Adolescents' health and health behaviour as predictors of injury death. A prospective cohort follow-up of 652,530 person-years

<p>Abstract</p> <p>Background</p> <p>Injuries represent an important cause of mortality among young adults. Longitudinal studies on risk factors are scarce. We studied associations between adolescents' perceived health and health behaviour and injury death.</p> <p>Methods</p> <p>A prospective cohort of 57,407 Finns aged 14 to 18 years was followed for an average of 11.4 years. The end-point of study was injury death or termination of follow-up in 2001. The relationships of eight health and health behaviour characteristics with injury death were studied with adjusted Cox's proportional hazard model.</p> <p>Results</p> <p>We identified 298 (0.5%) injury deaths, 232 (0.9%) in men and 66 (0.2%) in women. The mean age at death was 23.8 years. In the models adjusted for age, sex and socioeconomic background, the strongest risk factors for injury death were recurring drunkenness (HR 2.1; 95% CI: 1.4–3.1) and daily smoking (HR 1.7; 95% CI: 1.3–2.2). Poor health did not predict injury death. Unintentional and intentional injury deaths had similar health and health behavioural risk factors.</p> <p>Conclusion</p> <p>Health compromising behaviour adopted at adolescence has a clear impact on the risk of injury death in adulthood independent from socioeconomic background. On the other hand, poor health as such is not a significant predictor of injury death. Promotion of healthy lifestyle among adolescents as part of public health programmes would seem an appropriate way to contribute to adolescent injury prevention.</p

Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury

<p>Abstract</p> <p>Background</p> <p>The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning.</p> <p>Methods</p> <p>This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis.</p> <p>Results</p> <p>Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning.</p> <p>Conclusion</p> <p>This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.</p

A multicentre, randomised, parallel group, superiority study to compare the clinical and cost-effectiveness of external frame versus internal locking plate for complete articular pilon fracture fixation in adults: protocol for the ACTIVE randomised controlled trial

Aims A pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5-7% of all tibial fractures), this injury causes amongst the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients’ quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures. Methods A randomised controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal locking plate fixation will be compared with external frame fixation. The primary outcome and endpoint will be the Disability Rating Index (a patient selfreported assessment of physical disability) at 12 months. This will also be measured at baseline, 3, 6 and 24 months after randomisation. Secondary outcomes include the Olerud and Molander Ankle Score (OMAS), the EQ-5D-5L score, complications (including bone healing), resource use, work impact and patient treatment preference. The acceptability of the treatments and study design to patients and health care professionals will be explored through qualitative methods. Discussion The two treatments being compared are the most commonly used for this injury, however there is uncertainty over which is most clinically and cost-effective. ACTIVE is a sufficiently powered and rigorously designed study to inform clinical decisions for the treatment of adults with this injury. Clinical relevance of the paper Recent reviews of the literature and NICE treatment guidance have identified the need for robust RCTs to assess whether internal or external fixation is better for management of pilon fractures. The outcome of this study will directly influence clinical decision-making and health policy by informing international and United Kingdom national guidance, improve outcomes for patients and reduce the financial burden associated with the injury. A systematic review by NICE identified no economic evaluations, which this study is addressing