Turbans vs. Helmets: A Systematic Narrative Review of the Literature on Head Injuries and Impact Loci of Cranial Trauma in Several Recreational Outdoor Sports

When in public, faith-based mandates require practising Sikh men to wear a turban which may not be covered by hats or caps. This makes it impossible for practising Sikhs to wear helmets and other protective headwear, mandatory in many countries and facilities for engagement in recreational pursuits (e.g., skiing) and on adventure outdoor recreation camps mandatorily run for school groups. The result is often social exclusion and ostracisation in the case of school children. Despite studies into the efficacy of protective helmets in some recreational outdoor activity settings, virtually nothing is known about the protective potential of turbans. This paper systematically reviews the extant literature on head injuries in several recreational outdoor activities and sports sectors (aerial, water, winter, wheeled and animal-based sports) and finds that the extant literature is of limited value when trying to understand the spatial distribution of trauma on the cranial surface. As the data do not permit to make inferences on the protective potential of turbans, future systematic, evidence-based epidemiological studies derived from hospital admissions and forensic examinations are required. Failure to do so perpetuates social exclusion and discrimination of religious grounds without an evidentiary basis for defensible public health measures.

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Socially Excluded Persons in Ireland Have an Increased Annual Risk of Hospitalisation Due to Venous Thromboembolic Disease

Blood ◽

10.1182/blood-2019-130371 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4702-4702

Author(s):

Karl Ewins ◽

Fionnuala Ni Ainle ◽

Eoghan Dunlea ◽

Sarah Kelliher ◽

Vicky Sandys ◽

...

Keyword(s):

Board Of Directors ◽

Social Exclusion ◽

Research Funding ◽

Hospital Admissions ◽

Significant Proportion ◽

Service Planning ◽

Hospital Inpatient ◽

Care Provision ◽

Advisory Committees ◽

Socially Excluded

Introduction Social exclusion in Ireland is strongly associated with injecting drug use, particularly injection of opiates into the groin: a strong risk factor for venous thromboembolism (VTE) (O'Reilly et al, 2015). Ní Cheallaigh et al (2017) reported a high burden of disease in socially excluded individuals in Ireland that can be effectively addressed by dedicated service planning and care provision. VTE in socially excluded persons has been identified by our group as a key knowledge gap. We have generated preliminary data demonstrating that socially excluded people account for a significant proportion of patients presenting with VTE in Dublin. Methods We extracted national Hospital InPatient Enquiry (HIPE) data from Health Atlas Ireland using the methods outlined in Kevane et al (2019). We identified individuals as "socially excluded persons" if their records contained one or more of the variables identified by Aldridge et al (2018): homeless individuals, prisoners, sex workers and individuals with substance use disorders. We identified all emergency inpatient hospital admissions for those with any diagnosis of VTE during 2017 using VTE-associated ICD-10 codes. Results There were 494,972 emergency inpatient admissions in patients >16 years during this 12 month period, of which 5,717 (1.2%) had a VTE diagnosis (55% of which were DVTs). 306 (5.3%) of hospital episodes with VTE occurred in socially excluded individuals. Applying maximum and minimum assumptions on the estimated population denominator we estimated that overall the annual incidence rate of VTE-related hospitalisation per person was approximately 10-fold higher in socially excluded individuals when compared to the general population (in which it was 0.12%). Conclusions This is the first time that an approximately ten-fold increase in the risk of hospitalisation due to VTE has been shown to be associated with social exclusion. This information was generated from national data, using surrogate identifiers for socially excluded persons. We hypothesise that detailed characterisation of VTE events in socially excluded clients will permit improved service planning and care provision for these vulnerable patients, enabling better VTE prevention and management. This may save lives and prevent the disabling and common long-term consequence of post-thrombotic syndrome with debilitating leg ulcers, which in this population results in numerous admissions and severe mobility issues. Planning such initiatives has the potential to reduce morbidity and mortality, improve quality of life but also to reduce hospital admissions (which are hugely over-represented in this patient group), save costs and resources and most importantly results in more equitable health care for socially excluded patients. Disclosures Ewins: Amgen: Other: Conference Fees & Travel Expenses; Bayer: Other: Conference Fees & Travel Expenses. Ni Ainle:BMS: Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Boehringer: Membership on an entity's Board of Directors or advisory committees; Leo Pharma: Research Funding; Actelion: Research Funding. Cliona:Pfizer: Research Funding; MSD: Other: Travel Expenses.

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A prospective Study of Cranial Injuries: A Review of Management Traumatic brain Injury

Neuroscience and Neurological Surgery ◽

10.31579/2578-8868/195 ◽

2018 ◽

Vol 2 (4) ◽

pp. 01-02

Author(s):

Presnall Rabas ◽

Polozar Norbert

Keyword(s):

Risk Factors ◽

Cranial Nerve ◽

Traffic Accidents ◽

Quantitative Estimation ◽

Seat Belt ◽

Head Injuries ◽

Epidemiological Studies ◽

Incidence Rates ◽

Traumatic Amnesia ◽

A Prospective Study

Head injuries (HI) are one of the most common causes of death, morbidity and disabilities in young adults. Epidemiological studies allow a quantitative estimation in terms of incidence and a qualitative estimate for the identification of risk factors in specific populations. These estimates may enable appropriate prevention programs. Estimates of annual incidence rates depend on territories, periods and methodological tools. Annual rates for hospitalized patients are found between 150 and 300/100,000 inhabitants. Severity of HI can be assessed by the Glasgow Coma Scale (GCS), the Abbreviated Injury Scale (AIS) or the Post-Traumatic Amnesia duration. Annual incidences of severe HI will depend on the selected score: around 25/100,000 inhabitants for cerebral trauma with intracranial injuries, around 9/100,000 for the most severe HI, with an AIS maximum of 5 with coma. The male:female ratio increases with degree of severity. Traffic accidents were the most frequent cause of HI. Many patients have associated injuries, worsening the outcome. Some risk factors are considered. Preventive measures are mainly conducted for traffic accidents, and include speed limit and regulations on helmet or seat belt use. Results of these measures are analysed Postoperative dysfunction affected one cranial nerve in 25 patients, two nerves in four and three nerves in one patient. Most cranial nerve injuries were asymptomatic or mild in severity, resolved in one to 12 months and probably were caused by intraoperative retraction.

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Evaluation of Nonresponse Bias in a Case–Control Study of Pleural Mesothelioma

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176146 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6146

Author(s):

Chiara Airoldi ◽

Daniela Ferrante ◽

Dario Mirabelli ◽

Danila Azzolina ◽

Corrado Magnani

Keyword(s):

Case Control Study ◽

Hospital Admissions ◽

Reference Group ◽

Epidemiological Studies ◽

Case Control ◽

Education Level ◽

Nonresponse Bias ◽

Cumulative Exposure ◽

The Status ◽

Control Study

Nonparticipation limits the power of epidemiological studies, and can cause bias. In a case–control study on pleural malignant mesothelioma (MM), we found low participation in interviews (63%) among controls. Our goal was to characterize nonresponder controls and assess nonresponse bias in our study. We selected all nonresponder controls (204) and a random sample of responder controls (174). Data were obtained linking hospital admissions and town registrars, and concordance between sources was assessed. Nonresponse bias was evaluated using a logistic regression model applying the inverse probability weighting approach. The odds ratio (OR) for the status of the respondents was 0.61 (95% confidence interval (CI): 0.33–1.16) for controls aged 61–70, 0.37 (CI: 0.20–0.66) for those aged 71–80, and 0.40 (CI: 0.20–0.80) for those aged above 80 (reference group: ≤60 years). Controls with low education level had lower OR (0.47; CI: 0.26–0.84). After adjustment, the ORs for MM by categories of cumulative exposure to asbestos were similar to the unadjusted results, ranging from 4.6 (CI: 1.8–11.7) for cumulative exposures between 0.1 and 1 f/mL-y to 57.5 (CI: 20.2–163.9) above 10 f/mL-y. Responder controls were younger and had higher education level. Nevertheless, there was little evidence of bias from nonresponse in the risk estimates of MM.

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Trends in admission and death rates due to paediatric head injury in England, 2000–2011

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308615 ◽

2015 ◽

Vol 100 (12) ◽

pp. 1136-1140 ◽

Cited By ~ 6

Author(s):

Robin Marlow ◽

Julie Mytton ◽

Ian K Maconochie ◽

Hazel Taylor ◽

Mark D Lyttle

Keyword(s):

Head Injury ◽

Traffic Accidents ◽

Hospital Admissions ◽

Road Traffic ◽

Head Injuries ◽

National Guidelines ◽

Number Of Children ◽

Risk Of Death ◽

Paediatric Head Injury ◽

The Uk

BackgroundThe number of children admitted to hospital is increasing year on year, with very short-stay admissions doubling in the last decade. Childhood head injury accounts for half a million emergency department attendances in the UK every year. The National Institute for Health and Care Excellence (NICE) has issued three iterations of evidence-based national guidance for head injury since 2003.ObjectivesTo assess if any changes in the rates of admission, death or causes of head injury could be temporally associated with the introduction of sequential national guidelines by longitudinal analysis of the epidemiology of paediatric head injury admissions in England from 2000 to 2011.MethodsRetrospective analysis of English Hospital Episode Statistics data of children under the age of 16 years old admitted to hospital with the discharge diagnosis of head injury.ResultsThe number of hospital admissions with paediatric head injury in England rose by 10% from 34 150 in 2000 to 37 430 in 2011, with the proportion admitted for less than 1 day rising from 38% to 57%. The main cause of head injury was falls (42–47%). Deaths due to head injury decreased by 52% from 76 in 2000 to 40 in 2011. Road traffic accidents were the main cause of death in the year 2000 (67%) but fell to 40% by 2011. In 2000, children who were admitted or died from head injuries were more than twice as likely to come from the most deprived homes compared with least deprived homes. By 2011, the disparity for risk of admission had narrowed, but no change was seen for risk of death.ConclusionsTemporal relationships exist between implementation of NICE head injury guidance and increased admissions, shorter hospital stay and reduced mortality. The underlying cause of this association is likely to be multifactorial.

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Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211038895 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110388

Author(s):

Amy L. Xu ◽

Krishna V. Suresh ◽

R. Jay Lee

Keyword(s):

Hospital Admission ◽

Emergency Departments ◽

Hospital Admissions ◽

Head Injuries ◽

Injury Rate ◽

The United States ◽

Annual Number ◽

Hospital Admission Rate ◽

Closed Head Injuries ◽

Closed Head

Background: Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose: To update our understanding of the epidemiology of cheerleading-related injuries. Study Design: Descriptive epidemiology study. Methods: We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results: From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) ( P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders ( P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) ( P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders ( P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) ( P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) ( P < .01). The hospital admission rate increased by 9.0% ( P = .02). Conclusion: The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.

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Head Trauma in Children

Pediatrics in Review ◽

10.1542/pir.15.6.213 ◽

1994 ◽

Vol 15 (6) ◽

pp. 213-219

Author(s):

Brahm Goldstein ◽

Karen S. Powers

Keyword(s):

Head Injury ◽

Hospital Admissions ◽

Motor Vehicle ◽

Pediatric Population ◽

Head Injuries ◽

Motor Vehicle Accidents ◽

Initial Assessment ◽

Severe Injuries ◽

Vehicle Accidents ◽

Pediatric Head Injury

Head injury, either alone or in association with multiple other injuries, is extremely common. The initial assessment and management of children who have a head injury is an important topic for all pediatricians. Epidemiology Table 1 lists definitions of minor, moderate, and severe head injuries as determined by the initial neurologic presentation. The most common method to assess a child's neurologic status initially is to assign a score based on the Glasgow Coma Scale (GCS). The GCS is determined by eye opening and best verbal and motor responses (Tables 2 and 3). Mild-to-moderate head injuries are far more common than severe injuries in the pediatric population. More than 90% of children requiring admission to a hospital following head injury have a GCS score of 13 to 15; severe head injury (GCS≤ 8) accounts for approximately 5% of admissions. Motor vehicle accidents, bicycle accidents, falls, sporting accidents, assaults, and child abuse are the most common causes of pediatric head injury. Despite a significant reduction in the number of pediatric fatalities due to implementation of the 55 mile/hour speed limit, motor vehicle accidents still result in a large number of hospital admissions and deaths each year. Many of these accidents are associated with drug or alcohol abuse.

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Effect of Ozone Exposure on Maximal Airway Narrowing in Non-Asthmatic and Asthmatic Subjects

Clinical Science ◽

10.1042/cs0890619 ◽

1995 ◽

Vol 89 (6) ◽

pp. 619-624 ◽

Cited By ~ 32

Author(s):

T. J. N. Hiltermann ◽

J. Stolk ◽

P. S. Hiemstra ◽

P. H. B. Fokkens ◽

P. J. A. Rombout ◽

...

Keyword(s):

Hospital Admissions ◽

Epidemiological Studies ◽

Significant Rise ◽

Ozone Exposure ◽

Major Constituent ◽

Maximal Degree ◽

Sputum Induction ◽

Airway Narrowing ◽

Ambient Ozone ◽

Mild Asthmatic

1. Ozone is a major constituent of air pollution in the summer. Epidemiological studies have demonstrated that there is an increase in hospital admissions for respiratory diseases 1 day after peak levels of ambient ozone. This may be due to an increase in the responsiveness of the airways to bronchoconstrictor stimuli. 2. In the present study we therefore studied the effect of a controlled exposure to ozone on the maximal degree of airway narrowing to a non-specific bronchoconstrictor, methacholine, 12 h after exposure. Both non-asthmatic and mild-asthmatic volunteers were exposed to ozone. 3. The study had a single blind design. Experimental exposures were to filtered air, 0.40 ppm ozone and filtered air respectively, at 1-week intervals. The duration of each exposure was 2 h with alternating periods of 15 min rest and exercise. At 12 h after exposure, methacholine inhalation challenge tests and sputum induction were performed. 4. Twelve hours after exposure to ozone there was a significant increase in the maximal degree of airway narrowing to methacholine (P < 0.02) compared with exposure to air, in non-asthmatic as well as asthmatic subjects. These physiological changes were accompanied by a significant rise in the percentage of neutrophils in induced sputum (P < 0.02). All changes had returned to baseline values 1 week after exposure to ozone. 5. Exposure to ozone causes a transient increase in the maximal degree of airway narrowing to methacholine in both non-asthmatic and asthmatic subjects. These laboratory results, obtained using relatively high ozone exposure in carefully selected subjects, might provide an explanation for the temporal relationship between ambient ozone levels and hospital admissions for asthma.

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A prospective Study of Cranial Injuries: A Review of Management Traumatic brain Injury

Neuroscience and Neurological Surgery ◽

10.31579/2578-8868/037 ◽

2018 ◽

Vol 2 (4) ◽

pp. 01-02

Author(s):

Presnall Rabas

Keyword(s):

Risk Factors ◽

Cranial Nerve ◽

Traffic Accidents ◽

Quantitative Estimation ◽

Seat Belt ◽

Head Injuries ◽

Epidemiological Studies ◽

Incidence Rates ◽

Traumatic Amnesia ◽

A Prospective Study

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Association between Ambient Temperature and Severe Diarrhoea in the National Capital Region, Philippines

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158191 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8191

Author(s):

Paul L. C. Chua ◽

Chris Fook Sheng Ng ◽

Adovich S. Rivera ◽

Eumelia P. Salva ◽

Miguel Antonio Salazar ◽

...

Keyword(s):

Ambient Temperature ◽

Hospital Admissions ◽

Healthcare Services ◽

Epidemiological Studies ◽

National Capital Region ◽

Severe Diarrhoea ◽

Capital Region ◽

Relative Risks ◽

Increased Risk ◽

National Capital

Epidemiological studies have quantified the association between ambient temperature and diarrhoea. However, to our knowledge, no study has quantified the temperature association for severe diarrhoea cases. In this study, we quantified the association between mean temperature and two severe diarrhoea outcomes, which were mortality and hospital admissions accompanied with dehydration and/or co-morbidities. Using a 12-year dataset of three urban districts of the National Capital Region, Philippines, we modelled the non-linear association between weekly temperatures and weekly severe diarrhoea cases using a two-stage time series analysis. We computed the relative risks at the 95th (30.4 °C) and 5th percentiles (25.8 °C) of temperatures using minimum risk temperatures (MRTs) as the reference to quantify the association with high- and low-temperatures, respectively. The shapes of the cumulative associations were generally J-shaped with greater associations towards high temperatures. Mortality risks were found to increase by 53.3% [95% confidence interval (CI): 29.4%; 81.7%)] at 95th percentile of weekly mean temperatures compared with the MRT (28.2 °C). Similarly, the risk of hospitalised severe diarrhoea increased by 27.1% (95% CI: 0.7%; 60.4%) at 95th percentile in mean weekly temperatures compared with the MRT (28.6 °C). With the increased risk of severe diarrhoea cases under high ambient temperature, there may be a need to strengthen primary healthcare services and sustain the improvements made in water, sanitation, and hygiene, particularly in poor communities.

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The neurological risks of playing association football

JRSM Open ◽

10.1177/20542704211055558 ◽

2021 ◽

Vol 12 (11) ◽

pp. 205427042110555

Author(s):

Oliver C Cockerell ◽

Natalie Iino Hayes ◽

Richard Sylvester

Keyword(s):

Neurological Disease ◽

Chronic Traumatic Encephalopathy ◽

Head Injuries ◽

Epidemiological Studies ◽

Current Evidence ◽

Professional Football ◽

Review Of The Literature ◽

Association Football ◽

Controversial Area

Summary Aims: The present study aims to provide a narrative review of the literature surrounding concussion and head injury in football and its clarity in evaluating the risk of long-term neurological disease. Findings: Epidemiological studies have shown correlations between participation in professional football and increased incidence of neurodegenerative disease and there have been reports of chronic traumatic encephalopathy (CTE) in the brains of former players in autopsy. These findings have been assumed by some to be the result of repetitive brain injury from head injuries and/or from heading the ball over a player's career. Data linking increased heading exposure with dementia is conflicting, and studies are limited by the reliance on retrospection and undocumented reports of concussion. It remains unclear whether CTE is unique to sportsmen or a variant of dementia pathology endemic in the population. Conclusions: Although logically appealing, there is no current evidence that heading is the cause of neurodegeneration amongst footballers and risks should be balanced by the protective mental and physical benefits of the sport. Physicians have an important role in providing balanced views in this emotive and controversial area.

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