Dissertationen zum Thema „Injuries“

Iatrogenic vascular injuries (IVIs) and injuries associated with vascular surgery can cause severe morbidity and death. The aims of this thesis were to study those injuries in the Swedish vascular registry (Swedvasc), the Swedish medical injury insurance where insurance claims are registered, the Population and Cause of death registries, and in patient records, in order to explore preventive strategies. Among 87 IVIs during varicose vein surgery 43 were venous, mostly causing bleeding in the groin. Among 44 arterial injuries, only 1/3 were detected intraoperatively. Accidental arterial stripping predominated, with poor outcome. Four patients died, all after venous injuries. IVIs increased over time, and constitute more than half of the vascular injuries registered in the Swedvasc. Lethal outcome was more common (4.9%) among patients suffering IVIs than among non-iatrogenic vascular injuries (2.5%). Risk factors for death were age, diabetes, renal insufficiency and obstructive lung-disease. Fifty-two patients died within 30 days after IVI. The most common lethal IVIs were puncture during endovascular procedures (n=24, 46%), penetrating trauma during open surgery (11) and occlusion after compression (6). Symptoms were peripheral ischemia (n=19), external bleeding (14), and hypovolemic chock without external bleeding (10). Most died within two weeks (n=36, 69%). After >2 weeks the IVI as a cause of death was uncertain. Among 193 insurance claims after vascular surgery during 2002-2007, nerve injuries (91) and wound infections (22) dominated. Most patients suffered permanent injuries, three died. Patients with insurance claims were correctly registered in the Swedvasc in 82%. In 32 cases of popliteal artery injury during knee arthroplasty symptoms were bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Only twelve injuries (38%) were detected intraoperatively. Patency at 30 days was 97%, but only seven (22%) patients had complete recovery. Six of those had intraoperative diagnosis of popliteal injury and immediate vascular repair. In conclusion, registration of IVIs is increasing and outcome is often negatively affected by diagnostic and therapeutic delay. Not all fatalities after IVIs are attributable to the injury itself. The most common causes of insurance claims after vascular surgery were nerve injuries, and 82% were correctly registered in Swedvasc.

Background The incidence of traumatic brain injuries (TBI) is about 500 cases per 100,000 inhabitants per year, a majority of which are mild TBI (MTBI). The incidence of whiplash injuries is about 300/100,000/year. There are several similarities between MTBI and whiplash injuries with regard to the causes of injury (traffic crashes and falls), the demographic profile of the injured (mostly young persons), and the type of symptoms exhibited by some of the injured (for example head/neck pain, fatigue, irritability, impaired cognitive functioning, and depression).  Main aim To investigate the epidemiology and long-term consequences in terms of symptoms, disability, and life satisfaction in cases of TBI and whiplash injuries in a well-defined population. Material and methods Data on frequencies and characteristics of TBI and whiplash injuries were extracted from the injury database at the emergency department (ED) of Umeå University Hospital (UUH). The results were presented as descriptive epidemiology. The 18-65 year-old persons who sustained an MTBI or whiplash injury in 2001, were provided a questionnaire three and five years after injury respectively, in which questions were asked about: Symptoms; Rivermead Post Concussion Symptoms Questionnaire (RPQ) Disability; Rivermead Head Injury Follow Up Questionnaire (RHFUQ) Life satisfaction; LiSat-11 A local reference population was used for comparison of the RPQ. A national cohort was used as reference for LiSat-11. Data on sick leave for the cases of whiplash injuries were analysed to calculate the cost to society for loss of productivity. Results In 2001, the incidence of TBI was 354/100,000/year. The mean age was 23 and 55% were men. Ninety-seven percent of the injuries were classified as mild (Glasgow coma scale 13-15). The main causes were falls (55%) and traffic related injury events (30%). In 8% of the cases (17% of the elderly persons) an intracranial bleeding was detected by using CT. The 3-year follow-up of the MTBI patients showed that women had more symptoms and disability (~50%) than men (~30%). Both women and men had more symptoms and lower life satisfaction compared with the reference population. The incidence of traffic-related whiplash injuries in adults was 235/100,000/year and the annual incidences were relatively stable during 2000-2009. Combining the incidences with national insurance data showed that the proportion of insurance claims decreased during the period. When looking at whiplash trauma following all causes of injury in 2001, traffic crashes caused 61% of the injuries and falls caused 14%. Neck fractures occurred in 3% of the cases. Five years after whiplash injury, the injured persons had more symptoms and lower life satisfaction than the references. Sick leave ≥15 days was granted in 14% of the cases of whiplash injuries. The median number of sick days was 298 and the cost of loss of productivity during the follow-up was 5.6 million USD. The frequencies of symptoms were relatively alike when comparing subjects with whiplash injuries to subjects with MTBI. Conclusion TBI and whiplash injuries are common, especially among young people, and the injuries render long-term symptoms, disability, and impaired life satisfaction in up to 50% of the cases. Symptoms exhibited are alike between the two types of injuries. The cost to society for loss of productivity is high, and there is a need for enhanced preventive measures aiming at reducing traffic-related injuries, sports injuries, alcohol-related injuries, and falls. Physical, mental, and social factors are important and should be addressed when examining and treating patients with persisting symptoms following TBI and whiplash injuries.
Bakgrund Skallskador utgör ett stort folkhälsoproblem, särskilt eftersom många som skadas är unga. Skallskador är också, parallellt med självmord, den vanligaste dödsorsaken hos ungdomar och unga vuxna. De flesta av skadorna klassas som ”lätta” i akutskedet men trots det så kommer en del av patienterna att drabbas av kvarstående besvär, t ex smärta, koncentrationssvårigheter, depression och nedsatt livstillfredsställelse. Whiplashskador är nästan lika vanligt förekommande som skallskador och uppkommer framförallt i trafikolyckor. Även fall- och sportskador orsakar emellertid ett betydande antal whiplashskador. I normalfallet avtar de akuta symptomen inom några veckor men en del av patienterna anger att de får kvarstående besvär. Ett flertal skademekanismer i nackens vävnader är kända men tyvärr svåra att verifiera eller utesluta. Huvudsyfte Att undersöka förekomsten av skallskador och whiplashskador i en väldefinierad population samt beskriva restsymptom, funktions-nedsättningar och livstillfredsställelse hos de drabbade tre till fem år efter skadan. Material och metod Förekomsten av skadorna (Studie I, III och IV) Studierna baseras på skadedatabasen vid Norrlands Universitetssjukhus i Umeå (NUS). I skadedatabasen registreras alla patienter som söker till akutmottagningen efter en skadehändelse, ca 10 000 fall per år. När patienterna anmäler sig i receptionen tilldelas de en skadejournal som de själva fyller i i väntan på att bli undersökta. När patienter inkommer med svårare skador får anhöriga i möjligaste mån fylla i journalen. Primärvårdens jour har under åren för studiens genomförande varit belägen på akutmottagningen under kvällar, nätter och helger vilket inneburit att de få skadefall som konsekvent missats har varit lättare skador som behandlats dagtid på vårdcentralerna i upptagningsområdet.   Långtidsuppföljning (Studie II, III och V) En uppföljande enkätundersökning bestående av ett antal validerade frågeformulär skickades till alla skall- och whiplashskadade patienter i arbetsför ålder tre respektive fem år efter skadehändelsen. De frågeformulär som analyserades var: För symptom: Rivermead Post Concussion Symptoms Questionnaire (RPQ) För funktionsnedsättning: Rivermead Head Injury Follow Up Questionnaire (RHFUQ) För livstillfredsställelse: Life Satisfaction-11 (LiSat-11) För smärta (hos de whiplashskadade): Visual Analogue Scale (VAS)  Resultaten från RPQ och LiSat-11 jämfördes med sedan tidigare tillgängligt material från åldersmatchade referenspopulationer. När det gäller de whiplashskadade genomfördes en femårsuppföljning avseende sjukskrivning. Data från Försäkringskassan analyserades och samhällskostnaden för produktionsbortfall beräknades baserat på den genomsnittliga kostnaden för en årsarbetare. Resultat Förekomsten av skallskador vid NUS under 2001 var 354 skadade per 100 000 invånare. Medelåldern på de skadade var 23 år och 55% var män. Andelen lätta skallskador var 97%. Fallolyckor orsakade flest skador (55%) och trafikolyckor var näst vanligast (30%). Minst 17% av patienterna (ofta medelålders personer) var alkoholpåverkade. Hos 8% av patienterna (17% av personer över 65 år) upptäcktes blödningar i hjärnan. I uppföljningen efter tre år noterades att de skallskadade patienterna i arbetsför ålder hade högre symptomfrekvens och lägre livstillfredsställelse än referenspopulationerna. Kvinnorna rapporterade högre förekomst av symptom och funktionsnedsättning än männen. Funktionsnedsättning av varierande grad samt så kallat postkommotionellt syndrom (med förekomst av minst tre specificerade symptom) fanns hos ca 50% av kvinnorna och hos ca 30% av männen. Medelförekomsten av whiplashskador till följd av trafikolyckor var under 2000-2009 235 fall per 100 000 invånare och år. Sammantaget var förekomsten relativt stabil under perioden; en ökning med 1% per år noterades. När siffrorna matchades mot data från Försäkringsförbundet noterades en minskning av andelen försäkringsärenden under perioden. 2001 års incidens av akuta whiplashskador efter alla typer av skadehändelser var 383 skadade per 100 000 invånare. Könsfördelningen var 56% män / 44% kvinnor och medelåldern var 32 år. Trafikolyckor orsakade 61% av whiplashskadorna medan fallolyckor stod för 14%. Frakturer i nacken var ovanliga och hittades hos 3% av patienterna. I femårsuppföljningen av whiplashpatienter i arbetsför ålder noterades att de hade högre frekvens (ca 50%) av symptom samt lägre livstillfredsställelse än referenspopulationerna. Funktionsnedsättning av varierande grad fanns hos ca 50% av patienterna. Kvinnorna skattade sin smärta högre än männen men i övrigt fanns ingen könsskillnad beträffande förekomsten av symptom, funktionsnedsättning och livstillfredsställelse. Vid jämförelse mellan whiplashskadade och skallskadade noterades att förekomsten av symptom med några få undantag inte skilde sig åt mellan grupperna. Fjorton procent av de whiplashskadade blev sjukskrivna i mer än 14 dagar. Sjukskrivningens medianlängd var 298 dagar och i 3% av fallen fortskred sjukskrivningen under hela 5-årsperioden. Trafikskadade sjukskrevs oftare än fallskadade och noterbart är också att nackfrakturer ej resulterade i längre sjukskrivningar än mjukdelsskador. Samhällskostnaden för produktionsbortfall var i snitt ca 600 000 kr per sjukskrivning. Konklusion Avhandlingen bidrar med nya grunddata som ytterligare förstärker bilden av att skallskador och whiplashskador är vanliga och att det framförallt är unga personer som drabbas. Grad och typ av kvarstående besvär är likartade efter båda skadetyper. Samhällskostnaden för skadorna är hög och lämpliga områden för skadepreventivt arbete tycks vara fallskadeprevention, trafikskadeprevention, skadeprevention inom hästsport, fotboll och ishockey samt prevention av alkoholrelaterade skador. Både fysiska, psykologiska och sociala faktorer inverkar på läkningsförloppet och symptombilden efter skadorna och det är viktigt att utvärdera och behandla patienterna med utgångspunkt från detta.

The aim of the study was to analyse mortality and morbidity from external causes among Lithuanian children and adolescents. Methods. Information on deaths from major external causes during the period of 1988-2000 for Lithuanian children and adolescents aged 0-19 was obtained from the Department of Statistics. Information on the number of admissions to health care institutions due to injuries for children aged 0-14 years was gathered from Lithuanian Health Information Center. International comparisons were performed using data from the WHO/Europe Health for All Database. Mortality rates were age-standardized using the European standard, and analysed by sex, age, and place of residence. Years of life lost due to external causes were calculated. Mortality and morbidity trends were explored using the regression analysis. Results. External causes were the most common causes of death among Lithuanian children and adolescents aged up to 19 years, accounting for 36.5% of overall mortality during the period of 1988-2000. Children or adolescents lost approximately 330,000 (23.7 per 1,000 population) years of life due to external causes in 1988-2000, or every dead child or adolescent lost, on the average, close to 60 years of life. Age-standardized mortality from external causes of Lithuanian children and adolescents was 40.1 per 100 000 population in 1988-2000. Considerable inequalities in mortality by sex, age, and place of residence were disclosed, pointing out boys, children under one year of age, adolescents aged 15-19 years, and residents of rural areas as the most vulnerable groups. Throughout the study period mortality from external causes was decreasing, while the number of admissions to health care institutions and hospital discharges due to injuries was increasing. Despite a recent decline, mortality from external causes among children and adolescents remains at extremely high level in Lithuania as compared to other countries of Europe. Conclusions. High mortality rates due to external causes, and an increasing number of non-fatal injuries among Lithuanian children and adolescents demonstrate the great need for a definite, well-coordinated, and competent injury prevention strategy.

ISBN 91-7997-136-9

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/36592

Informed by narrative inquiry and storywork, this qualitative research analyzes the extent to which non-Indigenous frontline workers are engaging with and responding to colonial history. The research aimed to gather and reflect on stories non-Indigenous service providers tell about their practice with Indigenous substance users. Within such stories, do practitioners speak of their role, if any, with regard to historically-determined inequities? Do they engage in hopeful exchanges? Five non-Indigenous practitioners working with Indigenous service users with substance use issues participated in the research. The analysis of the five in-depth interviews was informed by the author’s own mental health and addictions education and practice training, relevant Indigenous and mainstream research, literature, teachings and stories. This thesis contributes to understanding the role of practitioners in response to problematic substance use and social injuries in Canada. Findings suggests that while some social workers are keenly aware of colonial history, ongoing colonial violence and their relevance to work with Indigenous service users, they struggle with how to operationalize that knowledge. In terms of implications for social work, findings highlight ways in which the work of participants is ‘responsive to history,’ responsive to colonial complicity, and suggest considerations and concerns that require further attention. The study contributes to a fuller understanding of the constituents of decolonizing practice—history, cultural humility, etc.—as viewed by non-Indigenous practitioners.
Arts, Faculty of
Social Work, School of
Graduate

Background: Severe facial trauma is often associated with intracerebral injuries. So it seemed to be of interest to study stress propagation from face to neurocranium after a fistlike impact on the facial skull in a finite element analysis
Hintergrund: Frakturen des Gesichtsschädels gehen häufig mit intrakraniellen Verletzungen einher. Deshalb erschien es interessant, die Weiterleitung und Verteilung von Spannungen, wie sie bei einem Faustschlag auftreten, vom Gesichtsschädel zum Hirnschädel in einer Finite Elemente Analyse zu untersuchen

The goal of this thesis is to investigate the potential of predictive modelling for football injuries. This work was conducted in close collaboration with Tottenham Hotspurs FC (THFC), the PGA European tour and the participation of Wolverhampton Wanderers (WW). Three investigations were conducted: 1. Predicting the recovery time of football injuries using the UEFA injury recordings: The UEFA recordings is a common standard for recording injuries in professional football. For this investigation, three datasets of UEFA injury recordings were available: one from THFC, one from WW and one that was constructed by merging both. Poisson, negative binomial and ordinal regression were used to model the recovery time after an injury and assess the significance of various injury-related covariates. Then, different machine learning algorithms (support vector machines, Gaussian processes, neural networks, random forests, naïve Bayes and k-nearest neighbours) were used in order to build a predictive model. The performance of the machine learning models is then improved by using feature selection conducted through correlation-based subset feature selection and random forests. 2. Predicting injuries in professional football using exposure records: The relationship between exposure (in training hours and match hours) in professional football athletes and injury incidence was studied. A common problem in football is understanding how the training schedule of an athlete can affect the chance of him getting injured. The task was to predict the number of days a player can train before he gets injured. The dataset consisted of the exposure records of professional footballers in Tottenham Hotspur Football Club from the season 2012-2013. The problem was approached by a Gaussian process model equipped with a dynamic time warping kernel that allowed the calculation of the similarity of exposure records of different lengths. 3. Predicting intrinsic injury incidence using in-training GPS measurements: A significant percentage of football injuries can be attributed to overtraining and fatigue. GPS data collected during training sessions might provide indicators of fatigue, or might be used to detect very intense training sessions which can lead to overtraining. This research used GPS data gathered during training sessions of the first team of THFC, in order to predict whether an injury would take place during a week. The data consisted of 69 variables in total. Two different binary classification approaches were followed and a variety of algorithms were applied (supervised principal component analysis, random forests, naïve Bayes, support vector machines, Gaussian process, neural networks, ridge logistic regression and k-nearest neighbours). Supervised principal component analysis shows the best results, while it also allows the extraction of components that reduce the total number of variables to 3 or 4 components which correlate with injury incidence. The first investigation contributes the following to the field: • It provides models based on the UEFA injury recordings, a standard used by many clubs, which makes it easier to replicate and apply the results. • It investigates which variables seem to be more highly related to the prediction of recovery after an injury. • It provides a comparison of models for predicting the time to return to play after injury. The second investigation contributes the following to the field: • It provides a model that can be used to predict the time when the first injury of the season will take place. • It provides a kernel that can be utilized by a Gaussian process in order to measure the similarity of training and match schedules, even if the time series involved are of different lengths. The third investigation contributes the following to the field: • It provides a model to predict injury on a given week based on GPS data gathered from training sessions. • It provides components, extracted through supervised principal component analysis, that correlate with injury incidence and can be used to summarize the large number of GPS variables in a parsimonious way.

This thesis explores the prevalence, nature and pathogenesis of injuries in boxing. Following an introductory chapter and literature review (Chapters 1 and 2 respectively); Chapter 3 examines injuries in the GB boxing squad from 2005 to 2009. There were a total of 66 boxers on the squad during this period 61% were injured, a total of 297 injuries were recorded. The injury rate in competition was at least 460 times higher than in training, and most injuries were new rather than recurrent (246 v 51). The incidence of concussion is comparatively low compared to other studies in amateur boxing (5 in 5 years). Hand and wrist injuries were the most frequent (23.2%). Chapter 4 describes the nature of hand and wrist injuries in more detail. ‘Boxers’ knuckle’, skiers thumb, Bennett’s fracture and carpometacarpal instability were the most frequent hand and wrist injuries and also took the longest time to recover compared to all other hand and wrist injuries that occurred. These injuries occur significantly more frequently in competition than in training (347 injuries per 1,000 hours in competition less than 0.5 per 1000 hours in training). Chapter 5 describes efforts to identify and validate a means to measure the pressure at each knuckle, given that ‘boxers’ knuckle’ was found to be such a debilitating injury. This does differentiate between the proportion of knuckle impact forces (PKIF) displayed during punching and no punching but displays very poor test-re-test reliability. This method might allow the impact of changes in the hand wraps or the gloves to be measured. Chapters 6 and 7 deal with head injury in boxing. Head guards were removed from amateur boxers in 2013. The effect of this removal on boxers’ health was investigated by reviewing the number of bouts stopped due to blows to the head both with and without head guards (Chapter 6). To improve the quality of this analysis, an examination of video from championships with and without head guards (Chapter 7) was carried out. A significant decrease in observable signs of concussion (p < 0.05) and a significant increase in cuts (p < 0.001) was observed when the head guards were removed. This work will have implications for the protection of boxers’ hands and the use of head guards in other contact sports.

Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, School of Engineering, System Design and Management Program, 2017.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 89-90).
Each year, 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare workers in U.S. (CDC, 2015). Out of the overall sharps injuries, approximately 67% are caused by needlestick devices ("CDC: Stop Sticks, Sharps Injuries," 2013). Numerous pathogens can be transmitted through needlestick injuries, but the three most common pathogens are Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus. There are processes in place to reduce needlestick injuries such as work-practice control, engineering control, personal protective clothing and equipment, employee training, etc., but they have not eliminated needlestick injuries. The purpose of this thesis is to investigate the systematic causes of needlestick injuries in Massachusetts hospitals. System thinking process is used to define the needlestick system, interaction between stakeholders and see how injuries affect the needlestick system. System Dynamics model is also used to illustrate the pathway of the root causes of needlestick injuries. By using system thinking, current literature, stakeholder interviews, and knowledge from shadowing at one of the reputable hospitals in Boston, a systematic solution is proposed. The proposed solution addresses the root causes of needlestick injuries: professional pressure, high patient load/long hours, and patient-centric safety culture. The proposed solution also includes methods to address underreporting. Professional pressure and high patient load is addressed by creating programs that focus on improving self-care and reducing level of fatigue for the healthcare workers. In order to change the patient-centric safety culture, to patients and healthcare workers focused safety culture, the current prevention methods are reiterated. Furthermore, programs to create awareness of needlestick injuries, which forces doctors and nurses to consciously think about needlestick injury safety is proposed. An example is given of sharps injury prevention in surgeon's "time-out" checklist, similar to what is used at the Boston hospital. Finally, to address underreporting, programs to provide quick and easy reporting process are proposed for the healthcare workers. An important complement to the reporting system is a safety culture, where the healthcare workers do not feel fear of reporting due to repercussion on their jobs. A holistic solution is needed for a complex problem such as needlestick injuries. Only with a systematic solution that focuses on all of the root causes of needlestick injuries can they truly be reduced to a negligible amount.
by Jolly Pradhan.
S.M. in Engineering and Management

The aim of this dissertation is to review the current literature on severe head injuries in children, with particular respect to epidemiology, clinical features and investigation, pathophysiology, management and outcome. In addition a retrospective study was carried out on severe head injuries at Red Cross War Memorial Children's Hospital. Finally, the findings of this study are discussed in the light of the experience of other neurosurgical and trauma centres. In this way similarities as well as features peculiar to our setting can be identified with the aim of improving the understanding and management of severe head injuries in children in the Western Cape.

According to the Translating Research into Injury Prevention Practice framework, prior to implement any preventive intervention, it is crucial to complete some steps: to conduct high quality and evidence based injury surveillance (step 1), to understand the injury risk factors associated with the context and target population (step 2) and to create interventions that target the risk factors found previously (step 3). In order to implement preventive interventions to reduce MSI incidence in a Brazilian Navy cadet’s cohort, the main purpose of this thesis was to complete steps 1 to 3 of the TRIPP framework. In Chapter 2 we investigated the incidence of anterior cruciate ligament reconstruction in Brazil and the differences between age and sex groups. Chapter 3 described the 12-month prevalence rate of self-reported musculoskeletal symptoms in Navy cadets comparing differences between sex and school year. In chapter 4 the intent was to provide normative data on commonly used physical performance tests that may be associated with MSIs in Navy cadets, and assess for sex and limb dominance differences. Chapter 5 investigated if 2D-video analysis is a reliable and valid method of measuring trunk and lower extremity frontal plane kinematics during athletics tasks. Chapter 6 investigated the reliability and validity of a popular wearable motion system for measurements of frontal plane knee motion in healthy adults during a single leg squat task. In chapter 7, it was conducted a prospective cohort study in order to investigate clinically-identified risk factors associated with acute and chronic musculoskeletal injury in a Brazilian Navy cadet cohort. Chapter 8 investigated the effect of Injury Prevention Program on landing biomechanics as they relate to the dominance theories of ACL injury. Finally, the last chapter of this thesis (Chapter 9) presents final considerations, including the main findings and clinical implications of the thesis as well as future research.

Thesis (M.S.)--West Virginia University, 2009.
Title from document title page. Document formatted into pages; contains vii, 107 p. : ill. (some col.). Includes abstract. Includes bibliographical references. WVU users: Also available in print for a fee.

Databases on ocean lifeguard injuries are scarce and it is likely that available injury data on lifeguards underestimates the prevalence of musculoskeletal injuries in this population. Currently, the prevalence of injuries in California ocean lifeguards is unknown. The purpose of this study was to identify and describe musculoskeletal injuries present in California ocean lifeguards. This study additionally examined the distribution of injury according to several demographic categories. Of the lifeguards who took this survey, 61% stated they have sustained a work-related injury at some point in their career, and 1410 total injuries were reported. Age, years of experience, employment status, and swimming as a method of maintaining fitness for the job were significantly associated the occurrence of injury. Over half of the injuries reported were within the following lower body segments: thigh/knee, lower leg/ankle, and foot. The knee was the most common injury location requiring surgery. Proper identification and treatment of ocean lifeguard injuries should be a priority due to the high prevalence of injury and the unknown potential effects of these injuries on the individuals. If risk factors for injuries in lifeguards can be identified early on in their career, then interventions can be implemented, which may overall reduce future injury rates within this population.

Sports law in South Africa is a field requiring exciting and intensive research. With so many sporting codes changing their status to professional sport, intensive research on the legal implications pertaining to each professional sporting code has also become necessary. Professional rugby in South Africa has grown into a multimillion rand industry. It is an industry whose role players need specialized legal advice on a multitude of issues. This dissertation addresses the legal issues arising out of the situation where a professional player is injured, during practice or a game, due to the intentional or negligent action of another. The medico-legal aspects of rugby, relating to causation and proof of injuries are an indispensable element of proving liability where rugby injuries are concerned. These aspects are crucial in assessing the criminal and delictual liability of players, coaches, referees, team physicians and even the union concerned. The problem of rugby violence, causing injury, is addressed by both the criminal law and the law of delict with the issue of consent being central to this discussion. Furthermore, the labour law implications can be far-reaching for both the player and the employer union due to the unique features of sport as an industry. All role players in professional rugby will have to cooperate with the legal community to ensure that a practical body of law is established in order to make rugby a safer sport for all concerned and to protect the professional player from unnecessary, incapacitating injury.

The purpose of this thesis was to study the injury characteristics in elite football, and risk factors for injury with special emphasis on anterior cruciate ligament injury. All five papers followed a prospective design using a standardised methodology. Individual training and match exposure was recorded for all players participating as well as all injuries resulting in time loss. Severe injury was defined as absence from play longer than 4 weeks. In Paper I, all 14 teams in the Swedish men’s elite league were studied during the 2001 season. In this paper, all tissue damage regardless of subsequent time loss was also recorded. There were no differences in injury incidence between the two injury definitions during match play (27.2 vs. 25.9 injuries per 1000 hours, p=0.66) or training (5.7 vs. 5.2 injuries per 1000 hours, p=0.65). Significantly higher injury incidences for training injury, overuse injury and re-injury were found during the pre-season compared to the competitive season. Thigh strain was the single most common injury (14%). In Paper II, 8% of all players in the Swedish men’s elite league 2001 had a history of previous ACL injury at the start of the study period. These players had a higher incidence of new knee injury during the season than players without previous ACL injury (4.2 vs. 1.0 injuries per 1000 hours, p=0.02). The higher incidence of new knee injury was seen both when using the player (relative risk 3.4, 95% CI 1.8-6.3) and the knee (relative risk 4.5, 95% CI 2.3-8.8) as the unit of analysis. In Paper III, eleven clubs in the men’s elite leagues of five European countries were studied during the 2001-2002 season. The incidence of match injury was higher for the English and Dutch teams compared to the Mediterranean teams (41.8 vs. 24.0 injuries per 1000 hours, p=0.008) as well as the incidence of severe injury (2.0 vs. 1.1 injuries per 1000 hours, p=0.04). Players having international duty had a higher match exposure (42 vs. 28 matches, p<0.001), but a tendency to a lower training injury incidence (4.1 vs. 6.2 injuries per 1000 hours, p=0.051). Thigh strain was the most common injury (16%) with posterior strains being more frequent than anterior ones (67 vs. 36, p<0.0001). In Paper IV, the national teams of all 32 countries that qualified for the men’s European Championship 2004, the women’s European Championship 2005 and the men’s Under-19 European Championship 2005 were studied during the tournaments. There were no differences in match and training injury incidences between the championships. Teams eliminated after the group stage in the women’s championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 hours, p=0.02). Non-contact mechanisms were ascribed for 41% of the match injuries and these injuries were more common in the second half. In Paper V, all 12 clubs in the Swedish women’s elite league and 11 of 14 clubs in the men’s elite league were studied during the 2005 season. The prevalence of a history of previous ACL injury at the start of the study was three times higher among the female players (15% vs. 5%, p=0.0002). During the season, 16 new ACL injuries were recorded. There was a tendency to a lower mean age at injury among the women (20 vs. 24 years, p=0.069). Adjusted for age, no gender-related difference in the incidence of ACL injury was seen (relative risk 0.99, 95% CI 0.37-2.6). Age was associated with ACL injury incidence in women where the risk decreased by 24% for each year increase in age (relative risk 0.76, 95% CI 0.59-0.96).

The aims of this thesis were to study the incidence, severity and pattern of injury in male and female elite football players; to study time trends in injury risk; to identify risk factors for injury; and to test the effectiveness of an intervention programme aimed at preventing re-injury. All studies followed a prospective design using standardised definitions and data collection forms. Individual training and match exposure was registered for all players participating. Time loss injuries were documented by each team’s medical staff. The amount of training increased by 68% between the 1982 and 2001 Swedish top male division seasons, reflecting the shift from semi-professionalism to full professionalism. No difference in injury incidence or injury severity was found between seasons. The injury incidence was 4.6 vs. 5.2/1000 training hours and 20.6 vs. 25.9/1000 match hours. The incidence of severe injury (absence >4 weeks) was 0.8/1000 hours in both seasons. The Swedish and Danish top male divisions were followed during the spring season of 2001. A higher risk for training injury (11.8 vs. 6.0/1000 hours, p<0.01) and severe injury (1.8 vs. 0.7/1000 hours, p=0.002) was observed among the Danish players. Re-injury accounted for 30% and 24% of injuries in Denmark and Sweden respectively. The Swedish top male division was studied over two consecutive seasons, 2001 and 2002, and comparison of training and match injury incidences between seasons showed similar results. Players who were injured in the 2001 season were at greater risk for injury in the following season compared to non-injured players (relative risk 2.7; 95% CI 1.7-4.3). Players with a previous hamstring injury, groin injury and knee joint trauma were two to three times more likely to suffer an identical injury to the same limb in the following season, but no such relationship was found for ankle sprain. Age was not associated with an increased injury risk. The effectiveness of a coach-controlled rehabilitation programme on the rate of re-injury was studied in a randomised controlled trial at amateur male level. In the control group, 23 of 79 injured players suffered a recurrence during the season compared to 10 of 90 players in the intervention group. There was a 75% lower re-injury risk in the intervention group for lower limb injuries (relative risk 0.25; 95% CI 0.11-0.57). The preventive effect was greatest during the first weeks after return to play. Both the male and female Swedish top divisions were followed during the 2005 season. Male elite players had a higher risk for training injury (4.7 vs. 3.8/1000 hours, p<0.05) and match injury (28.1 vs. 16.1/1000 hours, p<0.001) than women. However, no difference was observed in the rate of severe injury (0.7/1000 hours in both groups). The thigh was the most common site of injury in both men and women, while injury to the hip/groin was more frequent in men and to the knee in women. Knee sprain accounted for 31% and 37% of the time lost from training and match play in men and women respectively.
Serienumret i serien Linköping University medical dissertation är fel. Det korrkta numret är 988. The serial number in the series Linköping University medical dissertation is incorrect. The correct number is 988.

In the Republic of South Africa, an autopsy is required in all cases of unnatural death, or in cases where the cause of death is unknown in terms of the Inquest Act of 1959. These are performed at the Salt River Medicolegal Laboratory by Forensic Pathologists and Registrars of the Department of Forensic Medicine and Toxicology of the University of Cape Town. The Salt River Medicolegal Laboratory serves the greater Cape Town area with a population of approximately 2,5 million, including the magisterial districts of Cape Town, Wynberg, Mitchell's Plain and Simonstown. Cape Town has one of the world's highest homicide rates and in 1986 the incidence was 56, 91 100000 population per annum. In contrast, Singapore has a homicide rate of only 2, 5/100 000, while the United States has an overall homicide rate of 7,7/ 100 000 population. In order to document the true impact of penetrating chest injuries, and to place mortality data in perspective, a retrospective descriptive study of all cases with fatal penetrating chest injuries admitted to the Salt River Medicolegal Laboratory in Cape Town during 1990 was undertaken. In 1990, a total of 5 758 cases was admitted to the Salt River Medicolegal Laboratory of which 1834 cases (39%) were the result of homicide. Of the homicide cases, 408 (22%) were the result of firearm injuries. A total of 2044 (35, 5%) cases admitted was deemed to have died of natural causes. This study identified a total of 841 cases of fatal penetrating injuries of the chest admitted during 1990, which constituted 22,6% of all non-natural cases admitted.

Schoolboy rugby injuries are a cause for concern in medical and non-medical circles, but few scientific investigations into their nature and frequency have been undertaken. The majority of reported rugby injury surveys are retrospective, have considered only specific injuries, or have reported only those seen at one location. Also, most studies have not distinguished minor injuries from major injuries. A pilot study conducted at one school in Cape Town during the 1982 rugby season, showed clear patterns of injury related to the age of players, their level of competition, playing position, the stage of the rugby season and the phase of play at the time of injury (Nathan et al. 198 3) . The studies as reported in this thesis were designed as a comprehensive follow-up study. The research methods and definition were similar but a much larger sample was studied and new areas not covered by the pilot study were introduced. During two 18-week seasons, in which approximately 4 700 players from 26 high schools played 6766 rugby matches, 905 players were prevented from participating in rugby for at least one week due to injury. The incidence and nature of injuries occurring to these players were followed in a prospective study and results were analysed for: (i) overall number and incidence of injured players; (ii) age-group and playing level; (iii) time of the season; (iv) phase of play; (v) playing position; (vi) type of injury; (vii) anatomical site; (viii) specific diagnoses; (ix) match vs practice injuries; (x) number of days off rugby; and (xi) medical treatment. The use of correspondence as a survey method resulted in 40 to 50% of injuries not being reported over the two-year period of the study. It appeared that the most accurate method of data collection was direct personal contact between the researcher and the injured player.

Complications after surgical repair of intrasynovial flexor tendon injuries in the hand occur despite advanced suture techniques and structured postoperative rehabilitation regimens. Early controlled tendon mobilization prevents adhesion formations and improves tendon healing as well as digit range of motion. To allow early postoperative rehabilitation, the strength of the repair must withstand forces created during the rehabilitation maneuvers. Improvements in suture biomechanics have increased repair strength, but up to 18 percent of repaired tendons still rupture. The overarching aim of this thesis was to investigate how to best treat intrasynovial flexor tendon injuries with limited risk of repair rupture, decreased adhesion formations, and to estimate the effect of individual patient and injury characteristics on functional outcome. In two observational studies, we identified risk factors for rupture of repaired intrasynovial flexor digitorum profundus (FDP) tendons, and studied effects of these risk factors on the long-term outcome. Age was associated with increased risk of repair rupture and impaired digital mobility the first year after surgical repair. Concomitant flexor digitorum superficialis (FDS) transection was associated with increased risk of repair rupture without affecting digital mobility. Concomitant nerve transection lowered the rupture risk without affecting digital mobility. To better understand forces generated in the flexor tendons during rehabilitation maneuvers, we measured in vivo forces in the index finger FDP and FDS tendons during rehabilitation exercises. Highest forces were measured during isolated FDP and FDS flexion for the FDP and FDS respectively. For the FDS tendon, higher forces were observed with the wrist at 30° flexion compared to neutral position, and for the FDP tendon, forces were higher during active finger flexion compared to place and hold. PXL01 is a lactoferrin peptide with anti-adhesive effects previously demonstrated in animal studies and a clinical trial to improve digital mobility when administrated around repaired tendons. We studied the mechanism of action of its corresponding rabbit peptide, rabPXL01 in sodium hyaluronate (HA) in a rabbit model of flexor tendon transection and repair and used RT-qPCR to assess mRNA levels for different genes. Increased levels of PRG4 (encoding lubricin) were observed in rabPXL01 in HA treated tendons. The expression of Interleukin 1β, 6, and 8 was repressed in tendon sheaths. RabPXL01 in HA might stimulate the release of lubricin and diminish inflammation, which correspondingly reduces tendon-gliding resistance and adhesion formations during postoperative rehabilitation exercises. The results of this thesis suggest individually adapted treatment plans, depending on repair strength, patient and injury characteristics, as a possible way to improve outcome after flexor tendon repair.

The purpose of this thesis is to trace and explain the history and development of the Criminal Injuries Compensation Scheme from its creation in 1964 as a purely administrative arrangement up until, and including, its transition into a statutory creature under the Criminal Justice Act 1988. It is argued that the Scheme is best understood as performing a symbolic function; its purpose is to make a social statement about the victim of violent crime. This thesis is borne out by an examination of the creation and evolution of the Scheme. All aspects of the Scheme are discussed in detail: the procedures through which an award of compensation is made; the way in which the amount of an award is calculated; the scope of the Scheme; and the methods used to ensure that only those who deserve compensation receive awards. As regards each of these major elements of compensation, an account is provided of 1) the process through which the original format of the Scheme came into being, 2) the problems which particular formulations of the rules have caused, 3) the way in which the provisions of the Scheme have evolved to meet these difficulties and 4) the drafting of the new statutory rules. The research was carried out primarily by extensive analysis of official publications and discourse: Parliamentary debates; Command Papers and other such publications; the annual Reports of the Criminal Injuries Compensation Board; and legal cases.

 

Aim

The purpose of this project has been to research injuries among elite sailors in single handed dinghies in Sweden. The intention was to find the most common injuries in relation to age groups, compare male and females and look into how common preventative training is.

 

Method

The chosen methods for this project were quantitative and qualitative. Questionnaires were sent out by email to 120 sailors where 42 chose to participate. Swedish elite sailors in single handed dinghies were targeted in age 13 to >28. Two interviews were performed with one experienced coach and physiotherapist. Two question templates were prepared to capture their expertise in the area following a main theme. Interviews were completed over internet (Skype).

 

Results

The researched showed that 76% have had one or more sailing related injuries in their sailing career. The most common injury is knee injury, followed by back injury which together calculated for over 50% of all injuries. The main type of injury for sailors is overuse injury that develop over time. There was a significant difference between male and female in injury frequency where males tend to injure themselves more often. 30% of males have injured themselves eight times or more. Both male and female showed knees as the most common injury. The majority of sailors, 75% of males and 78% of females, do regularly or sometimes perform specific training. Research showed that 80% of sailors warm up before sailing, either regularly or sometimes. The most strenuous manoeuvre identified was 'knees while hiking'.

 

Conclusions

The majority of sailors, 76%, have had injuries in their sailing careers. Knees and back were the most pronounced injuries and can be categorised as overuse injuries that develop over time. There are indications of injuries starting in an early age and lack of training knowledge might be a factor. Females have greater discrepancy of injuries however males tend to injure themselves more often, although more males than females perform specific training to prevent or rehabilitate an injury. The majority of sailors, 80% of males and 60% of females believed their injuries could have been prevented by more knowledge and proper training.

Residual dysfunction after a fracture of the distal radius is most often mild but may give rise to significant impairment especially in the younger active population. The symptoms often manifest around the distal ulna when loading the hand or rotating the forearm. In this region are found articular and soft tissue connections running from the distal ulna to the distal radius as well as to the ulnar side of the carpus. The aims of this thesis were to investigate the effects of distal radius fractures on the structures about the distal ulna and to what extent malunion and ulnar soft tissue lesions affect function. Both patients and cadaver specimens were used in the five different studies. In a retrospective study of 17 malunited distal radius fractures supination impairment improved significantly by correction of the skeletal malunion. This highlights the importance of distal radioulnar joint congruity for forearm rotation in a subset of cases. The pathomechanisms of injury to the triangular fibrocartilage complex (TFCC) were studied. In a cadaveric distal radius fracture model different restraining properties and injury patterns were investigated. Similar patterns of injury were then observed in 20 patients with a displaced distal radius fracture. It was found that a TFCC injury can be expected with dorsal displacement of the distal radius fragment of 32o or more from the anatomically correct position. The distribution of a TFCC injury apparently differs depending on the size of an associated ulnar styloid fracture. In cases of an intact ulnar styloid or a concomitant tip fracture (Type 1) the first stage of injury seems to be extensor carpi ulnaris subsheath separation from the distal ulna and the dorsal radioulnar ligament. Thereafter follows a disruption of the deep insertions into the fovea of the ulna starting from the palmar and extending dorsally and radially. An extensive injury can be detected with a novel non-invasive test called the ‘bald ulnar head test’, which is performed under anaesthesia. Diagnosis of an acute TFCC injury is difficult using non-invasive methods. In a prospective study of 48 patients, CT scanning to detect pathologic subluxation was found to be of little use in both acute and chronic cases, and is therefore not endorsed on this indication. A radioulnar stress test, which in previous studies has correlated well to a deep TFCC injury, was found to be highly reliable but not to correspond with significant disability in self-administered questionnaires of functional outcome two years or more after injury. This indicates that the subset of patients possibly benefiting from acute repair must be identified by other means.

The objective of this thesis was to investigate housing and management risk factors associated with the prevalence of hock injuries in freestall herds (n = 76) in two areas of intensive dairy production, Northeastern US (NE-US) and California (CA). One group of high-production multiparous cows (n = 38) was monitored for hock injuries on each farm and data on management, facility and stall design were collected. Risk factors associated with the overall proportion of cows having injuries or severe injuries at the univariable level were submitted to multivariable general linear models. In NE-US, overall hock injuries increased with the percentage of stalls with fecal contamination (OR = 1.26; CI = 1.02 to 1.54, for a 10% increase), and with the use of sawdust bedding (OR = 3.47; CI = 1.14 to 10.62), and decreased with deep bedding (OR = 0.05; CI = 0.02 to 0.14), sand bedding (OR = 0.06; CI = 0.02 to 0.15), bedding DM ≥ 83.9% (OR = 0.08; CI = 0.03 to 0.20), and access to pasture during the dry period (OR = 0.17; CI = 0.05 to 0.53). In the multivariable model, only the presence of deep bedding remained significant. Severe hock injuries increased with the use of automatic scrapers (OR = 2.29; CI = 1.11 to 4.71) and the percentage of stalls with fecal contamination (OR = 1.14; CI = 1.00 to 1.31, for a 10% increase), and decreased with sand bedding (OR = 0.22; CI = 0.10 to 0.49), deep bedding (OR = 0.24; CI = 0.11 to 0.52), bedding DM ≥ 83.9% (OR = 0.28; CI = 0.14 to 0.58), and access to pasture during the dry period (OR = 0.42; CI = 0.18 to 0.97). The multivariable model included the use of automatic scrapers and deep bedding. In CA, stall stocking density (OR = 1.41; CI = 1.00 to 2.01, for a 10% increase) and bedding concavity (OR = 1.08; CI = 1.01 to 1.16, for a 2.5-cm decrease) were associated with an increase of hock injuries. In general, deep-bedded and well-maintained stalls significantly reduced the risk of hock injuries.

Objectives. To estimate children's exposure to traffic, and to determine the role of exposure in pedestrian injuries.
Methods. A questionnaire was distributed to 4,080 children in grades 1 and 4 in a stratified, random sample of 43 schools in Montreal.
Results. The mean number of streets crossed was similar by sex and increased with age. Children who attended schools in neighbourhoods ranked as disadvantaged crossed, on average, 50% more streets than those attending non-disadvantaged schools. Similar trends emerged in other SES variables. When analyzed by police district, injury rates and exposure were positively correlated (r$ sp2$ = 0.53).
Conclusion. Differences in injury rates by sex or age are poorly explained by exposure to traffic, whereas exposure appears related to socio-economic status. The number of streets crossed is related to injury rates. These results suggest that although a reduction in children's exposure to traffic would possibly diminish the number of pedestrian injuries, a more promising strategy involves reducing the risk of traffic through environmental changes.

Muscle injuries are one of the most common sports related injuries. An audit published by The Football Association (FA) in 2004, suggested that 12% of all injuries were hamstring injuries, which are 2.5 times more common than quadriceps injuries (Woods et al., 2004). Recent figures published by Ekstrand et al suggested that, in a professional male football team of 25 players, about 5 hamstring injuries occur each season, equivalent to more than 80 lost football days (Ekstrand et al., 2011). In terms of professional elite athletes, shortened recovery time could mean continuing with training, increased game play and benefit to the team and club. Therefore, further research is needed to analyse the new techniques in treating muscle injuries. In 2008, an article in the British Journal of Sports Medicine titled "The early management of muscle strains in the elite athlete: Best practice in the world with a limited evidence", summarised that currently almost all our socalled knowledge has a basis of level 4 or level 5 (Orchard et al., 2008a). The panel of experts continued to highlight the importance of Dr. Mueller- Wohlfahrt's injection treatment regimen for treating muscle injuries. In brief, the treatment protocol involves multiple local injections and associated back injections with a mixture of a homeopathic and pharmacological cocktail (Wohlfahrt, 2008). Therefore, the biochemical property, pharmacodynamics and pharmacokinetics of each drug are altered and unpredictable. The only potential “active” substance in Dr. Mueller-Wohlfahrt’s cocktail could be a drug called “Actovegin” which is a licenced clinically used drug with a track record of over 60 years. Therefore in this PhD thesis, in order to avoid the unpredictable nature of poly-pharmacy as discussed above, only Actovegin will be investigated. In order to investigate the potential therapeutic effect or efficacy of Actovegin on muscle injury, basic muscle structures, histology and pathophysiology of the healing process were discussed. The biochemical 10 events following skeletal muscle injuries and repair are driven by cytokines, monocytes and leukocytes. The speed and quality of muscle healing are dependent on the inflammatory process. In order to alter the speed or quality of muscle repair, Actovegin must be able to modulate the inflammatory process. The in-vitro study in this PhD thesis was the first study to investigate the role of Actovegin in the inflammatory process and demonstrated significant results. It confirmed that Actovegin could modulate the inflammatory process by influencing the CD68+ and CD163+ macrophages and CD163+ THP-1 cells, which could influence the muscle healing process. Based on the findings from the in vitro studies and data from previous literature, a stand-alone single drug intramuscular Actovegin injection therapy regimen was developed to treat acute muscle injuries. The first clinical study using this stand-alone Actovegin treatment regimen was conducted in this PhD in professional footballer players and translated the in vitro findings to clinical practice, which confirmed that Actovegin could influence clinical outcome in treating acute muscle injuries. This thesis summarises the current evidence on Actovegin. Compared with conventional conservative RICE and NSAID therapy, Actovegin proposes an exciting and legal alternative for high performance athletes. From the studies, Actovegin injection therapy seems safe and well tolerated. Overall, this PhD has suggested that Actovegin has an active role in the treatment of muscle strain injuries biochemically and clinically.