Injury and risk-taking behavior - a systematic review

There is a substantial body of work in the scientific literature discussing the role of risk-taking behavior in the causation of injury. Despite the quantity of diverse writings on the subject most is in the form of theoretical commentaries. This review was conducted to critically assess the empirical evidence supporting the association between injury and risk-taking behavior. The review found six case-control studies and one retrospective cohort study, which met all the inclusion criteria. Meta-analysis was not possible due to the diversity of the independent and outcome variables in each of the studies reviewed. Overall the review found that risk-taking behavior, however it is measured, is associated with an increased chance of sustaining an injury except in the case of high skilled, risk-taking sports where the effect may be in the other direction. Drawing specific conclusions from the research presented in this review is difficult without an agreed conceptual framework for examining risk-taking behavior and injury. Considerable work needs to be done to provide a convincing evidence base on which to build public health interventions around risk behavior. However, sufficient evidence exists to suggest that effort in this area may be beneficial for the health of the community. (C) 2003 Elsevier Science Ltd. All rights reserved.

Lesões desportivas na ginástica artística: estudo a partir de morbidade referida

INTRODUÇÃO: Os níveis de exigência biomecânica devidos ao alto grau de dificuldade na realização de gestos fazem da ginástica artística (GA) uma modalidade com elevado risco de lesões. Assim, é necessário que os aspectos a elas relacionados sejam controlados. OBJETIVO: Analisar a ocorrência de lesões na Ginástica Artística, associando-as a fatores de risco específicos da modalidade e do atleta, a partir de inquérito de morbidade referida. MÉTODOS: Foram entrevistados 54 ginastas, recrutados ao acaso, classificados segundo o nível competitivo em duas categorias: regional e nacional. Utilizou-se o inquérito de morbidade referida (IMR) com a finalidade de reunir dados sobre a natureza da lesão, região corporal e aparelho ginástico. Os dados foram organizados e apresentados sob a forma de distribuição de freqüências e as variáveis, analisadas segundo nível de associação a partir do teste de Goodman para contrastes entre populações multinomiais, considerando significante o valor P < 0,05. RESULTADOS: Presença de lesão durante a temporada foi relatada por 39 (71,70%) atletas, sendo 22 (56,41%) mulheres e 17 (43,59%) homens. Nas categorias regional masculino e feminino e nacional feminino, a maior ocorrência de lesões foi de origem articular, correspondendo a 55,56%, 50% e 45,45% do total, respectivamente. Para o sexo feminino nacional, os membros inferiores foram os mais referidos (68,18%) e, em ambas as categorias, as lesões ocorreram nos aparelhos de saltos (79,41%), enquanto que no sexo masculino nacional o maior número de agravos foi verificado nos aparelhos de apoio e suspensão (72%). CONCLUSÕES: Há elevada freqüência de lesões, acometendo principalmente articulações e membros inferiores, sendo os aparelhos de saltos os mais referidos quanto à ocorrência de acometimentos. Foi observado também que, quanto maiores as exigências de desempenho técnico, maior a freqüência de lesões.

A Pilot Study of the Relationship of Calcium Intake and Frequency of Injuries In High School Athletes

Little information is available related to adolescent calcium intake and relationships with injuries they might suffer from sport participation. To determine calcium intake of high school athletes, to assess their self reported injury rates, and to examine the relationship between the two over a 12 month period of time. Participants received a questionnaire at their school and completed it anywhere they found convenient. Adolescent athletes in the Lincoln Public School system (n=43) that participated in at least one sport in the past year. Four age groups participated in the study with sixteen year olds having a significantly higher calcium intake at 1297 mg that of fourteen year olds. A variety of sports were represented with largest number of respondents participating in baseball/or softball at (55%). The next most played sport was basketball at (18%). Median total diet calcium was 1144.5 mg with a mean of 1182 mg + 567 mg. For the frequency of injuries that caused a missed practice or game in the past year, ankle injuries were the most common (25%). Knee injuries were the second most common (17%), followed closely by hand injuries (8%). Mean total diet calcium of athletes with five or more injuries that caused a missed practice or game was significantly higher at 1966 mg (P<.05) than athletes mean diet calcium with zero, one, two, and three injuries. Total milk calcium of those who reported three injuries that resulted in broken or fractured bones or dislocated joints was significantly higher (P<.05) at 1286 mg of total milk calcium than those who reported having zero, one, or two breaks or fractures. Athletes with higher calcium intakes have a higher number of reported injuries. This may be the result of increased vigorous activity which leads to increased calorie and calcium consumption. More importantly, this increased activity leads to an increased chance of injury. The greater calcium intake correlated with greater number of injuries may also be because of third parties advising the athletes who get injured to drink more milk and get more calcium in their diets because they have been injuries already.

A pilot case-control study of behavioral aspects and risk factors in Swiss climbers

Climbing is a popular sport in Switzerland, with approximately 100 000 active participants. There is an inherent risk of falls, overuse and stress-related trauma, with a reported injury rate of 4.2 injuries per 1000 climbing hours.

Altered left ventricular diastolic function in subjects with spinal cord injury

Study design: This is cross-sectional study. Objectives: The aim of this study is to investigate the cardiac structure and function of subjects with spinal cord injury (SCI) and the impact of metabolic, hemodynamic and inflammatory factors on these parameters. Setting: Sao Paulo, Brazil. Methods: Sixty-five nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI and 31 healthy subjects) were evaluated by medical history, anthropometry, laboratory tests, analysis of hemodynamic and inflammatory parameters and echocardiography. Results: Subjects with SCI had lower systolic blood pressure and higher levels of C-reactive protein and tumor necrosis factor receptors than the healthy ones. Echocardiography data showed that the SCI group presented similar left ventricular (LV) structural and systolic parameters, but lower initial diastolic velocity (Em) (9.2 +/- 0.5 vs 12.3 +/- 0.5 cm s(-1); P<0.001) and higher peak early inflow velocity (E)/Em ratio (7.7 +/- 0.5 vs 6.1 +/- 0.3; P = 0.009) compared with the able-bodied group, even after adjustment for systolic blood pressure and C-reactive protein levels. Furthermore, injured subjects with E/Em >8 had lower peak spectral longitudinal contraction (Sm) (9.0 +/- 0.7 vs 11.6 +/- 0.4cm s(-1); P<0.001) and cardiac output (4.2 +/- 0.2 vs 5.0 +/- 0.21 min(-1); P = 0.029), as well as higher relative wall thickness (0.38 +/- 0.01 vs 0.35 +/- 0.01; P = 0.005), than individuals with SCI with E/Em<8, but similar age, body mass index, blood pressure, injury level, metabolic parameters and inflammatory marker levels. Conclusion: Subjects with SCI presented impaired LV diastolic function in comparison with able-bodied ones. Moreover, worse LV diastolic function was associated with a pattern of LV concentric remodeling and subclinical decreases in systolic function among injured subjects. Overall, these findings might contribute to explain the increased cardiovascular risk reported for individuals with SCI. Spinal Cord (2011) 49, 65-69; doi: 10.1038/sc.2010.88; published online 27 July 2010

The functional outcome of children after a burn injury: A pilot study

Assessment of functional outcome can be used as a measure of the effectiveness of intervention during recovery from a burn injury. This pilot study identifies the factors that are likely to be most important for determining standardized functional outcome measures for children after a burn injury; it highlights the contribution of these factors to variations in children's postburn outcomes. A focus group of 8 parents and a self-report questionnaire administered to 12 children and 13 parents were the means of obtaining information for this exploratory study. Itching was found to be one of the primary impairments that contributed to reduced functional outcome during skin healing after a burn injury. The activities of children who had been burned that were most frequently affected by the injury (as reported by parents) were schoolwork and sports; these were closely followed by sleeping, playing with other children, and unliked activities. Least affected activities were enjoying the family, eating, seeing friends, watching television, and bathing or showering. Eighty-five percent of parents reported at least some level of interference with the listed daily activities. Burn injuries are likely to cause interference with several aspects of a patient's daily life. As a result, families require ongoing support and monitoring. Further research should longitudinally compare the performance of children who have been burned with other children and adolescents.

Dizziness after traumatic brain injury: Overview and measurement in the clinical setting

Traumatic brain injury (TBI) may result in a variety of cognitive, behavioural and physical impairments. Dizziness has been reported in up to 80% of cases within the first few days after injury. The literature was reviewed to attempt to delineate prevalence of dizziness as a symptom, impairments causing dizziness, the functional limitations it causes and its measurement. The literature provides widely differing estimates of prevalence and vestibular system dysfunction appears to be the best reported of impairments contributing to this symptom. The variety of results is discussed and other possible causes for dizziness were reviewed. Functional difficulties caused by dizziness were not reported for this population in the literature and review of cognitive impairments suggests that existing measurement tools for dizziness may be problematic in this population. Research on the functional impact of dizziness in the TBI population and measurement of these symptoms appears to be warranted.

Intravenous glutamine decreases lung and distal organ injury in an experimental model of abdominal sepsis

Introduction The protective effect of glutamine, as a pharmacological agent against lung injury, has been reported in experimental sepsis; however, its efficacy at improving oxygenation and lung mechanics, attenuating diaphragm and distal organ injury has to be better elucidated. In the present study, we tested the hypothesis that a single early intravenous dose of glutamine was associated not only with the improvement of lung morpho-function, but also the reduction of the inflammatory process and epithelial cell apoptosis in kidney, liver, and intestine villi. Methods Seventy-two Wistar rats were randomly assigned into four groups. Sepsis was induced by cecal ligation and puncture surgery (CLP), while a sham operated group was used as control (C). One hour after surgery, C and CLP groups were further randomized into subgroups receiving intravenous saline (1 ml, SAL) or glutamine (0.75 g/kg, Gln). At 48 hours, animals were anesthetized, and the following parameters were measured: arterial oxygenation, pulmonary mechanics, and diaphragm, lung, kidney, liver, and small intestine villi histology. At 18 and 48 hours, Cytokine-Induced Neutrophil Chemoattractant (CINC)-1, interleukin (IL)-6 and 10 were quantified in bronchoalveolar and peritoneal lavage fluids (BALF and PLF, respectively). Results CLP induced: a) deterioration of lung mechanics and gas exchange; b) ultrastructural changes of lung parenchyma and diaphragm; and c) lung and distal organ epithelial cell apoptosis. Glutamine improved survival rate, oxygenation and lung mechanics, minimized pulmonary and diaphragmatic changes, attenuating lung and distal organ epithelial cell apoptosis. Glutamine increased IL-10 in peritoneal lavage fluid at 18 hours and bronchoalveolar lavage fluid at 48 hours, but decreased CINC-1 and IL-6 in BALF and PLF only at 18 hours. Conclusions In an experimental model of abdominal sepsis, a single intravenous dose of glutamine administered after sepsis induction may modulate the inflammatory process reducing not only the risk of lung injury, but also distal organ impairment. These results suggest that intravenous glutamine may be a potentially beneficial therapy for abdominal sepsis.

Heat stress impairs performance parameters, induces intestinal injury, and decreases macrophage activity in broiler chickens

Studies on environmental consequences of stress on animal production have grown substantially in the last few years for economic and animal welfare reasons. Physiological, hormonal, and immunological deficits as well as increases in animals` susceptibility to diseases have been reported after different stressors in broiler chickens. The aim of the current experiment is to describe the effects of 2 different heat stressors (31 +/- 1 and 36 +/- 1 degrees C/10 h per d) applied to broiler chickens from d 35 to 42 of life on the corticosterone serum levels, performance parameters, intestinal histology, and peritoneal macrophage activity, correlating and discussing the obtained data under a neuroimmune perspective. In our study, we demonstrated that heat stress (31 +/- 1 and 36 +/- 1 degrees C) increased the corticosterone serum levels and decreased BW gain and food intake. Only chickens submitted to 36 +/- 1 degrees C, however, presented a decrease in feed conversion and increased mortality. We also showed a decrease of bursa of Fabricius (31 +/- 1 and 36 +/- 1 degrees C), thymus (36 +/- 1 degrees C), and spleen (36 +/- 1 degrees C) relative weights and of macrophage basal (31 +/- 1 and 36 +/- 1 degrees C) and Staphylococcus aureus-induced oxidative burst (31 +/- 1 degrees C). Finally, mild multifocal acute enteritis characterized by an increased presence of lymphocytes and plasmocytes within the jejunum`s lamina propria was also observed. The stress-induced hypothalamic-pituitary-adrenal axis activation was taken as responsible for the negative effects observed on the chickens` performance and immune function and also the changes of the intestinal mucosa. The present obtained data corroborate with others in the field of neuroimmunomodulation and open new avenues for the improvement of broiler chicken welfare and production performance.

Development of motor system dysfunction following whiplash injury

Dysfunction in the motor system is a feature of persistent whiplash associated disorders. Little is known about motor dysfunction in the early stages following injury and of its progress in those persons who recover and those who develop persistent symptoms. This study measured prospectively, motor system function (cervical range of movement (ROM), joint position error (JPE) and activity of the superficial neck flexors (EMG) during a test of cranio-cervical flexion) as well as a measure of fear of re-injury (TAMPA) in 66 whiplash subjects within 1 month of injury and then 2 and 3 months post injury. Subjects were classified at 3 months post injury using scores on the neck disability index: recovered (30). Motor system function was also measured in 20 control subjects. All whiplash groups demonstrated decreased ROM and increased EMG (compared to controls) at 1 month post injury. This deficit persisted in the group with moderate/severe symptoms but returned to within normal limits in those who had recovered or reported persistent mild pain at 3 months. Increased EMG persisted for 3 months in all whiplash groups. Only the moderate/severe group showed greater JPE, within 1 month of injury, which remained unchanged at 3 months. TAMPA scores of the moderate/severe group were higher than those of the other two groups. The differences in TAMPA did not impact on ROM, EMG or JPE. This study identifies, for the first time, deficits in the motor system, as early as 1 month post whiplash injury, that persisted not only in those reporting moderate/severe symptoms at 3 months but also in subjects who recovered and those with persistent mild symptoms. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

Electropalatographic assessment of tongue-to-palate contacts exhibited in dysarthria following traumatic brain injury: Spatial characteristics

Consonant imprecision has been reported to be a common feature of the dysarthric speech disturbances exhibited by individuals who have sustained a traumatic brain injury (TBI). Inaccurate tongue placements against the hard palate during consonant articulation may be one factor underlying the imprecision. To investigate this hypothesis, electropalatography (EPG) was used to assess the spatial characteristics of the tongue-to-palate contacts exhibited by three males (aged 23-29 years) with dysarthria following severe TBI. Five nonneurologically impaired adults served as control subjects. Twelve single-syllable words of CV or CVC construction (where initial C = /t, d, S, z, k, g/, V=/i, a/) were read aloud three times by each subject while wearing an EPG palate. Spatial characteristics were analyzed in terms of the location, pattern, and amount of tongue-to-palate contact at the frame of maximum contact during production of each consonant. The results revealed that for the majority of consonants, the patterns and locations of contacts exhibited by the TBI subjects were consistent with the contacts generated by the group of control subjects. One notable exception was one subject's production of the alveolar fricatives in which complete closure across the palate was demonstrated, rather than the characteristic groove configuration. Major discrepancies were also noted in relation to the amount of tongue-to-palate contact exhibited, with two TBI subjects consistently demonstrating increased contacts compared to the control subjects. The implications of these findings for the development of treatment programs for dysarthric speech disorders subsequent to TBI are highlighted.

Bucket-handle tear of the triangular fibrocartilage complex : case report of a complex peripheral injury with separation of the distal radioulnar ligaments from the articular disc.

Palmer previously proposed a classification system of triangular fibrocartilage complex (TFCC) injuries that proved to be useful in directing clinical management. However, dorsal peripheral tears (variants of class 1C) were not described and have rarely been reported in the literature since. We herewith present a rare case of bucket-handle tear of the TFCC. To our knowledge, this is the first case demonstrating partial separation of both the palmar and dorsal distal radioulnar ligaments (DRULs) from the articular disc. The particular wrist magnetic resonance (MR) arthrographic findings of this unusual complex peripheral TFCC tear (a variant of both class 1B and 1C) were nicely appreciated upon sagittal reformatted images.

Age Related Outcome in Acute Subdural Haematoma Following Traumatic Head Injury

Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH's) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. The authors present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland's national neurosurgical centre. The aim of this study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited.

Alcohol and nonlethal injuries: a Swiss emergency department study on the risk relationship between acute alcohol consumption and type of injury.

BACKGROUND: Acute alcohol consumption has been reported to be an important risk factor for injury, but clear scientific evidence on issues such as injury type is not available. The present study aims to improve the knowledge of the importance of alcohol consumption as an injury determinant with regards to two dimensions of the type of injury, namely the nature and the body region involved. METHODS: Risk relationships between two injury type components and acute alcohol use were estimated through multinomial and logistic regression models based on data from 7,529 patients-among whom 3,682 had injury diagnoses-gathered in a Swiss emergency department. RESULTS: Depending on the type of injury, between 31.1% and 48.7% of casualties report alcohol use before emergency department attendance. The multinomial regression models show that even low alcohol levels are consistently associated with nearly all natures of injury and body regions. A persistent dose-response effect between alcohol levels and risk associations was observed for almost all injury types. CONCLUSIONS: The results highlight the importance and consistency of the risk association between low and moderate levels of acute alcohol consumption and all types of injury. None of the body regions and natures of injury could pride on absence of association between alcohol and injury. Public health, prevention, and care implications are considered.