Increasing incidence of pediatric mild traumatic brain injury in Finland - a nationwide register study from 1998 to 2018

Peer reviewe

Risk for intracranial hemorrhage in individuals after mild traumatic brain injury who are taking serotonergic antidepressants

BackgroundSerotonergic antidepressants may predispose to bleeding, but little is known of the risk for traumatic intracranial bleeding. MethodsThis was a prospective case-control study of 218 patients with mild traumatic brain injuries (TBI) who were treated at a Finnish tertiary trauma hospital. Injury-related information and clinical findings were prospectively collected in the emergency department. Detailed pre-injury health history was collected from electronic medical records. Information on the use of serotonergic antidepressants was attained from the Finnish national prescription registry. All head CT scans were reviewed by a neuroradiologist based on the Common Data Elements. Cases were patients with traumatic intracranial hemorrhage on head CT. Controls were patients from the same cohort, but without traumatic intracranial lesions on CT. The proportion with traumatic intracranial bleeding for patients on serotonergic antidepressant medication was compared to the proportion for patients not on serotonergic medication. ResultsThe study cohort consisted of 24 cases with traumatic intracranial bleeding and 194 injured controls. The median age of the sample was 70 years (interquartile range = 50-83). One fifth (21.6%) of all the patients were taking a serotonergic antidepressant. Of the patients on an antidepressant, 10.6% (5/47) had an acute hemorrhagic lesion compared to 11.1% (19/171) of those who were not on an antidepressant (p = 0.927). In the regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use. ConclusionSerotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage after a mild TBI. The patients in this relatively small cohort were mostly middle-aged and older adults. These factors limit the generalizability of the results in younger patients with mild TBI.Peer reviewe

Interpreting change on the SCAT3 in professional ice hockey players

Objectives: To examine test-retest reliability of the. SCAT3 for two consecutive seasons using a large sample of professional male ice hockey players, and to make recommendations for interpreting change on the test. Design: A cross-sectional descriptive study. Methods: Preseason baseline testing was administered in the beginning of the seasons 2013-2014 and 2014-2015 to 179 professional male hockey players in rink side settings. Results: The test-retest reliabilities of the SCAT3 components were uniformly low. However, the majority of athletes remained grossly within their own individual performance range when two pre-season SCAT3 baseline scores were compared to published normative reference values. Being tested by the same person or a different person did not influence the results. It was uncommon for the Symptom score to worsen by >= 3 points, the Symptom Severity score to worsen by >= 5 points, SAC total score to worsen by >= 3 points, M-BESS total error points to increase by >= 3, or the time to complete Tandem Gait to increase by >= 4s; each occurred in less than 10% of the sample. Conclusions: The SCAT3 has low test-retest reliability. Change scores should be interpreted with caution, and more research is needed to determine the clinical usefulness of the SCAT3 for diagnosing concussion and monitoring recovery. Careful examination of the natural distributions of difference scores provides clinicians with useful information on how to interpret change on the test. (C) 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Incidence of surgically treated post-traumatic hydrocephalus 6 months following head injury in patients undergoing acute head computed tomography

Background Post-traumatic hydrocephalus (PTH) is a well-known complication of head injury. The percentage of patients experiencing PTH in trauma cohorts (0.7-51.4%) varies greatly in the prior literature depending on the study population and applied diagnostic criteria. The objective was to determine the incidence of surgically treated PTH in a consecutive series of patients undergoing acute head computed tomography (CT) following injury. Methods All patients (N=2908) with head injuries who underwent head CT and were treated at the Tampere University Hospital's Emergency Department (August 2010-July 2012) were retrospectively evaluated from patient medical records. This study focused on adults (18 years or older) who were residents of the Pirkanmaa region at the time of injury and were clinically evaluated and scanned with head CT at the Tampere University Hospital's emergency department within 48 h after injury (n = 1941). A thorough review of records for neurological signs and symptoms of hydrocephalus was conducted for all patients having a radiological suspicion of hydrocephalus. The diagnosis of PTH was based on clinical and radiological signs of the condition within 6 months following injury. The main outcome was surgical treatment for PTH. Clinical evidence of shunt responsiveness was required to confirm the diagnosis of PTH. Results The incidence of surgically treated PTH was 0.15% (n = 3). Incidence was 0.08% among patients with mild traumatic brain injury (TBI) and 1.1% among those with moderate to severe TBI. All the patients who developed PTH underwent neurosurgery during the initial hospitalization due to the head injury. The incidence of PTH among patients who underwent neurosurgery for acute traumatic intracranial lesions was 2.7%. Conclusion The overall incidence of surgically treated PTH was extremely low (0.15%) in our cohort. Analyses of risk factors and the evaluation of temporal profiles could not be undertaken due to the extremely small number of cases.Peer reviewe

Environmental Controls of InSAR-Based Periglacial Ground Dynamics in a Sub-Arctic Landscape

Periglacial environments are characterized by highly dynamic landscapes. Freezing and thawing lead to ground movement, associated with cryoturbation and solifluction. These processes are sensitive to climate change and variably distributed depending on multiple environmental factors. In this study, we used multi-geometry Sentinel-1 Synthetic Aperture Radar Interferometry (InSAR) to investigate the spatial distribution of the mean annual ground velocity in a mountainous landscape in Northern Norway. Statistical modeling was employed to examine how periglacial ground velocity is related to environmental variables characterizing the diverse climatic, geomorphic, hydrological and biological conditions within a 148 km(2) study area. Two-dimensional (2D) InSAR results document mean annual ground velocity up to 15 mm/yr. Vertical and horizontal velocity components in the East-West plane show variable spatial distribution, which can be explained by the characteristics of cryoturbation and solifluction operating differently over flat and sloping terrain. Statistical modeling shows that slope angle and mean annual air temperature variables are the most important environmental factors explaining the distribution of the horizontal and vertical components, respectively. Vegetation and snow cover also have a local influence, interpreted as indicators of the ground material and moisture conditions. The results show contrasted model performance depending on the velocity component used as a response variable. In general, our study highlights the potential of integrating radar remote sensing and statistical modeling to investigate mountainous regions and better understand the relations between environmental factors, periglacial processes and ground dynamics.Peer reviewe

Ecosystem shift of a mountain lake under climate and human pressure : A move out from the safe operating space

A multiproxy approach including chironomid, diatom, pollen and geochemical analyses was applied on short gravitational cores retrieved from an alpine lake (Lacul Balea) in the Southern Carpathians (Romania) to unveil how this lake responded to natural and anthropogenic forcing over the past 500 years.On the basis of chironomid and diatom assemblage changes, and supported by sediment chemical data and historical information, we distinguished two main phases in lake evolution. Before 1926 the lake was dominated by chironomids belonging to Micropsectra insignilobus-type and benthic diatoms suggesting well-oxygenated oligotrophic environment with only small-scale disturbance. We considered this state as the lake's safe operational space. After 1926 significant changes occurred: Tanytarsus lugens-type and T. mendax-type chironomids took over dominance and collector filterers increased until 1970 pointing to an increase in available nutrients. The diatom community showed the most pronounced change between 1950 and 1992 when planktonic diatoms increased. The highest trophic level was reconstructed between 1970 and 1992, while the indicator species of increasing nutrient availability, Asterionella formosa spread from 1982 and decreased rapidly at 1992. Statistical analyses evidenced that the main driver of the diatom community change was atmospheric reactive nitrogen (Nr) fertilization that drastically moved the community towards planktonic diatom dominance from 1950. The transformation of the chironomid community was primarily driven by summer mean temperature increase that also changed the dominant feeding guild from collector gatherers to collector falterers. Our results overall suggest that the speed of ecosystem reorganisation showed an unprecedented increase over the last 100 years; biological systems in many cases underwent threshold type changes, while several system components displayed non-hysteretic change between alternating community composition. We conclude that Lake Balea is outside of its safe operating space today. The main trigger of changes since 1926 was climate change and human impact acting synergically. (C) 2020 The Authors. Published by Elsevier B.V.Peer reviewe

Isometric force production parameters during normal and experimental low back pain conditions

BACKGROUND: The control of force and its between-trial variability are often taken as critical determinants of motor performance. Subjects performed isometric trunk flexion and extension forces without and with experiment pain to examine if pain yields changes in the control of trunk forces. The objective of this study is to determine if experimental low back pain modifies trunk isometric force production. METHODS: Ten control subjects participated in this study. They were required to exert 50 and 75% of their isometric maximal trunk flexion and extension torque. In a learning phase preceding the non painful and painful trials, visual and verbal feedbacks were provided. Then, subjects were asked to perform 10 trials without any feedback. Time to peak torque, time to peak torque variability, peak torque variability as well as constant and absolute error in peak torque were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak torque achieved. RESULTS: Absolute and constant errors were higher in the presence of a painful electrical stimulation. Furthermore, peak torque variability for the higher level of force was increased with in the presence of experimental pain. The linear regressions between peak dF/dt, time to peak dF/dt and peak torque were similar for both conditions. Experimental low back pain yielded increased absolute and constant errors as well as a greater peak torque variability for the higher levels of force. The control strategy, however, remained the same between the non painful and painful condition. Cutaneous pain affects some isometric force production parameters but modifications of motor control strategies are not implemented spontaneously. CONCLUSIONS: It is hypothesized that adaptation of motor strategies to low back pain is implemented gradually over time. This would enable LBP patients to perform their daily tasks with presumably less pain and more accuracy

Evaluating the use of testate amoeba for palaeohydrological reconstruction in permafrost peatlands

The melting of high-latitude permafrost peatlands is a major concern due to a potential positive feedback on global climate change. We examine the ecology of testate amoebae in permafrost peatlands, based on sites in Sweden (~ 200 km north of the Arctic Circle). Multivariate statistical analysis confirms that water-table depth and moisture content are the dominant controls on the distribution of testate amoebae, corroborating the results from studies in mid-latitude peatlands. We present a new testate amoeba-based water table transfer function and thoroughly test it for the effects of spatial autocorrelation, clustered sampling design and uneven sampling gradients. We find that the transfer function has good predictive power; the best-performing model is based on tolerance-downweighted weighted averaging with inverse deshrinking (performance statistics with leave-one-out cross validation: R2 = 0.87, RMSEP = 5.25 cm). The new transfer function was applied to a short core from Stordalen mire, and reveals a major shift in peatland ecohydrology coincident with the onset of the Little Ice Age (c. AD 1400). We also applied the model to an independent contemporary dataset from Stordalen and find that it outperforms predictions based on other published transfer functions. The new transfer function will enable palaeohydrological reconstruction from permafrost peatlands in Northern Europe, thereby permitting greatly improved understanding of the long-term ecohydrological dynamics of these important carbon stores as well as their responses to recent climate change