Search

Blast-induced traumatic brain injury is the most prevalent military injury in Iraq and Afghanistan, yet little is known about the mechanical effects of blasts on the human head, and still less is known about how personal protective equipment affects the brain's response to blasts. In this study we investigated the effect of the Advanced Combat Helmet (ACH) and a conceptual face shield on the propagation of stress waves within the brain tissue following blast events. We used a sophisticated computational framework for simulating coupled fluid--solid dynamic interactions and a three-dimensional biofidelic finite element model of the human head and intracranial contents combined with a detailed model of the ACH and a conceptual face shield. Simulations were conducted in which the unhelmeted head, head with helmet, and head with helmet and face shield were exposed to a frontal blast wave with incident overpressure of 10 atm. Direct transmission of stress waves into the intracranial cavity was observed in the unprotected head and head with helmet simulations. Compared to the unhelmeted head, the head with helmet experienced slight mitigation of intracranial stresses. This suggests that the existing ACH does not significantly contribute to mitigating blast effects, but does not worsen them either. By contrast, the helmet and face shield combination impeded direct transmission of stress waves to the face, resulting in a delay in the transmission of stresses to the intracranial cavity and lower intracranial stresses. This suggests a possible strategy for mitigating blast waves often associated with military concussion. computational models | personal protection equipment doi/ 10.1073/pnas.1014786107

Objective To measure the use of motorcycle helmets in children and to determine the reasons why children wear helmets less often than adults. Methods The frequency of helmet wearing among adults and children was ascertained by trained roadside observers, and randomized road user surveys were completed in four major centres in Viet Nam: Hanoi, Ho Chi Minh City, Can Tho and Da Nang. Survey data on key questions were cross tabulated, and [chi square] was calculated for significant differences between parents and non-parents (0.05). Findings The frequency of helmet use in the four study locations ranged from 90-99% among adults, from 15-53% among children [less than or equal to] 7 years of age, and from 38-53% among children > 7 but [less than or greater than] 14. Of the parents surveyed, 67% said the fear of neck injury was the most important reason their children did not wear a helmet. Conclusion Children wear motorcycle helmets much less often than adults. Legislation to penalize adults whose children do not wear motorcycle helmets has been proposed in Viet Nam. Furthermore, ongoing advocacy and social marketing efforts are being made to disseminate information about the safety benefits of helmets to combat erroneous public perceptions. Objectif Mesurer la frequence d'utilisation du casque de motocycliste chez les enfants et determiner les raisons pour lesquelles les enfants portent moins souvent un casque que les adultes. Methodes La frequence de port du casque chez les adultes et les enfants a ete determinee par des observateurs formes et places sur le bord des routes et des enquetes randomisees sur les usagers de la route ont ete effectuees dans quatre grands centres urbains du Viet Nam: Hanoi, Ho Chi Minh Ville, Can Tho et Da Nang. On a construit une table de contingence avec les reponses aux principales questions et on a calcule le [ji al cuadrado] pour rechercher des differences significatives entre les personnes ayant des enfants de moins de 14 ans et celles n'en ayant pas (0,05). Resultats La frequence de port du casque sur les quatre sites etudies variait de 90 a 99% chez les adultes, de 15 a 53% chez les enfants de 7 ans et moins et de 38 a 53% chez les enfants dont l'age se situait entre 7 et 14 ans (inclus). Parmi les parents interroges, 67% ont indique que la crainte d'un traumatisme a la nuque etait la principale raison motivant l'absence de casque chez leur enfant. Conclusion Les enfants portent bien moins souvent un casque de motocycliste que les adultes. Une legislation penalisant les adultes dont les enfants ne portent pas de casque de motocycliste a ete proposee au Viet Nam. En outre, des efforts de sensibilisation et de marketing social sont en cours pour diffuser des informations sur les benefices pour la sante des casques de motocycliste et dissiper les idees erronees parmi le public. Objetivo Determinar la frecuencia del uso del casco de motocicleta por los ninos y averiguar los motivos por los que lo usan menos que los adultos. Metodos La frecuencia del uso del casco por los adultos y los ninos fue determinada por observadores entrenados situados en las carreteras. Tambien se realizaron encuestas aleatorizadas entre los usuarios de las vias de transito en cuatro grandes ciudades de Vietnam: Hanoi, Ciudad Ho Chi Minh, Can Tho y Da Nang. Los datos de las encuestas sobre cuestiones clave se introdujeron en tablas de contingencia, calculandose la [ji al cuadrado] para detectar diferencias significativas entre padres y no padres (0,05). Resultados La frecuencia del uso del casco en los cuatro lugares estudiados oscilo entre el 90 y el 99% en los adultos, el 15 y el 53% en los ninos [menor que o igual a] 7 anos, y el 38 y e153% en los ninos > 7 pero [menor que o igual a] 14 anos. Entre los padres encuestados, el 67% dijo que el temor a las lesiones cervicales era el motivo mas importante para que sus hijos no usaran el casco. Conclusion La frecuencia del uso del caso es mucho menor en los ninos que en los adultos. En Viet Nam se ha propuesto una ley para penalizar a los adultos cuyos hijos no utilicen caso de motocicleta. Ademas, con el fin de combatir percepciones erroneas del publico, se estan realizando actividades de promocion y de marketing social para difundir informacion sobre los beneficios del uso del casco., Introduction Viet Nam has a high burden of road traffic injuries. In 2007 there were 12 800 deaths, or 15 deaths per 100 000 population, according to official statistics. (1) [...]

The history of motorcycle helmet legislation in the United States reflects the extent to which concerns about individual liberties have shaped the public health debate. Despite overwhelming epidemiological evidence that motorcycle helmet laws reduce fatalities and serious injuries, only 20 states currently require all riders to wear helmets. During the past 3 decades, federal government efforts to push states toward enactment of universal helmet laws have faltered, and motorcyclists' advocacy groups have been successful at repealing state helmet laws. This history raises questions about the possibilities for articulating an ethics of public health that would call upon government to protect citizens from their own choices that result in needless morbidity and suffering. (Am J Public Health. 2007;97:208-217 doi:10.2105/AJPH.2005.083204)

Head injury is the most frequent reason for hospital admission and the most common cause of death among skiers and snowboarders with an 8% fatality rate among those admitted to hospital with head injuries. Helmet use is associated with reduced risk of head injury among them and there is a lower risk for neck injuries as well.

Byline: Franco Cavaliere (1), Giorgio Conti (1), Roberta Costa (1), Rodolfo Proietti (1), Antonino Sciuto (2), Simonetta Masieri (2) Keywords: Non invasive ventilation; Helmet; Nasal mask; Facial mask; Noise exposure Abstract: Objective To assess noise exposure during noninvasive ventilation (NIV) with different types of interface (helmet, nasal, and facial masks). Subjects and methods Ten 'naive' healthy volunteers underwent NIV at pressure support levels of 10 and 15 cm[H.sub.2]O with: (a) helmet, (b) helmet equipped with HME filters at the junctions between the helmet and the inspiratory and expiratory branches of the respiratory circuit, (c) nasal mask, and (d) facial mask. Noise intensity was assessed with a sound level meter by placing a microphone near the right ear. Noise intensity and degree of discomfort were also assessed subjectively with a visual analogue scale. Results Inside the helmet noise exceeded 100 dB. Noise intensity was poorly affected by pressure support level and unaffected by the presence of HME filters. During NIV with nasal or facial masks the noise did not exceed 70 dB (i.e., noise was not louder than the usual noise background in ICU). Subjective evaluation of noise intensity mirrored objective measurements however, the presence of HME filters was associated with the feeling of less noise inside the helmet. The discomfort associated with the helmet did not significantly differ from that associated with the masks. Conclusions NIV helmet is associated with significantly greater noise than nasal and facial masks, but is as comfortable as masks, at least in the short term. Medium- and long-term exposure to loud noise may potentially impair ear function and increase the patient's discomfort. Author Affiliation: (1) Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy (2) ENT Department, University La Sapienza, Rome, Italy Article History: Registration Date: 17/05/2004 Received Date: 12/05/2004 Accepted Date: 17/05/2004 Online Date: 08/06/2004

Byline: NicolA2 Patroniti (1), Giuseppe Foti (1), Annamaria Manfio (1), Anna Coppo (1), Giacomo Bellani (1), Antonio Pesenti (1) Keywords: Continuous positive airway pressure; Head helmet; Face mask; Hypoxemic respiratory failure; Healthy volunteers Abstract: Objective To assess selected physiological effects of non-invasive continuous positive airway pressure delivered by head helmet (CPAP.sub.H), a special interface device designed to completely contain the head of the patient, compared to face mask (CPAP.sub.M). Design Randomized physiological study. Setting University research laboratory. Patients Eight healthy volunteers. Intervention Continuous positive airway pressure delivered by face mask and CPA[P.sub.H ]in random order. Three gas flow rates (20-30-40 l/min and 30-45-60 l/min, respectively, for CPAP.sub.M and CPAP.sub.H) and four CPAP levels (0-5-10-15 cm[H.sub.2]O) were employed in a randomized sequence. Measurements and results In each patient we monitored airway pressure, esophageal pressure, expiratory flow, and inspiratory and expiratory CO.sub.2 concentration. End-expiratory lung volume changes from CPAP 0 were measured by inductance plethysmography. The application of increased levels of CPAP resulted in a significant increase in end-expiratory lung volume, similar for CPAP.sub.H and CPAP.sub.M. Inspiratory changes of airway pressure were comparable for the two CPAP modes. Inspiratory CO.sub.2 concentration was higher during CPAP.sub.H (significantly decreased at increased gas flow rates), compared to CPAP.sub.M. Conclusions Continuous positive airway pressure delivered by head helmet is as effective as CPAP.sub.M in increasing end-expiratory lung volume and in compensating for airway pressure changes without the need of a reservoir bag. Higher gas flow rates are necessary to maintain a relatively low inspiratory CO.sub.2 concentration. Author Affiliation: (1) Department of Anesthesia and Intensive Care, Ospedale San Gerardo Nuovo dei Tintori, University of Milano-Bicocca, Via Donizetti 106, 20052, Monza (Milano), Italy Article History: Received Date: 17/09/2002 Accepted Date: 30/06/2003 Online Date: 28/08/2003

Byline: Davide Chiumello (1), Paolo Pelosi (2), Eleonora Carlesso (1), Paolo Severgnini (2), Michele Aspesi (2), Chiara Gamberoni (2), Massimo Antonelli (3), Giorgio Conti (3), Maurizio Chiaranda (2), Luciano Gattinoni (1) Keywords: Interfaces; Facial mask; Helmet; Comfort of breathing; Work of breathing; Noninvasive ventilation Abstract: Objective This bench and human study compared large and small helmets with face mask (FM) for delivery of noninvasive positive pressure ventilation. Design A lung simulator was employed, and the human study involved six healthy subjects. We evaluated a continuous high-flow (CPAP.sub.HF), low flow (CPAP.sub.LF), ventilator (CPAP.sub.VENT) CPAP, and pressure support ventilation (PSV 10 and 20 cm[H.sub.2]O). In the human study we used CPAP.sub.HF, CPAP.sub.VENT, and PSV 5 cm[H.sub.2]O. PEEP was 5 cm[H.sub.2]O. Measurements In the bench study during CPAP we measured the negative airway pressure time product (area.sub.CPAP), i.e., the area of airway pressure (Paw) under PEEP and during PSV the pressure airway time product (area.sub.PSV), i.e., the area of Paw from onset to end of inspiratory flow. In the human study we measured the breathing pattern and work of breathing (WOB). Results In the bench study during CPAP.sub.LF the helmets had a lower area.sub.CPAP than the FM, while during CPAP.sub.HF the three interfaces had similar area.sub.CPAP. Using CPAP.sub.VENT and PSV the FM reduced area.sub.CPAP and increased area.sub.PSV compared to helmets. At 20 cm[H.sub.2]O of PSV using helmets area.sub.PSV was similar to that obtained at 10 cm[H.sub.2]O of PSV using the FM. In human study using CPAP.sub.HF and CPAP.sub.VENT the tree interfaces had similar effects on breathing pattern and WOB, while using PSV the FM reduced WOB more than helmets. Conclusions During CPAP.sub.LF helmets were more efficient than FM, while during CPAP.sub.HF the three interfaces were comparable. Using CPAP.sub.VENT and PSV, FM was more efficient than helmets Author Affiliation: (1) Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico-IRCCS, Universita' degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy (2) Dipartimento di Scienze Cliniche e Biologiche, Universita' degli Studi dell'Insubria, Varese, Italy (3) Istituto di Anestesiologia e Rianimazione, Policlinico A. Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy Article History: Received Date: 03/12/2002 Accepted Date: 28/04/2003 Online Date: 12/06/2003

This study identified predictors of bicycle helmet usage in a sample of seniors in Mesa, Arizona. Participants reported: days/week bicycling, usual duration, where biking occurred, helmet ownership, bicycle accidents, injuries, and age and gender. Descriptive, non-parametric statistics, and regression analysis were utilized. Seventy-four females and 123 males completed the survey. The mean age was 70.7(7.2) years. Respondents biked a mean of 4.9(2.3) days per week and averaged 40.5 (32.5) minutes of riding per day. Eighty-two participants (41.6%) owned bicycle helmets and 55 (27.9%) were observed wearing helmets. Eighty-seven (44.2%) participants biked outside their retirement community and 25 (12.7%) reported an accident within the past year. Chi-square (2, N = 197) = 0.66, p = .72) indicated no differences in of male or female helmet usage. Those who rode outside the retirement communities ([chi square] (2,197) = 22.6, p = .001) were more likely to wear helmets than counterparts. Logistic regression found age to be a predictor of bicycle helmet usage. KEY WORDS: bicycle; helmets; seniors.

Objectives. This study sought to determine the impact of Maryland's all-rider motorcycle helmet law (enacted on October 1, 1992) on preventing deaths and traumatic brain injuries among motorcyclists. Methods. Statewide motorcyclist fatalities occurring during seasonally comparable 33-month periods immediately preceding and following enactment of the law were compared. Results. The motorcyclist fatality rate dropped from 10.3 per 10 000 registered motorcycles prelaw to 4.5 postlaw despite almost identical numbers of registered motorcycles. Motorcyclists wearing helmets had a lower risk of traumatic brain injury than those not wearing helmets (odds ratio = 0.31, 95% confidence interval = 0.14, 0.68). Conclusions. Maryland's controversial motorcycle helmet law appears to be an effective public health policy and may be responsible for saving many lives.

LANELLE BEMBENEK WIGGINS (*) The protection of children's health has recently become a mandated priority for federal policy makers. To assess many of the regulations that affect children's health, policy [...]

Bicycling is a popular recreational activity and a sound alternative mode of transportation that can reduce traffic congestion and air pollution and enhance physical fitness. An estimated 44.3 million US […]