High contact sports put athletes at a higher risk of sustaining a concussion. This work focused on assessing regional brain health in aging, retired Canadian Football League (rCFL) players years to decades after retirement. Advanced, quantitative magnetic resonance imaging (MRI) techniques were implemented to identify and quantify microstructural brain white matter damage, cognitive functional signal characteristics (fractal dimension (FD) and amplitude of low frequency fluctuations (ALFF) and fractional ALFF (fALFF)), and cerebral blood flow (CBF) dysregulation. Due to the high reproducibility of diffusion tensor imaging (DTI) and resting state functional MRI (rsfMRI), a Z-scoring approach exploring outliers relative to a large normative dataset was implemented to examine each rCFL subject individually. However, arterial spin labelling (ASL) data is more sensitive to scanner inconsistencies, therefore a group-wise analysis was performed with the CBF and ASL spatial coefficient of variance (ASL sCoV) data. Minimal microstructural damage was detected in the rCFL subjects, but a substantial amount of functional and CBF abnormalities were present. The FD was significantly reduced in 48 of 91 regions-of-interest (ROIs) examined, and the four rCFL subjects with the highest number of abnormal ROIs all exhibited worse motor speed, social functioning and general health scores than the other rCFL subjects. Furthermore, the ALFF analysis identified the cerebellum, parietal lobe ROIs, and central sub-cortical ROIs to be consistently abnormal. Finally, the temporal occipital fusiform cortex, superior parietal gyrus, caudate nucleus, and the cerebellum were significantly abnormal bilaterally based on CBF and ASL sCoV values, which also correlated with worse physical functioning and elevated daily chronic pain. This work adds to the growing literature that brain changes are present later in life that may be related to concussions and repetitive sub-concussive head impacts sustained years earlier. Several consistently damaged ROIs also correlated with adverse clinical presentations to indicate areas of future research. / Dissertation / Doctor of Philosophy (PhD) / Clinical concussion assessment has a limited ability to identify brain injury location and severity. Therefore, there is a need for more advanced diagnostic tools to provide meaningful, objective information to concussion patients and clinicians. The work presented in this thesis aimed to assess brain health using magnetic resonance imaging (MRI) techniques of retired professional football players with a complex history of concussions and repetitive sub-concussive impacts. Our research found concussion-related functional and cerebral blood flow brain abnormalities past that of normal aging, but minimal white matter damage, present in the retired athletes that also correlated with clinically testable health metrics such as motor speed, emotional well-being, and pain. Through personalized subject-specific analyses, this work provides further evidence of the effects of concussions later in life.

No description available.

The Minnesota Multiphasic Personality Inventory (MMPI) is often used for evaluating candidates for gastric bypass surgery, chronic pain patients, head trauma victims, and medical school applicants. However, due to the considerable time involved in completing and scoring the standard MMPI, researchers have attempted to devise short versions of this instrument to reduce the time required while providing similar results. In recent years, the Faschingbauer Abbreviated MMPI (FAM) and the MMPI-16 8 have been proposed as viable MMPI substitutes. The present study examined the comparability between profiles using these short versions of the MMPI with the patterns obtained using the entire measure. Participants consisted of equal numbers of gastric bypass candidates, chronic pain patients, head trauma victims, and medical school applicants. Scores on the FAM tended to be similar to scores on the complete MMPI for gastric bypass, chronic pain and head trauma patients. In contrast, the MMPI-16 8 yielded profiles which were similar to complete MMPI profiles with chronic pain and head trauma patients.

Traumatic brain injury, concussion, and subconcussion are different clinical conditions associated with head injury. These conditions share a common origin, mechanical forces directly or indirectly transmitted to the head. In sports, modalities with high exposure to head traumas require further investigation, especially those in which strikes directly to the head are allowed and a determinant of success, such as combat sports. The causes and effects of brain injuries in combat sports such as Mixed Martial Arts, boxing, Muay Thai, and kickboxing are complex and require a comprehensive investigation of many factors. The objective of this dissertation was to explore the main causes that justify combat sports as the main sport sample when it comes to head injury and the effects of chronic exposure to head trauma in this population. Original studies were developed to assess the head injury risk in competition and in training, the level of knowledge of athletes and coaches, and the consequences of chronic exposure to head traumas in the balance function, brain activity, and spinal cord excitability. The risk of a fight ending due to head strikes in competition is directly related to the weight category, and the risk seems to be exacerbated in female athletes. Combat sports athletes are exposed to numerous strikes to the head in simulated fights on a weekly basis in training, when healthcare professionals are absent. During this time that makes up the bulk of exposures, therefore, athletes and coaches are the ones managing potential cases of concussion. However, coaches are not familiar with assessment tools and don’t often seek out concussion knowledge. Alarmingly, coaches, often prior athletes themselves, are the main source of concussion knowledge for their athletes. High exposure to head trauma both in competition and training in addition to iv poor knowledge and behavior are liable to cause consequences in the nervous system. Athletes chronically exposed to head trauma presented subtle deficits in static balance in the most basic human stance, which is the double-leg over a firm surface. Moreover, while the literature consistently shows impairments in brain function, our study expanded the association between head trauma and nervous system deficits to the least studied component of the nervous system, the spinal cord. While athletic training promotes neuroplastic benefits in spinal cord excitability, these were hindered in a sample of athletes chronically exposed to head traumas. The studies in this dissertation demonstrated that athletes in combat sports are chronically exposed to intentional and repetitive head traumas, and that this exposure is likely associated with long-term functional detriments in balance and spinal cord excitability. / Graduate

Made available in DSpace on 2016-04-27T13:10:23Z (GMT). No. of bitstreams: 1 Monica Oliveira Bernardo.pdf: 3960791 bytes, checksum: cdb03a40c1d26631a8419067ae0e81eb (MD5) Previous issue date: 2013-12-17 / Radiological examinations have greatly increased, especially in children after craniocerebral trauma (CCT). Recent studies indicate a higher incidence of cancer and cataracts in children undergoing computed tomography (CT) compared to those without exposure. Some countries have promoted campaigns to avoid unnecessary CT and reducing the radiation dose. Objectives: 1. To assess whether the reduction of radiation dose in CT affect exam interpretation and diagnosis in children with CCT. 2. To stimulate discussion and implementation of measures to reduce the radiation dose received by children requiring health care and, also, stimulating awareness of pediatricians and families about the radiation dangers. Methods: We selected two groups of CT from children with CCT that underwent to CT performed in Philips 64 channels Multi Slice CT scanner at Unimed Hospital (Sorocaba-SP) from January to August 2012. We initially selected the 30 last CT performed with usual radiation dose in children. Then to the next CT for CCT we apply the protocols to reduce radiation load (approximately 50%) according to the guidelines of The Alliance for Radiation Safety in Pediatric Imaging. We reduced the kilovoltage (KV) to the maximum shown by tomography equipment and set a limit to the milliamperes per second (mAs) according to analysis of the tomography equipment after the completion of digitized radiography tomography, according to thickness and length of area of the patient being examined. We oriented the technical team to restrict the exam to the extent of the area requested by the doctor. The two CT series were presented to 19 pediatricians and 02 neurosurgeons from the Emergency Unit and to 7 radiologists from Unimed Hospital blind to the technical differences. The participants answered a specific questionnaire asking if they noticed any difference comparing the two series of exams; if they had any difficulty in making the diagnosis and taking the necessary conduct; if they need any training to exam the CTs and to assess the load of radiation and, finally, if they consider useful to implement a booklet for each child to register his/her radiological examinations. Results: Four participants noticed differences between the CT series and reported greater "noise" (image graininess) in those with reduced radiation load, had no difficulty in making a diagnosis and take the right conduct; most would like to have training and education on radioprotection and all agreed that the booklet to register and control radiological examinations would be useful for education and surveillance of parents and health professionals. Conclusion: This study showed that is possible to reduce the radiation dose in CT scans of children up to 50% without loss in the diagnosis accuracy; health professionals are motivated for continuing education and have attitudes to reduce the load of radiation. The direction of the hospital implemented the booklet to record radiological examinations. The campaign was publicized in the local media and on websites of Unimed Sorocaba and Unimed Brazil and has been well accepted by the hospital community and families / Os exames radiológicos têm aumentado muito, especialmente em crianças pós-trauma crânio-encefálico (TCE). Estudos recentes indicam maior incidência de câncer e catarata em crianças submetidas à tomografia quando comparadas àquelas sem exposição. Alguns países já promovem campanhas para evitar exames desnecessários e reduzir a dose de radiação. Objetivos: 1. Avaliar se a redução da dose de radiação em tomografias computadorizadas (TC) de crânio prejudica a interpretação do exame e o diagnóstico em crianças com TCE. 2. Desencadear no ambiente de trabalho a discussão e implementação de medidas capazes de reduzir a dose de radiação recebida por crianças que necessitem atenção à saúde estimulando também a conscientização dos pediatras e dos familiares. Métodos: Selecionamos dois grupos de TC de crianças com TCE, realizados em tomógrafo Philips Multi Slice de 64 canais no Hospital da Unimed de Sorocaba no período de janeiro a agosto de 2012. Inicialmente selecionamos as 30 últimas TC realizadas com dose de radiação habitual. A seguir, aos próximos exames, aplicamos os protocolos de redução da carga de radiação (aproximadamente 50%) segundo as diretrizes da The Alliance for Radiation Safety in Pediatric Imaging. Reduzimos a Quilovoltagem (KV) ao máximo demonstrado pelo equipamento de tomografia e estabelecemos um limite para a Miliamperagem por segundo (mAs) de acordo com a análise do equipamento de tomografia após a realização da radiografia digitalizada na tomografia, de acordo a espessura e o comprimento da área a ser analisada do paciente. Orientamos a equipe técnica para que restringisse a extensão do exame somente à região solicitada no pedido médico. As duas séries de exames foram apresentados a 19 pediatras, 2 neurocirurgiões da Unidade de Emergência e a 7 radiologistas do Hospital da Unimed Sorocaba que desconheciam as diferenças técnicas. Os participantes responderam por um questionário específico se encontraram diferenças entre os exames; se tiveram dificuldade em fazer o diagnóstico e tomar a conduta necessária; se sentiam necessidade de capacitação para avaliar os exames e a carga de radiação e se consideravam útil a implantação de uma caderneta individual de registro dos exames radiológicos. Resultados: Quatro participantes viram diferenças entre os exames e referiram maior "ruído" (granulação da imagem) naqueles com redução da carga de radiação; não tiveram dificuldade em realizar o diagnóstico e orientar a conduta; a maioria gostaria de ter capacitação e educação preventiva e todos concordam que a caderneta de controle de registro de exames radiológicos seria útil para a educação e vigilância dos pais e profissionais de saúde. Conclusão: O estudo evidenciou ser possível reduzir a dose de radiação em TC de crianças em até 50% sem prejuízo no diagnóstico e na conduta; os profissionais de saúde estão motivados a se capacitarem e a ter atitudes visando reduzir a carga de radiação. A direção do hospital implantou a caderneta de registro de exames radiológicos. A campanha foi divulgada na mídia local e nos sites da Unimed de Sorocaba e na Unimed do Brasil e tem sido bem aceita pela comunidade hospitalar e familiares

La biomécanique des chocs vise à étudier les lésions, établir des limites de tolérance et de proposer des mesures de protections adéquates. La méthode des éléments-finis permet l’étude approfondie des mécanismes de lésions, évitant des problèmes liés à l’expérimentation et d’éthique. La biomécanique de la tête humaine chez l’adulte a pris ce virage très tôt, et des modèles de la tête de l’adulte existent, dont celui développé à l’Université de Strasbourg : le SUFEHM (Strasbourg University Finite Element Head Model). Le présent projet a pour but d’ouvrir cette thématique à la modélisation des traumatismes crâniens du nourrisson. Deux axes de travail ont été conduits successivement pour étudier des situations d’accidents et de maltraitances. Le premier axe consiste à développer un modèle de l’œil du nourrisson pour l’étude des hémorragies rétiniennes. Le deuxième consiste à améliorer le modèle de tête en intégrant d’une part les données de l’imagerie médicale comme l’orientation et la densité des fibres axonales, et d’autre part en validant la formulation du crâne pour prédire les fractures crâniennes. / Impact biomechanics aim at studying injuries, establishing tolerance limit and propose efficient protective systems. The finite-element method permits to study precisely injury mechanisms by avoiding questions linked to experimentation and ethics. For the human adult head biomechanics, this methodology was taken earlier and several stable and validated models exist worldwide, among which one can find the Strasbourg University Finite Element Head Model (SUFEHM). This thesis aims at widening the human head biomechanics by studying infant head trauma. The research work has been conducted in two steps. In the first one, an infant eye numerical model was developed in order to study retinal hemorrhages. The second one consisted in improving the infant head model by integrating medical images data such as axonal fiber density and orientations into the infant brain and by validating the mechanical formulation of the infant skull in order to predict skull fractures.

Parmi les manifestations de la maltraitance de l’enfant, problème de santé publique, le traumatisme crânien infligé de l’enfant est une des premières causes de mortalité par maltraitance. L’objectif de cette thèse était d’évaluer l’opportunité d’un dépistage de la maltraitance physique de l’enfant. Le premier obstacle mis en évidence était l’imprécision et le manque de standardisation de la définition de la maltraitance physique. Face à cet obstacle,nous nous sommes interrogés sur la perception qu’avaient les professionnels de santé et les parents des urgences pédiatriques du CHU de Bordeaux de la violence physique des parents vis-à-vis de leur enfant. Les professionnels étaient plus tolérants vis-à-vis de ces violences.Une même situation était évaluée différemment selon le professionnel. Nous avons illustré la variabilité de perception d’une même situation lorsque l’enfant ne présente pas encore de conséquences graves de maltraitance à travers un cas clinique de traumatisme crânien infligé,ainsi que les craintes d’une stigmatisation des parents directement en lien avec la difficulté à identifier précocement ces situations et les effets négatifs que peut avoir la prise en charge.Enfin, nous avons simulé par un modèle de Markov, en tenant compte des incertitudes identifiées, l’impact d’un programme de prévention primaire et d’un programme de dépistage du traumatisme crânien infligé. Ce modèle a permis de confirmer l’intérêt d’un programme de prévention primaire. Il a également montré l’importance de déterminer les effets possibles d’une stigmatisation à tort des parents dans le cadre du dépistage pour s’assurer qu’un tel programme ne serait pas néfaste. / Among child abuse, which is a major public health issue, Pediatric Abusive Head Trauma is one of the major causes of death in abused children. The aim of this thesis was to assess the opportunity of screening for physical child abuse. The first identified obstacle was the lack of knowledge about the beginning of physical child abuse, and the vagueness and lack ofstandardization of its definition. Therefore, we conducted a study to assess the perception of physical violence by parents toward their children, by parents and professionals in the emergency department of the university hospital of Bordeaux. The professionals were more tolerant than parents and the perception of a same situation could vary according to the professional. We have illustrated this variation with a clinical case of Pediatric Abusive Head Trauma, when the child had not already serious consequences of child abuse. Similarly, the difficulty of early identification of abused children was responsible for the fear of mother’sstigmatization. And we discussed the impact of management of the children and their mother.Finally, we evaluated the impact of a primary prevention program and screening program ofPediatric Abusive Head Trauma using a Markov model considering identified uncertainties.The simulation confirmed the potential benefits of primary prevention program documentedthe huge uncertainty regarding benefits associated with screening of Pediatric Abusive HeadTrauma. Future research should in particular focus on describing the effects of wrong lyidentifying parents as abusers.

No description available.

Introduction : La réduction des inégalités sociales de santé est un objectif de santé publique au Canada. Les liens entre les facteurs socio-économiques et les traumatismes en général ont été abondamment mesurés et illustrés notamment en pédiatrie, mais l’association entre les traumatismes crâniens et les inégalités sociales n’est pas assez investiguée dans la littérature. L’intérêt de ce travail en santé publique nous permettra de mieux connaitre les liens entre la défavorisation et les traumatismes crâniens particulièrement la sévérité. Objectif : L’objectif général de cette étude est d’examiner la relation entre les traumatismes crâniens et le statut socio-économique. Méthode : L’échantillon comprend 2269 patients ayant consulté le service d’urgence de l’Hôpital du Sacré Coeur de Montréal entre le 17 Mars 2008 et le 11 Janvier 2012, âgés de 14 ans et plus et habitant Montréal et Laval. Des analyses de régression logistiques ont été appliquées pour examiner la relation entre le quintile du statut socio-économique (mesuré à l’aide d’un proxy écologique) et la sévérité du traumatisme crânien (mesuré à l’aide de la tomodensitométrie). Résultat : A Montréal et à Laval, la cote d’avoir un scan normal est plus élevée chez les patients de quintile de revenu plus pauvre Q1 par rapport au quintile de revenu plus riche Q5, avec les valeurs respectives de 1,104 et 1,522 pour les régions de Montréal et Laval. A Laval lorsqu’on passe du quintile le plus pauvre Q1 au quintile le plus riche Q5, les cotes diminuent de 1,522 pour Q1; 1,302 pour le quintile de revenu bas; 1,126 pour le quintile de revenu moyen; 1,176 pour le quintile élevé à 1 pour le quintile le plus riche (quintile de référence). Conclusion : Bien que la relation entre les traumatismes et le statut socio-économique soit non significative, plusieurs questions se posent à travers ce mémoire notamment les causes différentes du traumatisme crânien en fonction du statut socio-économique et le territoire de résidence. D’autres recherches plus approfondies seraient utiles pour mieux informer les programmes de santé publique. Mots Clés : Traumatisme crânien, Statut socio-économique, Santé publique, Inégalités sociales, Chutes, Accidents de la route, Causes de traumatisme, Quintile de revenu / Introduction: Reducing social inequalities in health is a goal of health public in Canada. The links between socioeconomic factors and injuries in general have been extensively measured and illustrated, but the association between head trauma and social inequality is not enough investigated in the literature. The interest of this work in public health will enable us to better understand the links between deprivation and brain injuries. Objective: The overall objective of this study is to examine the relationship between brain injury and socioeconomic status Methods: The sample included 2269 patients who consulted the emergency department of the Hôpital du Sacré-Coeur de Montréal from March 17th 2008 to January 11th 2012, and aged 14 and over and living in Montreal and Laval. Logistic regression analyzes were used to examine the relationship between socioeconomic status (measured using a proxy ecological) and the severity of head injury (measured by computed tomography). Results: A Montreal and Laval, the odds of having a normal scan are higher in patients poorest income quintile compared to Q1 richest income quintile Q5, with the respective values of 1.104 and 1.522 for the Montreal and Laval. A Laval when moving from the poorest quintile Q1 to Q5 the richest quintile, the odds decrease by 1,522 for Q1; 1,302 for the bottom quintile of income 1,126 for the middle income quintile, 1.176 for quintile 1 for the richest (quintile reference). Conclusions: Although the relationship between head trauma and the socio-economic status is not significant, several questions arise through this memory of different causes including head trauma based on the socio-economic status and age, area of residence. Other further research would be useful to better inform public health programs. Keywords: Head trauma, Socioeconomic Status, Public Health, Social Inequality, falls, Crashes, Causes of trauma, income quintile

No description available.