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Using data from the 2022 Korea Community Health Survey (n  = 13 320), this study investigated helmet use and related factors among Korean adults using personal mobility devices, without distinguishing between private and hired users. Among mobility device users, 32.1% responded that they always wore a helmet. The proportion of helmet use was 35.2% among men, 25.8% among women, 29.2% among those aged 19–44 years, 42.3% among those aged 45–64 years and 26.6% among those aged 65 years or older. Furthermore, those who drank less frequently and were physically active were more likely to wear helmets. Moreover, people who always wore a seat belt when driving a car or sitting in the rear seat and people who always wore a helmet when riding a motorcycle were more likely to wear a helmet while using electric personal mobility devices. Approximately one-third of users always wore a helmet. The helmet-wearing rate was related to general characteristics such as gender and education level, and to safety behaviors such as wearing a seat belt when driving a car, sitting in the rear seat of a car, or when riding a motorcycle. In addition to considering personal characteristics investigated in this study, the helmet-wearing rate should be improved through policies or systems at the national or regional levels. [ABSTRACT FROM AUTHOR]

Abstract Background The rugby league tackle has been identified as the game event with the greatest propensity for a clinically diagnosed concussion. This study aims to replicate the work conducted in professional rugby league and rugby union by examining Head Injury Assessment (HIA) events to determine the associated tackle characteristics that increase concussion risk in sub-elite rugby league players. This comparison between competition levels is important due to the less developed physiological and tackle proficiency characteristics of sub-elite rugby league players and the fewer resources available for an on-field diagnosis, compared to the elite level of the sport. Results Tackles resulting in Head Injury Assessments (HIAs, n = 131) and 2,088 tackles that did not result in a head injury were identified and coded from one season of the 2019 Queensland Cup. The body position of both ball carrier and tackler, tackle height, and body contact areas were evaluated. The propensity for tacklers to undergo a head injury assessment was 1.49 HIAs per 1,000 tackles, equating to a 2.5-fold higher risk than that of the ball carrier (0.59 HIAs per 1,000 tackles). The risk for an HIA was 2.75-fold greater when the tackler was upright (2.89 HIAs per 1,000 tackles) compared to a bent-at-the-waist tackler (1.05 HIAs per 1,000 tackles). The greatest risk for the tackler and ball carrier sustaining an HIA occurred when the tackle height was high, with head-to-head contact having the greatest propensity for an HIA (44.37 HIAs per 1,000 tackles). HIA risk was also greater for both players when the ball carrier did not employ an evasion strategy (3.73 HIAs per 1,000 tackles). Conclusions The study replicates results from research in elite rugby league and rugby union. A combination of higher head contact/proximity and upright body position significantly increase an HIA risk. Tackler head position and ball carrier evasion behaviours also affect risk, suggesting that injury prevention strategies designed to reduce tackle height and improve tackle technique by focusing on head position, body position, and in a novel finding, ball carrier evasion, may reduce head injury risk in sub-elite rugby league players.

Purpose: Mandating headgear for field players in girls’ lacrosse to reduce head injuries, including concussion, has been heavily debated. However, research regarding the need and effectiveness of mandated headgear use in girls’ lacrosse is still developing. Therefore, this qualitative study aimed to identify the need for and barriers to the development of mandated headgear use policies in girls’ lacrosse in Ohio. Methods: We conducted six virtual focus groups, three with concussion experts (clinicians and researchers) and three with girls’ lacrosse stakeholders (high school players, parents, coaches, and officials). A focus group guide was developed to explore study participants’ perceptions and opinions on concussion in girls’ lacrosse, headgear use among players, and policies and policy development related to headgear use or a headgear mandate. We developed the codebook using an inductive and iterative approach based on focus group transcripts and used ATLAS.TI to code and analyze the transcript data. Results: Concussion experts and stakeholders understood the potential consequences of concussion but did not perceive concussion as a pervasive problem in girls’ lacrosse. The prevention of head and facial injuries was regarded as a potential benefit of headgear use. However, stakeholders expressed that the myriad of arguments discussed opposing mandated headgear use including increased aggressive play and/or targeting, concerns over changes in the game, and cost strongly outweighed the benefits. Finally, both concussion experts and stakeholders identified multiple organizations, including USA Lacrosse, who could act as facilitators and/or barriers to developing, enacting, and implementing headgear policies. Conclusions: Concussion experts and stakeholders identified possible reasons for headgear use related to injury prevention but also identified several important barriers to the development of a headgear mandate for girls’ lacrosse in Ohio. [ABSTRACT FROM AUTHOR]

Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available. To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs. Case series. The 2022 American football preseason. Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards. Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance. No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P =.20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P =.51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P =.72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P =.32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P =.29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P =.32) between sessions for the 7 players who completed all 6 workouts. These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players. [ABSTRACT FROM AUTHOR]

Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal–Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants. [ABSTRACT FROM AUTHOR]

Background: The rugby league tackle has been identified as the game event with the greatest propensity for a clinically diagnosed concussion. This study aims to replicate the work conducted in professional rugby league and rugby union by examining Head Injury Assessment (HIA) events to determine the associated tackle characteristics that increase concussion risk in sub-elite rugby league players. This comparison between competition levels is important due to the less developed physiological and tackle proficiency characteristics of sub-elite rugby league players and the fewer resources available for an on-field diagnosis, compared to the elite level of the sport. Results: Tackles resulting in Head Injury Assessments (HIAs, n = 131) and 2,088 tackles that did not result in a head injury were identified and coded from one season of the 2019 Queensland Cup. The body position of both ball carrier and tackler, tackle height, and body contact areas were evaluated. The propensity for tacklers to undergo a head injury assessment was 1.49 HIAs per 1,000 tackles, equating to a 2.5-fold higher risk than that of the ball carrier (0.59 HIAs per 1,000 tackles). The risk for an HIA was 2.75-fold greater when the tackler was upright (2.89 HIAs per 1,000 tackles) compared to a bent-at-the-waist tackler (1.05 HIAs per 1,000 tackles). The greatest risk for the tackler and ball carrier sustaining an HIA occurred when the tackle height was high, with head-to-head contact having the greatest propensity for an HIA (44.37 HIAs per 1,000 tackles). HIA risk was also greater for both players when the ball carrier did not employ an evasion strategy (3.73 HIAs per 1,000 tackles). Conclusions: The study replicates results from research in elite rugby league and rugby union. A combination of higher head contact/proximity and upright body position significantly increase an HIA risk. Tackler head position and ball carrier evasion behaviours also affect risk, suggesting that injury prevention strategies designed to reduce tackle height and improve tackle technique by focusing on head position, body position, and in a novel finding, ball carrier evasion, may reduce head injury risk in sub-elite rugby league players. Key Points: • An upright tackle results in the greatest risk for a Head Injury Assessment (HIA) for both the tackler and ball carrier. • The tackler is more likely to experience an HIA than the ball carrier. • When a ball carrier does not employ an evasion strategy, the risk for an HIA is greater for both the ball carrier and the tackler. [ABSTRACT FROM AUTHOR]

The objective was to examine the efficacy of the Get aHEAD Safely in Soccer™ intervention on head impact kinematics and neck strength in female youth soccer players. The control group (CG) consisted of 13 players (age: 11.0 ± 0.4 yrs), while the experimental group (EG) consisted of 14 players (age: 10.6 ± 0.5 yrs). Head impact kinematics included peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV). Pre- and post-season measures included strength measures of neck/torso flexion (NF/TF) and extension (NE/TE). Data were analysed using a multilevel linear model and ANOVA techniques. No differences in PLA, PRA, or PRV were observed between groups. The EG showed significant improvement in NF strength while the CG showed significant improvement in NE strength. Both groups significantly improved in TF pre- to post-season. The foundational strength components of the Get aHEAD Safely in Soccer program appear to show a benefit in youth soccer players beginning to learn the skill of purposeful heading. [ABSTRACT FROM AUTHOR]

Leopard attacks on human beings is common in Uttarakhand which is an area of national conservation. The objective of this study is to examine the pattern of injuries and circumstances to encourage ways of reducing such conflicts. There were eight deaths from leopard attacks brought for autopsy to the mortuary between January 2019 and August 2020. Incidents occurred mostly in a forest close to human settlements. One tourist was among the male victims, the remainder of whom were women carrying out household duties near the forest. Leopard attack injuries present in the head and neck were ante-mortem, with abdomen, buttocks and limbs post-mortem. People living at the border of protected areas need alternative means of support to enable them to avoid using forest resources, tourists must be warned to avoid wandering in the area. [ABSTRACT FROM AUTHOR]

To reduce head impact exposure (HIE) in youth football, further understanding of the context in which head impacts occur and the associated biomechanics is needed. The objective of this study was to evaluate the effect of contact characteristics on HIE during player versus player contact scenarios in youth football. Head impact data and time-synchronized video were collected from 4 youth football games over 2 seasons in which opposing teams were instrumented with the Head Impact Telemetry (HIT) System. Coded contact characteristics included the player's role in the contact, player speed and body position, contact height, type, and direction, and head contact surface. Head accelerations were compared among the contact characteristics using mixed-effects models. Among 72 instrumented athletes, 446 contact scenarios (n = 557 impacts) with visible opposing instrumented players were identified. When at least one player had a recorded impact, players who were struck tended to have higher rotational acceleration than players in striking positions. When both players had a recorded impact, lighter players and taller players experienced higher mean head accelerations compared with heavier players and shorter players. Understanding the factors influencing HIE during contact events in football may help inform methods to reduce head injury risk. [ABSTRACT FROM AUTHOR]

Head impacts during blind football are common and have high injury rates; however, their characteristics and impact are still underreported. We compared head impact characteristics in blind football players with and without falls on all 18 official blind football match videos from the Tokyo 2020 Paralympic games. The rate of head impacts with falls was significantly higher in the preliminary phase, offense phase, and during dribbling. Significant differences in the region of the head impacted were also observed among the impact subjects/objects. The findings in this study would contribute to the development of injury prevention measures to minimize head injuries from head impact in blind football. [ABSTRACT FROM AUTHOR]

Considering the frequency and magnitude of head impacts occurring during sport participation is important to guide prevention initiatives. Our purpose was to compare magnitude and frequency of lacrosse players' head impacts based on anticipation level and impact activity. Lacrosse athletes (16 men, 15 women) wore xPatch sensors during games and practices that measured impact magnitude (linear and rotational accelerations) and frequency of video verified head impacts. The interaction between impact activity and preparedness was not significant, multivariate: F(8, 1,730) = 1.03, p =.41, η2 =.01. Having a detailed understanding of the characteristics of head impacts could allow for focused interventions to reduce injury risk. [ABSTRACT FROM AUTHOR]

Focused Clinical Question: Do soft-shell helmet covers reduce head impact severity in American football helmets? Clinical Bottom Line: There is consistent SORT level C evidence to support that soft-shell helmet covers reduce measures of head impact severity and measures of linear and rotational acceleration. The impact reductions occurred at magnitudes less than the average reported concussive impact, which limits the application of the evidence with respect to concussion incidence or risk among American football players. [ABSTRACT FROM AUTHOR]

Given the scientific and public concern regarding the short-, medium- and long-term consequences of heading on brain health, being proactive about developing and implementing guidelines that help reduce the burden (volume, impact magnitude and injury risk) of heading in young and beginner players appears justified. This narrative review explores the evidence underpinning strategies that could be incorporated into future heading guidelines to reduce heading burden in players across all levels of football. A four-step search strategy was utilised to identify all data-based papers related to heading in football. Eligibility criteria for inclusion were: (1) original data, (2) study population included football players, (3) outcome measures included one or more of the following: number of headers, measurement of head acceleration during heading, or head/brain injury incidence, and (4) published in English or English translation available. In total, 58 papers were included that outlined strategies based on (1) game or team development, (2) player skill development and (3) equipment. In particular, greater emphasis existed for small-sided games (particularly in young players) where fewer headers are observed when compared with the conventional 11 versus 11 game, as well as reducing headers from goal kicks and corners. Evidence also existed for developing a heading coaching framework that focusses on technical proficiency as well as neuromuscular neck exercises integrated into general injury reduction exercise programs, enforcement of rules related to deliberate head contact and using lower-pressure match and training balls. To mitigate potential risks of heading on brain health, a number of pragmatic strategies have been examined in scientific studies and may be considered as part of future heading guidelines. [ABSTRACT FROM AUTHOR]

Context: Review articles published in 2010 concluded that there was strong evidence to support the use of helmets as a way to decrease the risk of sustaining a head injury during snow sport participation. However, new research published over the last decade on this relationship warrants revisiting this primary injury prevention approach. Clinical Question: What is the effect of helmet use on the occurrence of head injuries in snow sports? Clinical Bottom Line: The results from the included studies did not consistently find a reduction in head injury occurrence with helmet use in snow sports. Rather, the collective findings were more supportive of a neutral relationship between helmet use and head injuries. Therefore, these heterogeneous findings indicate there is SORT Level B evidence to support the use of helmets as a primary head injury prevention approach in snow sports. Future initiatives should acknowledge the multifaceted nature of injury occurrence and seek to educate the public more clearly on the limitations of helmet use during skiing and snowboarding. [ABSTRACT FROM AUTHOR]

An editorial is presented on FIFA World Cup is a prestigious, international, and well-televised experience for the people of the world irrespective of age, gender, and race. Topics include prehospital medical concerns were raised during games for players with head and neck injuries; and increase awareness of potential head and spinal injuries.

The purpose of this research was to compare the frequency and magnitude of head impact events between Pee Wee and Bantam ice hockey players. Videos of Pee Wee and Bantam boys' ice hockey were analysed to determine the frequency and type of head impact events. The head impact events were then reconstructed in the laboratory using physical and finite element models to determine the magnitude of strain in the brain tissues. The results showed that Pee Wee boys experienced more head impacts from elbows and boards, while Bantam players had more head impacts to the glass. Pee Wee and Bantam players experienced similar frequency and magnitudes of very low, low, and medium and above (med+) levels of strain to the brain. This research suggests to ice hockey leagues and coaches that to reduce the incidence of these levels of brain trauma, consideration must be given to either reducing the level of contact along the boards or the removal of body checking. In addition, companies who innovate in ice hockey should develop protective devices and equipment strategies that aim to reduce the risk of head injury from shoulder and glass impacts for Bantam players. [ABSTRACT FROM AUTHOR]

Objective: Pediatric head trauma is one of the leading causes of childhood death. However, it is possible to reduce deaths with measures to be taken. Since it is important to educate the person(s) responsible for the care of the child and for whom the education should be applied first, we aimed to conduct a study to shed light on this situation. Methods: 14,243 patients aged 0-6 years admitted to the emergency department with head trauma were included in the study. Apart from the routine parameters, who was responsible for the care of the patient during the trauma was questioned. It was investigated whether there was a correlation between the person(s) who took care of the patient and the severity of the trauma. Results: It was determined that patients in all age groups were predominantly under maternal supervision. For the remaining patients, older siblings and fathers in younger age groups; in older age groups, grandmother, grandmother and grandfather played the role of caregiver. Non-family persons, who constitute a very small group in caregiving, show an equal distribution for age groups. The incidence of moderate head trauma was found to be higher in patients who were cared for by third parties, compared to other caregiver groups (p<0.05). No relationship was found between the mild and severe head trauma and caregiver groups. Conclusion: Mortality and morbidity rates due to pediatric head trauma are high. It is possible to prevent traumas with the education of caregivers. Clinical experiences can provide guidance on what kind of training programs will be prepared and which groups of caregivers will receive these training primarily. [ABSTRACT FROM AUTHOR]

• The stringency of motorcycle helmet safety legislation varies widely across the US. • States with more stringent laws had significantly lower unhelmeted fatalities per 100,000 people and 100,000 motorcycles. • Exemptions to helmet wearing for certain riders and motorcycle-like vehicles significantly predicted higher fatalities. Motorcycle collisions comprise a large portion of motor vehicle injuries and fatalities with over 80,000 injuries and 5,500 fatalities per year in the United States. Unhelmeted riders have poor medical outcomes and generate billions in costs. Despite helmet use having been shown to lower the risk of neurological injury and death, helmet compliance is not universal, and legislation concerning helmet use also varies widely across the United States. In this study, we systematically reviewed helmet-related statutes from all US jurisdictions. We evaluated the stringency of these statutes using a legislative scoring system termed the Helmet Safety Score (HSS) ranging from 0–7 points, with higher scores denoting more stringent statutes. Regression modeling was used to predict unhelmeted mortality using our safety scores. The mean score across all jurisdictions was 4.73. We found jurisdictions with higher HSS's generally had lower percentages of unhelmeted fatalities in terms of total fatalities as well as per 100,000 people and 100,000 registered motorcycles. In contrast, some lower-scoring jurisdictions had over 100 times more unhelmeted fatalities than higher-scoring jurisdictions. Our HSS significantly predicted unhelmeted motorcycle fatalities per 100,000 people (β = -0.228 per 1-point increase, 95% CI: -0.288 to -0.169, p <.0001) and per 100,000 registered motorcycles (β = -6.17 per 1-point increase, 95% CI: -8.37 to -3.98, p <.0001) in each state. Aspects of our score concerning helmet exemptions for riders and motorcycle-type vehicles independently predicted higher fatalities (p <.0001). Higher safety scores predicted lower unhelmeted fatalities. Stringent helmet laws may be an effective mechanism for decreasing unhelmeted mortality. Therefore, universal helmet laws may be one such mechanism to decrease motorcycle-related neurological injury and fatality burden. In states with existing helmet laws, elimination of exemptions for certain riders and motorcycle-type vehicles may also decrease fatalities. [ABSTRACT FROM AUTHOR]

The majority of head injuries sustained during softball play are due to defensive fielders being struck by a ball. The main objective of this study was to test the impact attenuation and facial protection capabilities of fielder's masks from softball impacts. Testing with an instrumented Hybrid III headform was conducted at 2 speeds and 4 impact locations for several protective conditions: 6 fielder's masks, 1 catcher's mask, and unprotected (no mask). The results showed that most fielder's masks reduced head accelerations, but not to the standard of catcher's masks. On average, they reduced peak linear and angular acceleration from 40 mph impacts by 36% to 49% and 14% to 45%, respectively, whereas for 60 mph impacts, they were reduced by 25% to 42% and 13% to 46%, respectively. Plastic-type fielder's masks were observed to allow facial contact when struck at the nose region at high speed. A few fielder's masks performed appreciably different at certain impact locations suggesting influence from specific design features such as foam padding and frame properties. Overall, the results suggest that head/facial injuries may be mitigated through the broader use of masks, while further optimization of impact attenuation for fielder's masks is pursued. [ABSTRACT FROM AUTHOR]

Context: During thoroughbred races, jockeys are placed in potentially injurious situations, often with inadequate safety equipment. Jockeys frequently sustain head injuries; therefore, it is important that they wear appropriately certified helmets. Objective: The goals of this study are (1) to perform impact attenuation testing according to ASTM F1163-15 on a sample of equestrian helmets commonly used by jockeys in the United States and (2) to quantify headform acceleration and residual crush after repeat impacts at the same location. ParticipantsandDesign: Seven helmet models underwent impact attenuation testing according to ASTM F1163-15. A second sample of each helmet model underwent repeat impacts at the crown location for a total of 4 impacts. Setting: Laboratory. Intervention: Each helmet was impacted against a flat and equestrian hazard anvil. MainOutcome Measures: Headform acceleration was recorded during all impact and computed tomography scans were performed preimpact and after impacts 1 and 4 on the crown to quantify liner thickness. Results: Four helmets had 1 impact that exceeded the limit of 300g. During the repeated crown impacts, acceleration remained below 300g for the first and second impacts for all helmets, while only one helmet remained below 300g for all impacts. Foam liner thickness was reduced between 5% and 39% after the first crown impact and between 33% and 70% after the fourth crown impact. Conclusions: All riders should wear a certified helmet and replace it after sustaining a head impact. Following an impact, expanded polystyrene liners compress, and their ability to attenuate head acceleration during subsequent impacts to the same location is reduced. Replacing an impacted helmet may reduce a rider's head injury risk. [ABSTRACT FROM AUTHOR]

Head injury is the most common cause of death and disability in people aged one to 40 in the UK, and accounts for around 1.4 million attendances at emergency departments (EDs) in England and Wales each year. [ABSTRACT FROM AUTHOR]

Quantifying head impacts is a vital component to understanding and preventing head trauma in sport. Our objective was to establish the frequency and magnitude of head impact mechanisms in men's lacrosse athletes. Eleven male lacrosse athletes wore xPatch sensors during activity. Video footage of practices and games was analyzed to verify impacts and code them with impact mechanisms. The authors calculated incidence rates (IRs) per 1000 exposures with corresponding 95% confidence intervals (CIs) and used multivariate analysis of variances to compare the linear (g) and rotational (rad/s2) accelerations between mechanisms. A total of 167 head impacts were successfully verified and coded with a mechanism using video footage during 542 total exposures. The highest IR was head to body (IR = 118.08; 95% CI, 89.15–147.01), and the lowest was head to ball (IR = 3.69; 95% CI, 0–8.80) (incidence rate ratio = 32.00; 95% CI, 67.83–130.73). Analysis indicated that impact mechanism failed to significantly alter the combined dependent variables (multivariate F10,306 = 1.79, P =.06, η2 =.06, 1−β = 0.83). While head to head, body to head, and stick to head mechanisms are penalty-inducing offenses in men's lacrosse, head to ground, head to ball, and combination impacts have similar head accelerations. If penalties and rules are created to protect players from traumatic head injury, the authors recommend stricter enforcement. [ABSTRACT FROM AUTHOR]

This study aimed to compare head impact exposures between practices and games in football players ages 9 to 14 years, who account for approximately 70% of all football players in the United States. Over a period of 2 seasons, 136 players were enrolled from 3 youth programs, and 49,847 head impacts were recorded from 345 practices and 137 games. During the study, individual players sustained a median of 211 impacts per season, with a maximum of 1226 impacts. Players sustained 50th (95th) percentile peak linear acceleration of 18.3 (46.9) g, peak rotational acceleration of 1305.4 (3316.6) rad·s−2, and Head Impact Technology Severity Profile of 13.7 (24.3), respectively. Overall, players with a higher frequency of head impacts at practices recorded a higher frequency of head impacts at games (P <.001, r2 =.52), and players who sustained a greater average magnitude of head impacts during practice also recorded a greater average magnitude of head impacts during games (P <.001). The youth football head impact data quantified in this study provide valuable insight into the player exposure profile, which should serve as a key baseline in efforts to reduce injury. [ABSTRACT FROM AUTHOR]

Background: Injuries are the number one cause of death in children and cause significant morbidity. Common scenarios for injury include wheeled recreational devices (WRDs) that allow children to be mobile and independent (example ATV-all terrain vehicles, dirt bikes, bicycles, skateboards, and scooters). We present a case series review of these external causes of injury. This study aims to evaluate epidemiologic trends in WRD injuries and patterns in usage of protective gear. Results: A total of 263 patients were identified as meeting criteria for inclusion with the following causes of injuries-103 bicycle, 73 ATV, 27 dirt bike, 14 skateboard, 13 motorcycle, 7 go carts, 3 hover board, 3 roller skates, 1 dune buggy, 1 motor scooter, 1 rip stick, and 1 tractor toy. Ages of patients ranged from 2 to 18 years of age with the greatest range being noted for bicycles (2–17 years) and motorcycles (3–18 years). The mean age was higher for motorcycle and skateboard (12.9 and 11.6, respectively) and lowest for scooter and bicycle (8.3 and 9.2, respectively). The majority of [overall study (97%) and for each mode of transportation] patients were Caucasian, which is in contrast to our overall ED population, which is only 42% Caucasian. The majority of patients were male [190 (72%)]. Over half of the overall patients, 159 of the 263 (60%), were not wearing a helmet (with only 10 charts having no documentation of helmet use). In regard to ATV riders specifically, 58% were not wearing helmets at the time of injury, with an additional 5 patients who reported their helmet came off. The lowest percentage of riders reporting appropriate helmet use was skateboarders with only 21% wearing helmets, and the highest percentage was dirt bike riders with 74% reporting helmet use. Conclusion: Common scenarios for injury include WRDs that allow children to be mobile and independent. Most of these injuries were found in Caucasian males between the ages of 9–12 with low rates of helmet use. This study adds to the literature with a description of the breadth of products children use and are injured while using. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK.Methods: A retrospective analysis of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. Our institution's electronic patient record system was used to collect relevant data for analysis including age, gender, mechanism of injury, Glasgow coma scale (GCS) on arrival, incident date and time, injured body regions, 30-day mortality, helmet use and intubation rate. Comparison was made between groups of patients based on mechanism of injury.Results: A total of 605 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The most common mechanism was 'fall from cycle' (53.5%). The 'cyclist v vehicle' group was associated with a significantly higher Injury Severity score (ISS), lower GCS and higher intubation rate. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and intubation rate and a higher GCS.Discussion: With a likely increase in future cycling uptake, it is crucial that effective interventions are implemented to improve the safety of cyclists. The findings of this study may be used to guide any such intervention. A multi-faceted strategy involving driver and cyclist education, effective road infrastructure changes and helmet promotion campaigns specifically targeting the younger generation could be employed. [ABSTRACT FROM AUTHOR]

Background: In Benin, some riders of two-wheeled vehicles still do not wear helmets, the main protection against head injuries in road accidents. The objective of this study is to describe the characteristics of two-wheeled users, and to determine the factors influencing helmet use among this group. Methods: This is a prospective cross-sectional study of 977 two-wheeled road accident victims from a cohort. Proportions or means were calculated for the different variables. Statistical comparisons were made to test the association with helmet use. Logistic regression modelling was performed to identify factors associated with helmet use. Results: Among all subjects, 81.1% [CI95% (78.5; 83.4)] wore a helmet. Factors explaining helmet use were female gender (OR = 2.8 [1.3–6.1]), purpose of trip (OR = 1.7 [1.1–2.6]), possession of health insurance (OR = 3.7 [1.3–10, 5]), having been driving for 15–20 years (OR = 2.6 [1.4–4.7]) or more than 20 years (OR = 3.4 [2.0–5.8]), good road conditions (OR = 3.1 [2.0–4.8]), and good visibility (OR = 1.9 [1.3–3.1]). Conclusion: The factors influencing helmet use are gender, reason for travel, length of time as a driver, possession of health insurance, conditions, and visibility of the road on which the subject are driving. These factors are related to experience and appropriation of the notion of risk, but also related to the environment. To increase helmet use among two-wheelers, helmet awareness should take into account the individual factors found in this study. Enforcement actions should be strengthened, and the quality of the roads improved. [ABSTRACT FROM AUTHOR]

Introduction: Injury caused by large animals varies according to the regional distribution of the animals and their relationship to humans. Camels are usually friendly to humans; however, occasionally they become very hostile, especially in rutting season. Most in-hospital trauma deaths are related to head injury. Very few studies in the literature have discussed camel-related head injuries. We aimed to study the incidence, mechanism of injury, types, and outcome of camel-related head injury in a high-income developing country to give recommendations on preventive measures. Methods: We retrospectively collected data from all patients who were admitted to Al Ain Hospital with a camel-related head injury from January 1, 2015, to January 1, 2021. Data collected included demography, mechanism of injury, anatomical location, severity of the injury, associated injuries, and management. The patients were followed up during their hospital stay to record the length of hospital stay, complications, and outcome. Results: During the study period, 98 patients were admitted to Al Ain Hospital with camel-related injury. Thirty-nine (39.8%) of the admitted patients with a camel-related injury sustained a head injury; a camel-related head injury was more common during August (23.1%). Thirty-four (87.2%) patients were camel caregivers. Thirty-three patients (84.6%) were injured on farms. Seven patients suffered an intracranial hemorrhage, and six (85.7%) of them had a history of fall from a camel. Glasgow Coma Score was significantly correlated to the severity of head injury measured by Abbreviated Injury Severity of the head (P = 0.006, Spearman's correlation). One patient died during the study period after having decompressive craniectomy for subdural hemorrhage (overall mortality 2.6%). Conclusions: The majority of camel-related head injury occurred in camel caregivers at camel farms and can be considered a work-related injury. Careful handling of camels, especially during the summertime can reduce the toll of camel-related head injury and its serious consequences. None of the injured patients was wearing a helmet at the time of injury. Legislation for compulsory helmet usage by camel caregivers at farms may decrease the incidence of head injuries in those patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate how four types of successfully executed, legal front-on, one-on-one torso tackles influence the tacklers' and ball carriers' inertial head kinematics. Methods: A total of 455 successful front-on, one-on-one torso tackle trials completed by 15 rugby code players using three-dimensional motion capture were recorded. Tackles differed with respects to the height of the contact point on the ball carrier's torso. A series of mixed general linear models were conducted. Results: The tackler sustained the highest peak resultant linear (P < 0.001) and angular (P < 0.01) head accelerations when contacting the lower torso to execute a "dominant" tackle compared with mid or upper torso, although these latter tackle types had the lowest ball carrier inertial head kinematics. When executing a "smother" tackle technique, a significant decrease in peak resultant linear head acceleration was observed with a vertical "pop" then lock action used, compared with the traditional upper torso tackling technique (P < 0.001). Conclusions: Modifying the tackler's engagement with a ball carrier's torso, with respect to height and technical execution, alters the inertial head kinematics of the tackler and the ball carrier. The traditional thinking about optimal tackle technique, as instructed, may need to be reevaluated, with the midtorso being a potential alternative target contact height, whereas changes in tackle execution may be relatively protective for tacklers when executing either a dominant or smother tackle. This study provides critical scientific evidence to underpin revised coaching tackling technique interventions that might enhance player safety. Tackles in which the tackler contacts the ball carrier around the midtorso region, rather than lower torso, produce the lowest acceleration and thus may contribute to reducing head injury risk for the tackler. [ABSTRACT FROM AUTHOR]

Bicycling, snow sports, and other recreational activities and sports are important activities to keep children and youth active as part of a healthy lifestyle. These activities can be associated with serious and fatal head and facial injuries. Helmets, when worn correctly, are effective in decreasing head injuries and fatalities related to these activities. Legislation for helmet use is effective in increasing helmet use in children and, ultimately, in decreasing deaths and head and facial injuries. A multipronged strategy employing legislation, enforcement of laws, and medical clinicians and community programs is important for increasing helmet use to decrease deaths and injuries from recreational sports. [ABSTRACT FROM AUTHOR]

Introduction: Exercise can decrease fall risk in older adults but less is known about training to reduce injury risk in the event a fall is unavoidable. The purpose of this study was to compare standard fall prevention exercises to novel Fall Arrest Strategy Training (FAST); exercises designed to improve upper body capacity to reduce fall-injury risk in older women. Method: Forty women (mean age 74.5 years) participated in either Standard (n = 19) or FAST (n = 21) twice per week for 12 weeks. Both interventions included lower body strength, balance, walking practice, agility and education. FAST added exercises designed to enhance forward landing and descent control such as upper body strengthening, speed and practice of landing and descent on outstretched hands. Results: Both FAST and Standard significantly improved strength, mobility, balance, and fall risk factors from pre to post-intervention. There was a significant time by group interaction effect for upper body response time where FAST improved but Standard did not (p = 0.038). Discussion: FAST resulted in similar gains in factors that reduce fall risk as a standard fall prevention program; with the additional benefit of improving speed of arm protective responses; a factor that may help enhance landing position and reduce injury risks such as head impact during a forward fall. [ABSTRACT FROM AUTHOR]

Background: Skateboarding is a popular sport and U.S. trauma centers care for a significant number of skateboard-related injuries (SRIs). However, injury prevention strategies are still underdeveloped. This study was designed to compare the epidemiology, type, and location of skateboard injury as well as the use and influence of protective gear over two time periods.Methods: This is a retrospective National Trauma Data Bank study including all patients with SRIs between 2007and 2016. Study groups were divided into two 5-year periods: 2007-2011 and 2012-2016. The incidence and severity of traumatic brain injury (TBI), as well as the compliance and effectiveness of protective gear and skate parks, was assessed in various age groups in the two study periods using univariable and multivariable analyses. Univariable analysis was used to compare the two study periods, logistic regression analysis was performed to identify independent predictors of head injury and severe TBI.Results: 24,903 patients presented with SRIs: 10,594 from 2007 to 2011 and 14,309 from 2012 to 2016. Helmet use was low in both periods (5.7% and 5.4% respectively). The incidence of severe TBI (head AIS≥3) did not change significantly during the two periods (31.6% vs. 30.8%, p = 0.162). In children with severe TBI, there was no significant difference in helmet use across all ages, (10.4% vs. 11.5%, p = 0.467; 6.4% vs. 6.5%, p = 0.753; 4.2% vs. 3.7%, p = 0.201, respectively) with the lowest usage in the older than 16 years age group. On logistic regression, male gender (OR 1.526, 95% CI 1.372-1.698, p<0.001) was associated with increased odds of severe TBI, while helmet use (OR 0.534, 95% CI 0.455-0.627, p<0.001) and injuries at skate parks (OR 0.584, 95% CI 0.541-0.630, p<0.001), near home (OR 0.465, 95% CI 0.418-0.518, p<0.001), and public buildings (OR 0.386, 95% CI 0.440-0.541, p<0.001) were associated with reduced odds of severe TBI.Conclusions: Helmet use in patients with SRIs is low in all pediatric age groups. Helmet use and skate parks are protective against severe TBI. Older age children and male gender are at increased risk of severe TBI after skateboard-related injuries, and more targeted preventive education and legislation are needed. [ABSTRACT FROM AUTHOR]

Background: Studies in Africa have examined the association between helmet use and injury prevention, however, there has been no systematic review to synthesize the literature within an African context nor has there been any meta-analysis examining the effect of helmet use on injury prevention.Methods: The review was performed in accordance with the Joanna Briggs Institute for Systematic Reviews. Articles were searched using several databases (e.g. CINAHL, OVID Medline) and select gray literature (e.g. TRID) sources. Articles were included if they were quantitative studies published in English between 2000 and 2019 and examined the association between motorcycle helmet use with head injuries, hospitalizations, and deaths in low- and lower-middle income countries in Africa with comprehensive motorcycle helmet laws. A meta-analysis was performed using pooled effect sizes assessing the impact of helmet use on reducing head injuries.Results: After screening 491 articles, eight studies met the inclusion criteria. Helmet use ranged from 0 to 43%. The mean age of being involved in a crash was 30 years with males being two times more likely to be involved in motorcycle crashes than females. Drivers (riders) were more likely to be involved in a crash, followed by passengers and then pedestrians. Helmet use reduced injury severity and provided an 88% reduction in serious head injuries (OR 0.118, 95% CI: 0.014-0.968, p = 0.049).Conclusions: In our study, helmet usage significantly reduced the likelihood of fatal head injuries. African countries with no helmet laws should consider adopting helmet use policies to reduce severe head related injuries from motorcycle crashes. [ABSTRACT FROM AUTHOR]

In 2013, the International Boxing Association (AIBA) prohibited the use of headguards for elite male Olympic boxing competitions. Could the removal of the headguard from elite male boxing competitions potentially cause increased injury risk for boxers? The aim of the literature review is to analyse current knowledge about the use of protective headgear and injury prevention in boxing, in order to determine if there are increased injury risks associated with headguard use. Peer-reviewed studies (language: English, Norwegian, Swedish, Danish and Dutch) published from 1980 and onwards were considered. Five academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Only studies that included boxers as the study population with headguards as a factor were considered. A total of 39 articles were included in the review. The analysis of the reviewed literature indicates that headguards protect well against lacerations and skull fractures, while less is known about the protective effects against concussion and other traumatic brain injuries. Most of the analysed studies however use indirect evidence, obtained through self-report or observational techniques with relatively small non-representative samples. There are almost no randomised control trials, longitudinal research designs or samples from recreational boxing. Therefore, AIBA's decision to remove the headguard has to be seen with caution and injury rates among (male) boxers should be continuously evaluated. Highlights Research does not sufficiently support the statement that boxing without protective headgear is safer than boxing with a headguard. Headguards protect well against facial cuts and skull fractures. The systematic review indicates that headguards provide some protection against linear impacts to the head. The headguards protective effects against concussion are however uncertain. A research agenda is proposed. Priority areas include a focus on longitudinal research designs, randomized control trials, samples from recreational competitive boxing, as well as further research into coaches' and athletes' experiences and perspectives on headguards and injuries. [ABSTRACT FROM AUTHOR]

The article discusses the specialized sports medicine knowledge is needed to manage many of these patients, especially the elite athlete. Topics include the retrospective analysis of New South Wales (NSW) EDs, musculoskeletal injury was the most common diagnosis category; prohibited interventions that may result in suspension from sport, and the training, skills and responsibilities for work as a match day doctor (MDD).

Background: The tackle is the in-game activity carrying the greatest risk for concussion in rugby. A recent evaluation of tackle characteristics in rugby union precipitated a rule modification to reduce head impact risk during tackles. This study aims to replicate the work conducted in rugby union by examining the association between tackle characteristics and head injury events in professional rugby league. Methods: There were 446 tackles resulting in a head injury assessment (HIA) and 5,694 tackles that did not result in a head injury from two National Rugby League (NRL) seasons that were reviewed and coded. Tackle height, body position of players, and contact area on an opponent's body were evaluated, with the propensity of each situation to cause an HIA calculated as HIAs per 1000 events. Results: The propensity for tacklers to sustain a head injury was 0.99 HIAs per 1000 tackles, 1.74-fold greater than for the ball carrier (0.57 HIAs per 1000 tackles). There was a 3.2-fold higher risk for an HIA when the tackler was upright compared to bent-at-the-waist. The greatest risk of a tackler HIA occurred when head contact was very low (knee, boot) or high (head and elbow). HIAs were most common following head-to-head impacts. The lowest propensity for tackler HIA was found when the tackler's head was in proximity with the ball carrier's torso. Conclusions: The result of this study replicated the findings in professional rugby union. This has implications for the injury prevention initiatives implemented to reduce HIA risk because the majority of injuries are sustained by the tackler. [ABSTRACT FROM AUTHOR]

Background: Sport-related head and neck injuries, including concussion, are a growing global public health concern with a need to explore injury risk reduction strategies such as neck exercises. Objectives: To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) SRC. Methods: Five databases (Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science) and research lists of included studies were searched using a combination of medical subject headings and keywords to locate original studies which reported the association between incidence of head and/or neck injury and neck strength data, or included a neck exercise intervention either in isolation or as part of a more comprehensive exercise program. Results: From an initial search of 593 studies, six were included in this review. A narrative synthesis was performed due to the heterogeneity of the included studies. The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a SRC. Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including SRC. Conclusion: Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including SRC. Systematic Review Registration: PROSPERO (registration number: 194217). [ABSTRACT FROM AUTHOR]

Background: Participating in sports is a great way to gain physical, psychological, and social benefits. However, it also carries the risk of injury. Soccer is one of the most popular sports worldwide, and in recent years, there have been concerns about potential vulnerabilities to head injuries. Objectives: To investigate soccer-related head injuries (SRHIs), using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) surveillance system. Specifically, we aim to compare characteristics of SRHI cases to all head injury cases within the eCHIRPP database. Methods: Descriptive analyses of emergency department (ED) injury surveillance data (2011 to 2017) for individuals aged 5 to 29 years from all participating eCHIRPP sites. Computation of proportionate injury ratios (PIR) comparing SRHIs to all head injuries reported to eCHIRPP, and 95% confidence intervals (CI). Results: A total of 3,970 SRHIs were reported to eCHIRPP. Injuries were from contact with another player, the ball, ground, goal-post, and other causes. Of the injuries caused by contact with the ball, 9% were from purposely directing the ball with the head (heading). A higher proportion of concussions (PIR=1.32, 95% confidence interval [CI]: 1.27 to 1.37) and minor closed head injuries (PIR=1.20, 95% CI: 1.15 to 1.26) were observed in soccer players. Higher proportions of head injuries occurred in organized soccer and soccer played outdoors. However, admission to the ED for a SRHI was rare (PIR=0.40, 95% CI: 0.30 to 0.55). Conclusions: Overall, elevated proportions of brain injuries were observed among soccer players, however, these injuries were unlikely to result in a hospital admission. Moreover, purposely heading the ball contributed to few ED visits. [ABSTRACT FROM AUTHOR]

Physical activity during adolescence is associated with positive health outcomes, yet only 26% of US middle and high school students report daily physical activity. Moreover, the number of high school students playing a sport is declining, with the largest decline in football. One reason for this decline in playing football may be increased attention to the risk of head injury. For public health, the decline is alarming because football offers a physical activity opportunity for millions of young people every year. In response, efforts have been made to institute measures to enhance the safety of football. The objective of this topical review was to review these measures and the data supporting their effectiveness. We conducted a search of scientific literature supplemented by a web search to identify safety measures. We used the Indiana University library electronic database, PubMed, and web browser searches with specific search terms. In addition to peer-reviewed studies, we searched news stories and reports from sport-related organizations. We summarized the measures and evaluations of effectiveness and categorized the measures by type (game rules, practice guidelines, equipment innovations, strategic initiatives) and target age group (elementary/middle school, high school, college, professional). We found that attempts are being made to improve the safety of football at all levels. However, many measures lack scientific evidence to support their effectiveness. Therefore, researchers need to systematically evaluate safety measures. By implementing evidence-based interventions, we can balance the public health risk of playing football versus the public health risk of continued declines in participation. [ABSTRACT FROM AUTHOR]

Road traffic collisions (RTC) are a major cause of mortality and morbidity in Botswana. To our knowledge no research has been conducted in Botswana to investigate preventable deaths that occur as a result of RTCs. The aim of this study is to establish the rate of preventable deaths from RTCs in the greater Gaborone area in Botswana. This was a 5-year retrospective study conducted at the forensic pathology department for the greater Gaborone area, in Botswana. Nine hundred and nine (909) forensic pathology reports were retrieved. Sixty-eight percent (68.2%) of RTC deaths were considered preventable. Head injury in isolation and in combination with other injuries accounted for 87.6% (796/909) of deaths. Haemorrhagic shock was present in 70.2% (638) of all documented injuries. Another documented injury contributing to fatal RTCs was high spinal cord injury. This injury was documented in 13.1% (119/909) of all deaths. We recommend the implementation of a comprehensive trauma system in Botswana to reduce the number of deaths from RTCs. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the various topics within the issue, including abusive head trauma (AHT) prevention, family-focused practice (FFP) in families of parents with mental health problems, and child sexual abuse and exploitation prevention.

We searched the US National Library of Medicine's PubMed, Google Scholar and the American Psychological Association's Psychinfo databases during September 2019 for citations and abstracts on abusive head trauma (AHT) and shaken baby syndrome prevention dated 1 January 2000 to 31 August 2019. We identified 53 empirical studies and performed a structured review to identify the effects of prevention, if any, on AHT. We identified three lines of investigation that have focused on: (i) strategies which teach parents how to respond to newborn crying and the dangers of shaking babies; (ii) community and public health factors; and (iii) professional education and practice. Most studies were observational, although a small number used sophisticated designs such as prospective or randomised controlled trials. We note other strengths and weaknesses of these articles and suggest future directions for research in each of these areas based on the current level of scientific inquiry. 'Identified 53 empirical studies and performed a structured review to identify the effects of prevention... on AHT' Key Practitioner Messages: Research on AHT prevention is limited, although a growing research base supports teaching parents how to respond to newborn crying and about the dangers of shaking babies.Social care systems addressing provision of material and other support have positive effects on AHT rates.Professional education should improve practitioners' identification of families with increased risk and enhance AHT identification and treatment.Those wishing to prevent AHT should consider multilevel approaches and their own community needs, practice setting, and patient/client risk profiles when designing strategies. [ABSTRACT FROM AUTHOR]

Objectives: The broad objective of this paper is to inform policy, practice and research regarding the management of head injury risks in competitive skateboarding. The main motivation for the current study was the question of mandating helmet use in competitive skateboarding. The specific aims are to present current knowledge on (A) head injury risks in skateboarding, (B) preliminary biomechanical data on falls and head injury risks in a selection of competitive skateboarding events similar to those planned for the Summer Olympics, (C) standards for skateboard-styled helmets and (D) impact performance of helmets commonly used in skateboarding.Methods: A narrative review of the published literature on head injuries in skateboarding was conducted. Videos of skateboarding competitions from Vans Park Professional League, Street League Skateboarding and Dew Tour were reviewed to describe crashes and falls. Standards databases including the International Organization for Standardization (ISO), British Standards Institution (BSI), Snell, United States Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) were searched for skateboarding-styled helmet standards. A sample of helmets considered suitable for skateboarding was tested in standard impact tests.Results: The majority of previous literature focused on the paediatric population in a recreational setting with little data from competitive skateboarding. Head injuries comprised up to 75% of all injuries and helmet use was less than 35%. Video analysis identified high rates of falls and crashes during competitive skateboarding, but also a capacity for the athletes to control falls and limit head impacts. Less than 5% of competitive skateboarders wore helmets. In addition to dedicated national skateboard helmet standards, there are several national standards for skateboard-styled helmets. All helmets, with the exception of one uncertified helmet, had similar impact attenuation performance; that is, at 0.8 m drop height, 114-148 g; at 1.5 m, 173-220 g; and at 2.0 m, 219-259 g. Impact performance in the second impact was degraded in all helmets tested.Conclusion: Helmets styled for skateboarding are available 'off the shelf' that will offer protection to the head against skull fractures and intracranial injuries in competitive skateboarding. There is an urgent need to commence a programme of research and development to understanding and control head injury risks. [ABSTRACT FROM AUTHOR]

Effective prevention of abusive head trauma (AHT) requires the identification of potential perpetrators. Current evidence suggests that infant shaking, as a mechanism of AHT, produces immediate symptoms, allowing for the dating of the event based on clinical symptoms. Determining precisely when symptoms occurred may help law enforcement to identify the perpetrator. We retrieved written legal statements and medical records from birth to age at diagnosis of 100 infants consecutively diagnosed with AHT through shaking (2011–17), using forensic expertise files. Timing of abuse allowed for the identification of perpetrators in 91 cases. All abusive events occurred inside a home (parent's or nanny's), never outdoors or in a public place, and always in the presence of only one adult. Approximately one‐third (n = 32) of the perpetrators were males (31 fathers) and two‐thirds (n = 59) were females: 49 of them were the infant's nanny and ten were the infant's mother. Infants were not described as crying habitually. Better knowledge of the context of AHT events and risk situations, including recent implementation of a new or unusual modality of childcare, and being the only adult in a home with an infant, should facilitate prevention, including targeted training and avoidance of situations associated with risk. Key Practitioner Messages: Abusive events occur in the presence of a single adult, within the privacy of a home.First signs of abuse most commonly occur in a recent, therefore unusual, form of childcare.With rare exceptions, the perpetrator is either the nanny or one of the parents.Identification of the perpetrator and better knowledge of the context of abuse should allow improving targeted prevention. [ABSTRACT FROM AUTHOR]

Background: Studies suggest that the implementation of highquality education and support services for caregivers may reduce the incidence of unplanned harm to infants and young children under high-stress circumstances. Purpose: This pilot study evaluates the usefulness of the Period of PURPLE Crying program in a high-acuity NICU at The University of Chicago Comer Children's Hospital based on six measurable objectives. Methods: The pilot study utilized a Likert-style pretest-posttest survey design to evaluate how NICU nurses perceived the Period of PURPLE Crying program. Nurses were educated on the program content during an in-service to teach participants how to utilize the Period of PURPLE Crying program materials to support and educate families about Shaken Baby Syndrome (SBS). Results: The intervention effectively increased nursing confidence in delivering the SBS and Abusive Head Trauma (AHT) education and increased accessibility to available resources pertaining to SBS and AHT. Questions pertaining specifically to the Period of PURPLE Crying presented exclusively on the post-test were met with an overwhelmingly positive response, with the majority (n=33, 97%) of respondents agreeing that the intervention was useful in standardizing SBS education, providing meaningful, effective information on this topic area, and delivering SBS and AHT information promptly.incidence of unplanned harm to infants and young children under high-stress circumstances. [ABSTRACT FROM AUTHOR]

Abusive head trauma (AHT) is the most lethal form of child abuse; preventing AHT should be a national priority, but research into this area is woefully underfunded. Prevention programs have primarily focused on universal parent education during the neonatal period, a time when parents are a captive audience of the health care establishment whose focus is on the needs of their newborn infant, and who will soon be exposed to the frustration and anger of infant crying. Research has suggested a strong causal link between infant crying and AHT, and parents - particularly fathers and father figures - have been identified as the most common perpetrators of AHT. A number of studies have suggested that educating parents during the postnatal period about the normalcy of inconsolable infant crying and its evolution over the first several months of postnatal life improves parental knowledge about infant crying and a number of positive parenting behaviors, and decreases emergency room visits for crying. In 1998, we began a pilot program in Upstate New York near Buffalo that led to a 47% reduction in AHT incidence. Similar studies have demonstrated 35-75% reductions in incidence, which has led to enthusiasm for this approach to preventing AHT. We, as well as another group, have enacted statewide programs in Pennsylvania and North Carolina; unfortunately, these two large statewide replication trials failed to demonstrate any impact of such an intervention on AHT rates. Serial messages for parents, provided repeatedly over the period of greatest risk for AHT, might be another avenue of research. [ABSTRACT FROM AUTHOR]

Background/Aim: In clinical trials, there is potential for bias from unblinded observers that may influence ascertainment of outcomes. This issue arose in the Strategies to Reduce Injuries and Develop Confidence in Elders trial, a cluster randomized trial to test a multicomponent intervention versus enhanced usual care (control) to prevent serious fall injuries, originally defined as a fall injury leading to medical attention. An unblinded nurse falls care manager administered the intervention, while the usual care arm did not involve contact with a falls care manager. Thus, there was an opportunity for falls care managers to refer participants reporting falls to seek medical attention. Since this type of observer bias could not occur in the usual care arm, there was potential for additional falls to be reported in the intervention arm, leading to dilution of the intervention effect and a reduction in study power. We describe the clinical basis for ascertainment bias, the statistical approach used to assess it, and its effect on study power. Methods: The prespecified interim monitoring plan included a decision algorithm for assessing ascertainment bias and adapting (revising) the primary outcome definition, if necessary. The original definition categorized serious fall injuries requiring medical attention into Type 1 (fracture other than thoracic/lumbar vertebral, joint dislocation, cut requiring closure) and Type 2 (head injury, sprain or strain, bruising or swelling, other). The revised definition, proposed by the monitoring plan, excluded Type 2 injuries that did not necessarily require an overnight hospitalization since these would be most subject to bias. These injuries were categorized into those with (Type 2b) and without (Type 2c) medical attention. The remaining Type 2a injuries required medical attention and an overnight hospitalization. We used the ratio of 2b/(2b + 2c) in intervention versus control as a measure of ascertainment bias; ratios > 1 indicated the likelihood of falls care manager bias. We determined the effect of ascertainment bias on study power for the revised (Types 1 and 2a) versus original definition (Types 1, 2a, and 2b). Results: The estimate of ascertainment bias was 1.14 (95% confidence interval: 0.98, 1.30), providing evidence of the likelihood of falls care manager bias. We estimated that this bias diluted the hazard ratio from the hypothesized 0.80 to 0.86 and reduced power to under 80% for the original primary outcome definition. In contrast, adapting the revised definition maintained study power at nearly 90%. Conclusion: There was evidence of ascertainment bias in the Strategies to Reduce Injuries and Develop Confidence in Elders trial. The decision to adapt the primary outcome definition reduced the likelihood of this bias while preserving the intervention effect and study power. [ABSTRACT FROM AUTHOR]

Context: The rate of sport-related concussion diagnosis has significantly increased in recent years, which has created a need for injury prevention initiatives. There have been efforts put forth by researchers and American football organizations to teach athletes how to tackle properly in order to decrease the number of subconcussive head impacts and concussions. Clinical Question: Does the implementation of a behavioral tackling intervention decrease the head impact frequency in American football players? Clinical Bottom Line: There is moderate SORT Level B evidence to support the use of behavioral tackling interventions as a means for reducing head impact frequency in football athletes. All four included studies found a significant reduction in head impacts following a behavioral tackling intervention with study findings ranging from a 26–33% reduction in impact frequency. These findings were consistent in youth, high school, and college football players and for different types of behavioral tackling interventions. Therefore, these results indicate that behavioral tackling interventions have the potential to reduce the number of head impacts sustained by American football players, which may ultimately lead to a reduction in concussion occurrence as well. [ABSTRACT FROM AUTHOR]