Objective: The primary goal of this study was to investigate the possibility of a relationship between traumatic brain injury (TBI) and adolescent autonomy. Adolescents and their parent reported on lhree types of autonomy; renective autonomy, reactive autonomy, and functional independence. Adolescent cognitive skills, reading ability, and affective states, along with parent perceptions of !.he adolescents' executive functioning and parent-related stress were assessed in an attempt to elucidate the mechanisms through which TBI and autonomy interact. Participants and Methods: Participants included 20 adolescents, 12 to 19 years of age, with a history ofTS! and 19 age· and gender·matched adolescents wilh no history of TBI. Each adolescent was accompanied by one parent who completed parental reports while the adolescent underwent testing and completed questionnaires. Adolescents were screened for cognitive functioning and reading ability using subtests ofthe Reynolds Intellectual Assessment Scale (RIAS) and the Wide Range Achievement Test _ 4th Edition (WRAT4). Adolescents then completed questionnaires to assess depression (Beck Depression Inventory - 2nd Edition, SOl-TO and anxiety (Beck Anxiety Inventory, BAI). Lastly but most importantly. the adolescents completed questionnaires to assess reflective autonomy using a modified version of the Ryff Psychological Well Being Scale, and reactive autonomy (Adjectives Checklist, ACL). Meanwhile, parents completed a brief demographics questionnaire, a report of their adolescent's functional independence (Adaptive Behavior Assessment System II. ABAS-IO. executive functioning (Behavior Rating Inventory of Executive Functioning, BRIEF), and parenting-related stress (Stress Index for Parents of Adolescents, SlPA). Results: Significant group differences were noted on measures of reflective autonomy, but not on reactive aUlonomy. A history ofTBI was also influential in parent ratings of functional independence and executive functioning, but not levels of parent stress. The adolescents with TBI did not repon higher levels of depression or anxiety. Within the TBI group, significant correlations were found between parent ratings of adolescent functional independence and executive functioning, yet no correlations were found between adolescent and parent reports of autonomy, adolescent reports of autonomy and affect, or between parent ratings of adolescent functional independence/executive functioning and parent stress levels. Conclusions: These findings provide some indication of a potential relationship between TBI and both self-repons and parent repons of autonomy. Adolescent's with a history of TBI in this sample felt less in control of their decision making process regarding actions/behaviors, and were viewed by their parents as are less functionally independent. These findings do not provide any indication of a potential relationship between TBI and an adolescent's ability to resist external innuence. However, the number of participants was limited and there were several other factors which complicate the interpretation of this lack of difference between adolescents with and without TBI. Clearly. further investigation of this phenomenon is warranted, yet these findings suggest that clinicians working with adolescents with brain injury might benefit by considering both internal and external perceptions of autonomy in treatment implementation. / Graduate

Injuries are a serious public health concern and identifying risk factors for injury is a research priority. Previous research consistently supports the link between alcohol and risk of injury and between mental health and alcohol use. There is also some research to indicate an association between mental health and risk of injury. Given the nature of these independent relationships, examining how these variables are inter-related could have significant implications for injury prevention and informing public health policies. There is however, a dearth of research examining how mental health and alcohol interact and contribute to injury risk. The present study examines the independent and shared contributions of mental health and alcohol to injury. Furthermore, gender differences in these relationships are examined. The results indicate both alcohol use and mental health are significantly associated with increased risk of injury. Moreover, a synergistic effect between alcohol and mental health on injury is found among women. The implications for these results in practice and policy are discussed. / Graduate / 0622 / aroemer@uvic.ca

No description available.

Background: Survivors of severe acute kidney injury remain at high risk of death well-after apparent recovery from the initial event. Methods: We conducted a cohort study of hospitalized adults in Ontario from 1996 to 2008 with acute kidney injury who received temporary dialysis and survived for 90 days following discharge independent from dialysis. The exposure was nephrology follow-up. We used propensity scores to match individuals with early nephrology follow-up to those without. The primary outcome was time to mortality. Results : We identified 3877 patients with acute kidney injury who met the eligibility criteria. A total of 1583 patients had nephrology follow. The incidence of all-cause mortality was lower in those with early nephrology follow-up as compared to those without early follow-up (8.4 vs. 10.6 per 100 person-years, HR 0.76 (95% CI 0.62-0.93)). Conclusions: Nephrology follow-up after hospitalization with acute kidney injury and temporary dialysis was associated with improved survival.

Background: Survivors of severe acute kidney injury remain at high risk of death well-after apparent recovery from the initial event. Methods: We conducted a cohort study of hospitalized adults in Ontario from 1996 to 2008 with acute kidney injury who received temporary dialysis and survived for 90 days following discharge independent from dialysis. The exposure was nephrology follow-up. We used propensity scores to match individuals with early nephrology follow-up to those without. The primary outcome was time to mortality. Results : We identified 3877 patients with acute kidney injury who met the eligibility criteria. A total of 1583 patients had nephrology follow. The incidence of all-cause mortality was lower in those with early nephrology follow-up as compared to those without early follow-up (8.4 vs. 10.6 per 100 person-years, HR 0.76 (95% CI 0.62-0.93)). Conclusions: Nephrology follow-up after hospitalization with acute kidney injury and temporary dialysis was associated with improved survival.

The anterior cruciate ligament (ACL) stabilizes the knee during various sporting activities and has great importance as the knee relies entirely on the ligaments and muscles for stabilization. The ACL commonly gets injured during sports activities such as basketball, soccer, and football. In the United States over 80,000 ACL injuries occur every year. There has been decades of research performed on ACL injuries regarding the injury mechanisms of non-contact ACL injuries, but yet they are still not well understood. This is mainly because trials and tests cannot be conducted on live subjects to understand the injury mechanisms. Existing in-vivo and in-vitro studies in the literature do not relate the effects of dynamic knee muscle forces and kinematics of sports activities with the strain in the ACL. In this thesis, in-vivo and in-vitro approaches are combined to quantify the effects of muscle group forces on ACL strain during jump landing. This is done by first obtaining muscle force profiles of the knee by performing motion capture and inputting the ground reaction forces and kinematics into a musculoskeletal model. Using the muscle forces and a six axis sagittal plane dynamic knee injury simulator the jump landing simulation can be performed. Six electromechanical actuators controlled by a multi-axis control system apply dynamic muscle forces at the insertion sites of the hamstrings, quadriceps, gastrocnemius, and a hip moment to simulate the hip flexors. The ACL strain is measured using a differential variable reluctance transducer mounted on the ACL. Our results show that the simulator is able to successfully perform jump landing. The muscle force-time profiles tracked the input very well. The ACL strain from our studies fell within a reasonable level compared to data from other studies of jump landing. This simulator has proven to be successful in simulating high-risk motions.

Brain injuries (BI) are the leading cause of death and disability among people under the age of 45 (Ontario Brain Injury Association, 2004). With improved survival rates, more individuals each year return to the community with impairments and disabilities caused by their injury (Smith, Magill–Evans, and Brintnell, 1998). Adjusting to these impairments may affect the individual’s subjective well being; therefore, attention to community reintegration by researchers, policy developers, and health care providers is important. Using qualitative research methods and systems theory as the theoretical framework, the purpose of the study was to examine community reintegration from the perspectives of three key groups: individuals with BI, community based agencies, and primary care physicians regarding the meaning attributed to “successful reintegration”, as well as the key characteristics and barriers experienced during reintegration. “Successful” reintegration appears to be an individually derived concept. Participants consistently identified the need for information about the process of community reintegration, and resources available both during rehabilitation and after discharge from the hospital as being both a key aspect of community reintegration, as well as a barrier experienced during the return to community.

The original purpose of this investigation was to determine if soccer players who performed an agility training program in a specialized training shoe would have a lower incidence of acute ankle sprains as compared to controls. Two elite male college soccer teams participated in the study. The experimental team performed an agility training program two to three days per week over a three month period wearing the Nike Free Trainer. Data on ankle sprain incidence throughout the season was collected, as well as scores on tests of ankle strength, static balance, dynamic balance, agility and self-reports of ankle function. These scores were compared to those of the control team. Statistical analysis showed a statistically significant improvement in the experimental team members in the anteromedial reach direction of the dynamic balance test (p=0.001). This group also showed positive trends in ankle strength ratio and five of the eight other reach directions of the dynamic balance test. Unfortunately, pre-test, post-test statistical analysis was possible for only half of the experimental team subjects. Post-test data was not generated for the other half of these subjects due to unrelated injury or subject noncompliance. Lack of pre-test data due to subject non-compliance in the control team hindered between group statistical comparisons. This study uncovered promising trends as to the potential for gains in dynamic balance as a result of agility training with Nike Free Trainer. This study also established the reliability of three clinical tests of ankle strength, static balance and dynamic balance. Future well-designed studies are recommended to research this area further to discern the effect of this agility training program on dynamic balance and establish its’ effect on ankle sprain incidence.

Information from injury data collections is widely used to formulate injury policy, evaluate injury prevention initiatives and to allocate resources to areas deemed a high priority. Obtaining quality data from injury surveillance is essential to ensure the appropriateness of these activities. This thesis seeks to develop a framework to assess the capacity of an injury data collection to perform injury surveillance and to use this framework to assess the capacity of both injury mortality and morbidity data collections in New South Wales (NSW) Australia to perform work-related or motor vehicle crash (MVC)-related injury surveillance. An Evaluation Framework for Injury Surveillance Systems (EFISS) was developed through a multi-staged process, using information from the literature to identify surveillance system characteristics, SMART criteria to assess the suitability of these characteristics to evaluate an injury data collection, and by obtaining feedback on the characteristics from a panel of surveillance experts using a two round modified Delphi study. At the conclusion of development, there were 18 characteristics, consisting of 5 data quality, 9 operational, and 4 practical characteristics, that were identified as important for inclusion within an EFISS. In addition, a rating system was created for the EFISS characteristics, based on available evidence and reasonable opinion. The evaluation of six injury data collections using the EFISS for their capacity to perform either work- or MVC-related injury surveillance illustrated the inability of any of the data collections to enumerate all cases of either work- or MVC-related injury mortality or morbidity in NSW or to capture all of the data considered necessary for work- or MVC-related injury surveillance. This evaluation has identified areas for improvement in all data collections and has demonstrated that for both work- and MVC-related injury surveillance that multiple collections should be reviewed to inform both work- and MVC-related policy development and injury prevention priority setting in NSW. The development of an EFISS has built upon existing evaluation guidelines for surveillance systems and provides an important step towards the creation of a framework specifically tailored to evaluate an injury data collection. Information obtained through an evaluation conducted using an EFISS would be useful for agencies responsible for injury data collections to identify where these collections could be improved to increase their usefulness for injury surveillance, and ultimately, for injury prevention.

Rugby league is an international collision sport. Players complete physically demanding activities such as running, tackling and passing which often result in musculoskeletal injuries. Injury rates increase as playing level increases. From 1999 to 2007 there were 42,754 rugby league claims costing Accident Compensation Corporation $48,704,704. Moderate to severe injury claims (MSC) represented 14% of these claims but 88% of costs. New Zealand Maori recorded significantly more injury claims and total injury entitlement costs than all other ethnic groups. Soft tissue MSC injuries were common (47%) for females. Concussions accounted for 70% of total rugby league injuries to the head while the knee represented 23% of total injury claims and 20% of injury costs. Neck and spine injuries accounted for 6% of total MSC injury claims but 16% of total MSC costs. In video analysis of 80 games at international, national and youth competition levels, 50% of tackles involved tacklers from behind the visual fields of the ball carrier, either two or three tacklers, and contact with the mid-torso or hip-thigh region. From the prospective injury analysis of one professional team over two consecutive years, tackle-related injuries occurred more to the ball carrier when tackled at shoulder or mid-torso height, in their blind vision, with two or more tacklers, and in the fourth quarter of matches. Tackle-related injury type and site varied by positional group. Hit-up forwards and outside backs recorded more tackle-related injuries as the ball carrier than the tackler. In the prospective study of 63 amateur rugby league players, 80% of players injured as a result of match or training activities saw a health professional as part of their rehabilitation. Team coaches asked players to return to rugby league activities in 28% of cases for training participation and 29% of cases for match participation. In the cross sectional study assessing 95 rugby league support personnel's first aid, injury prevention and concussion knowledge, only 2% achieved an 80% pass mark, 39% incorrectly stated loss of consciousness was required for concussion and only 24% of coaches had a rugby league coaching qualification. This PhD research has contributed knowledge regarding costs and characteristics of injuries to amateur rugby league participants analysed by ethnicity, gender, injury site and injury type. Changes in anthropometric characteristics and speed in regards to incidence of injury, characteristics of tackles in match situations and common tackling positions and positional groups where injuries occur, player perspectives on why they return from injury to participation in rugby league, and the lack of first aid knowledge for rugby league personnel, have all been described.