysis were created for peak acceleration and peak force. Fifty‐percent probability of injury (95%CI) for force and acceleration were 4.5 (3.9–5.2 kN), and 16 (13–19 g). A majority of injuries affected the L1 spinal level. Peak axial forces and accelerations were greater for specimens that sustained multiple injuries or injuries at L2–L5 spinal levels. In general, force‐based tolerance was consistent with previous shorter‐segment lumbar spine testing (3–5 vertebrae), although studies incorporating isolated vertebral bodies reported higher tolerance attributable to a different injury mechanism involving structural failure of the cortical shell. This study identified novel outcomes with regard to injury patterns, wherein more violent exposures produced more injuries in the caudal lumbar spine. This caudal migration was likely attributable to increased injury tolerance at lower lumbar spinal levels and a faster inertial mass recruitment process for high rate load application. Published 2017. This article is a U.S. Government work and is in the public domain in the USA

The Pattern of Oral and Maxillofacial Injuries Among Patients Attending Muhimbili National Hospital, Dar es salaam, Tanzania

To determine the pattern of oral and maxillofacial injuries among patients attended at the Muhimbili National Hospital, Dar es Salaam, Tanzania. Descriptive cross-sectional hospital based study. The study was done at oral and maxillofacial surgery firm and emergency medicine department of Muhimbili National Hospital (MNH). All patients who attended the Oral and Maxillofacial Surgery firm and Emergency Medicine departments of MNH for treatment of oral and maxillofacial injuries during the period of the study and consented were included in the study. An interview of the patients with oral and maxillofacial injuries was done through structured questionnaire to obtain relevant information from the patient. Social-demographic information (age, sex, address, education level and marital status), patient’s main complaint, type of injury, place where injury took place, cause of injury, general condition of patient immediately after injury and afterwards and the time interval from injury to reporting to hospital were recorded. Clinical findings were recorded as follows: type of injury, site of injury, single or multiple, soft tissue or hard tissue injury. Soft tissue injuries were categorized as bruises, abrasions, cut wound, contusion, lacerations, avulsions, and burn. Hard tissue injury was categorized as fracture of facial bones such as nasal bone, maxilla, mandible, zygoma, frontal palatal and orbital bones. Accompanying injuries to the TMJ were also recorded. Radiological investigations including plain skull radiography (posterior anterior view, Water’s view, submental vertex view), orthopantomograph and where necessary a computed tomography (CT) were ordered. The interpretation of the radiological investigations was done by the principal investigator with the assistance of an experienced clinician and was recorded in a special form as fracture or no fracture, site and type of fracture. Treatment offered and treatment outcomes were also recorded. For admitted patients the number of days spent in hospital was recorded against the type of injury and treatment done. The data was entered into computer and analysis was done using Statistical Package for Social Sciences programme (SPSS) Version 15. Association of maxillofacial injury parameters vii (demographic factors, aetiology, treatment and complications) and type of injuries was evaluated using Chi –square test (X2). Significant level p<0.05 was used to draw out conclusion. A total of 137 patients, 123 (89.8%) males and 14 (10.2%) females with the male- female ratio of 9:1 were included in this study. The age range was from 4 to 70 years with a mean age of 30.13 years. The 21-30 and 31-40 years age groups were the most affected. Road traffic accidents (RTA) were the most (64.2%) common causes of oral and maxillofacial injuries. The most common soft tissue injury was laceration in 63 (26.9%) patients followed by bruises in 57 (24.4%) and cut wounds in 54 (23.1%). Ninety-three patients (67.9%) had sustained fractures of either the mandible, mid face or both and of those 93 patients who sustained fracture, most had mandibular fractures 42 (45.2%). All patients received basic resuscitation procedures, for stabilization of the patient. Almost all (97.8%) patients with oral and maxillofacial injuries were given analgesics for pain control and prophylaxis antibiotics (96.4%). Surgical wound debridement and wound suturing were the most (62.8% and 53.3% respectively) common treatment for soft tissue injuries, while intermaxillary or mandibulomaxillary fixation was the most (51%) common hard tissue injuries treatment. A total of 27 (19.7%) patients suffered some complications after treatment. Infection was the most (59.3%) common complication followed by malunion (33.3%). This study showed that road traffic accidents were the most common cause of maxillofacial injuries. Assaults/interpersonal violence were the second most common cause of maxillofacial trauma. These findings should alert the authorities, particularly the government and the road safety commission to the need for improvement of our roads, enforcement of existing traffic laws, and improvement of socio-economic conditions of the general population

The relationship between non-standard work arrangements and injuries in Europe

Abstract Background: Non-standard work arrangements are becoming an increasingly important determinant of health and safety among workers. The main objective of this study is to examine the relationship between indicators of non-standard work arrangements including precarious contract, long working hours, multiple jobs, shift work, and occupational injuries, using a representative European sample and taking into account several sociodemographic and work characteristics. Methods: The study was based on the data of the fifth European Working Conditions Survey (EWCS). For the purpose of this analysis, the sample was restricted to 26839 respondents from the 27 countries of the European Union, who were all employed workers. Associations between non-standard work arrangements and occupational injuries were studied with multilevel modeling techniques while adjusting for several confounders. Results: About 8.44% of the workers suffered from an occupational injury. Multivariate regression model showed an increased injury risk for those working long hours (OR 1.29, 95% CI 1.15 - 1.44), having multiple jobs (OR 1.23, 95% CI 1.03 - 1.47) and shift work (OR 1.35, 95% CI 1.18 - 1.54). The relationship between contract type and occupational injuries was not significant (OR 0.91, 95% CI 0.78 - 1.07). No significant gender difference was observed. Conclusion: This study confirms that indicators of non-standard work arrangements, except for precarious contract type, were significantly associated with occupational injuries. To reduce the burden of occupational injuries, not only risk reduction strategies and interventions are needed but also policy efforts at European level should be undertaken to limit non-standard work arrangements