Traumatic brain injury (TBI) is a great burden for the society worldwide and the statisticsindicates a relative constant total annual rate of TBI. It seems that the present preventativestrategies are not sufficient. To be able to develop head safety measures against accidents ine.g. sports or automobile environment, one needs to understand the mechanism behindtraumatic brain injuries. Through the years, different test subjects have been used, such ascadavers, animals and crash dummies, but there are ethical issues in animal and human testingusing accelerations at injury-level and crash dummies are not completely human-like. In aFinite Element (FE) head model, the complex shape of the intracranial components can bemodeled and mechanical entities, such as pressure, stresses and strains, can be quantified atany theoretical point. It is suggested that the size of the head, the skull-brain boundarycondition, the heterogeneity, and the tethering and suspension system can alter the mechanicalresponse of the brain. It can be seen that the shape of the skull, the composition of gray andwhite matter, the distribution of sulci, the volume of cerebrospinal fluid and geometry of othersoft tissues varies greatly between individuals. All this, suggests the development of patientspecific FE head models.A method to generate patient specific FE head model was contrived based on the geometryfrom Magnetic Resonance Imaging (MRI) scans. The geometry was extracted usingexpectation maximization classification and the mesh of the FE head model was constructedby directly converting the pixel into hexahedral elements. The generated FE model had goodelement quality, the geometrical details were more than 90 % accurate and it correlated wellwith experimental data of relative brain-skull motion. The method was thought to beautomatic but some hypothetically important anatomical structures were not possible to beextracted from medical images. This leads to investigations on the biomechanical influence ofthe cerebral vasculature, the falx and tentorium complex. It was found that biomechanicalinfluence of the cerebral vasculature was minimal, due to the convoluting geometry and thenon-linear elastic material properties of the blood vessels. It suggests that futurebiomechanical FE head model does not necessarily have to include these blood vessels. Theinclusion of falx and tentorium in an FE head model has on the other hand a substantialbiomechanical influence by affecting its surrounding tissue. Therefore, in the investigation ofthe biomechanical influence of the sulci, the falx and tentorium were manually added to theanatomically detailed 3D FE head model. The biomechanical influence of the sulci haspreviously not been studied in 3D and the results indicated an obvious reduction of the strainin the model with sulci compared to the model without sulci in all simulations, and mostinteresting was the consistent reduction of strain in the corpus callosum. The development ofgyri not only produces a larger area for synapses but also forms the sulci to protect the brainfrom external forces.Based on the results, a patient specific FE head model for traumatic brain injury predictionshould at least include the skull, cerebrospinal fluid, falx, tentorium and pia mater, in additionto the brain. With these anatomically detailed 3D models, the injury biomechanics can bebetter understood. Hopefully, the burden of TBI to the society can be alleviated with betterprotective systems and improved understanding of the patients’ condition and hence, theirmedical treatments / QC 20100811

This quality study was carried out with seven semi-structured interviews and five of them were with elite women´s football coaches. What has been studied is how elite women’s football coaches are working with injury prevention training to their knees for the women’s football players. An anterior cruciate ligament injury in elite women’s football is both common and serious knee injury. This is a major problem area of ​​the anterior cruciate ligament injuries in women's football. In a squad of 20 women's football players occur an anterior cruciate ligament injury every two years. Injury prevention training is important to prepare the women's football players for the physical stresses that will arise during the season[1].  In this study includes, for example, theories of loss prevention training and risk factors for elite women’s football player to suffer an ACL injury. The interview guide has been focusing on the coach’s work and why they have chosen to use loss prevention training and how it can be planned and executed. This is to get information on how the elite women coaches working with the training to give the elite women football players the best position possible to prevent an ACL injury. The elite coaches have the help of physiotherapists, doctors and / or physiological coach with the loss prevention training must include for different exercises, and then determine the elite coaches themselves when it will be done during training week. In addition to interviews with the elite women coaches have also been interviewed by a physiotherapist and a doctor. This interview has been used to get information about the problem area with an ACL injury in elite women football. After that question I also touched on how and why the elite women’s football players should prevent this knee injury. The elite women’s football coaches all think the injury prevention training is important to use. This is to prepare women football players for the loads and stresses which will occur during the season. The loss prevention training is somewhat different in the five elite women´s football team that is part of my study. Any association uses a knee control program more than others, and cardio and strength training workouts vary in number. What unites them is that they all use a combination and the pulsation of the training. That is, they use both low and high intensity training and other training is a combination of different exercises and exercise. And they all have the injury prevention training scheduled throughout the season. [1] Martin Hagglund physiotherapist, interview February 8 2012, Markus Waldén orthopedic, interview  February 3 2012

Hockey is a popular sport, and at its highest levels, it is a complex contact game characterized by physical strength, speed, and skill. The interaction of these characteristics contributes to the inherent risk of injury athletes must face while playing. Among hockey injuries, concussions are one of the most commonly sustained by athletes across all levels of play and age groups. Significant public attention, combined with poorly understood long-term effects, indicates the importance of tangible preventive strategies. The main goal of this thesis was to understand, through video analysis, how playing characteristics and mechanism of injury contribute to concussions in the National Hockey League (NHL). In the first study, the development and validation of an observational recording tool used to code and analyze NHL concussions observed via video analysis was described. The second study attempted to synthesize the description of players’ characteristics, antecedent events, and contextual variables associated with events leading to concussion at the NHL level. Several specific risk factors for concussion in NHL players were identified, including position, body size, specific locations on the ice, and particular situations based on a player's position. The final study systematically analyzed how concussions occur to identify potential pattern(s) of concussions. A common specific injury mechanism characterized by player-to-player contact and resulting in contact to the head by the shoulder, elbow, or gloves, was also identified. When the principal mechanism was refined further, several important characteristics were discernable: (i) contact was often to the lateral aspect of the head; (ii) the player who suffered a concussion was often not in possession of the puck; and (iii) no penalty was called on the play. Collectively, these studies served to address gaps in the literature; the implications for informing prevention and management strategies are also discussed.

Hockey is a popular sport, and at its highest levels, it is a complex contact game characterized by physical strength, speed, and skill. The interaction of these characteristics contributes to the inherent risk of injury athletes must face while playing. Among hockey injuries, concussions are one of the most commonly sustained by athletes across all levels of play and age groups. Significant public attention, combined with poorly understood long-term effects, indicates the importance of tangible preventive strategies. The main goal of this thesis was to understand, through video analysis, how playing characteristics and mechanism of injury contribute to concussions in the National Hockey League (NHL). In the first study, the development and validation of an observational recording tool used to code and analyze NHL concussions observed via video analysis was described. The second study attempted to synthesize the description of players’ characteristics, antecedent events, and contextual variables associated with events leading to concussion at the NHL level. Several specific risk factors for concussion in NHL players were identified, including position, body size, specific locations on the ice, and particular situations based on a player's position. The final study systematically analyzed how concussions occur to identify potential pattern(s) of concussions. A common specific injury mechanism characterized by player-to-player contact and resulting in contact to the head by the shoulder, elbow, or gloves, was also identified. When the principal mechanism was refined further, several important characteristics were discernable: (i) contact was often to the lateral aspect of the head; (ii) the player who suffered a concussion was often not in possession of the puck; and (iii) no penalty was called on the play. Collectively, these studies served to address gaps in the literature; the implications for informing prevention and management strategies are also discussed.

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

Background: Prolonged sitting in an automobile seat may alter the passive tissue stiffness of the lumbar spine differentially in males and females. Gender specific ergonomic interventions may be indicated for the automobile seat design. Purpose: To compare time-varying passive lumbar spine stiffness in response to a two hour simulated driving trial with time-varying lumbar spine and pelvic postures during sitting in an automobile seat. A secondary purpose was to investigate gender differences in lumbar spine stiffness, seat/occupant pressure profile, discomfort rating and posture. Methods: Twenty (10 males, 10 females) subjects with no recent history of back pain were recruited from a university population. Participants completed a simulated driving task for two hours. Passive lumbar range of motion was measured on a customized frictionless jig before, halfway through and at the end of the two-hour driving trial. Changes in the passive moment-angle curves were quantified using the transition zone slopes, breakpoints and maximum lumbar flexion angles. Lumbar spine and pelvic postures were monitored continuously during the simulated driving trial with average and maximum lumbar flexion angles as well as pelvic tilt angles being calculated. Results: Both men and women initially demonstrated an increase in transitional zone stiffness after 1 hour of sitting. After 2 hours of sitting, transitional zone stiffness was found to increase in males and decrease in females. During sitting, women were found to sit with significantly greater lumbar flexion than males and to significantly change the amount of lumbar flexion over the 2 hour period of simulated driving. Conclusions: Postural differences during simulated driving were demonstrated between genders in this study. In order to prevent injury to the passive elements of the spine during prolonged driving, gender specific ergonomic interventions, such as improved lumbar support, are indicated for the automobile seat.

Background: Prolonged sitting in an automobile seat may alter the passive tissue stiffness of the lumbar spine differentially in males and females. Gender specific ergonomic interventions may be indicated for the automobile seat design. Purpose: To compare time-varying passive lumbar spine stiffness in response to a two hour simulated driving trial with time-varying lumbar spine and pelvic postures during sitting in an automobile seat. A secondary purpose was to investigate gender differences in lumbar spine stiffness, seat/occupant pressure profile, discomfort rating and posture. Methods: Twenty (10 males, 10 females) subjects with no recent history of back pain were recruited from a university population. Participants completed a simulated driving task for two hours. Passive lumbar range of motion was measured on a customized frictionless jig before, halfway through and at the end of the two-hour driving trial. Changes in the passive moment-angle curves were quantified using the transition zone slopes, breakpoints and maximum lumbar flexion angles. Lumbar spine and pelvic postures were monitored continuously during the simulated driving trial with average and maximum lumbar flexion angles as well as pelvic tilt angles being calculated. Results: Both men and women initially demonstrated an increase in transitional zone stiffness after 1 hour of sitting. After 2 hours of sitting, transitional zone stiffness was found to increase in males and decrease in females. During sitting, women were found to sit with significantly greater lumbar flexion than males and to significantly change the amount of lumbar flexion over the 2 hour period of simulated driving. Conclusions: Postural differences during simulated driving were demonstrated between genders in this study. In order to prevent injury to the passive elements of the spine during prolonged driving, gender specific ergonomic interventions, such as improved lumbar support, are indicated for the automobile seat.

Problem Statement: The burden of musculoskeletal injuries among workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results. Strong evidence for intervention effectiveness is lacking.<p> Specific Aims: The goal of this study was to evaluate the effectiveness of a patient handling injury prevention program implemented in the Saskatoon Health Region (SHR) comparing it with a non-randomized control group, Regina QuAppelle Health Region (RQHR), in a pre-post design. Injury rates, lost-time days, and claim costs were the outcomes of interest.<p> Intervention: A Transfer, Lifting and Repositioning (TLR) program, consisting of engineering and administrative ergonomic controls, was implemented in SHR hospitals from 2002-2005.<p> Methods: Data on time loss and non-time loss injuries, lost time days, and claims costs were collected from the SHR and RQHR for corresponding time periods one year pre and one year post-intervention. Age, length of service, profession, and sex were selected as covariates. Full Time Equivalents (FTE) data were collected for each time period. Univariate and multivariate Poisson regression were performed.<p> Results: Rates for all injuries (number of injuries/100 FTE) dropped from 14.68 pre-intervention to 8.1 post-intervention. Control group all injury rates, while overall lower in absolute value, dropped to a lesser degree, from 9.29 to 8.4. Time loss injury rates decreased from 5.3 to 2.51 in the SHR, while they actually increased from 5.87 to 6.46 in the RQHR, for the same intervention periods. Poisson regression showed the greatest reduction in injury rate, both time loss (Rate ratio=0.48, 95% C.I: 0.34-0.68) and non-time loss (Rate Ratio=0.25, 95% C.I: 0.15-0.41) in the smaller long term care facility controlling for hospital size. Analysis of injury rates, incidence rate ratios, and incidence rate differences showed significant differences between the intervention and comparison group for all injuries and time loss injuries. Mean claim cost/injury decreased from $3906.20 to $2200.80 and mean time loss days/claim decreased from 35.87 days to 16.23 days for the SHR.<p> Conclusions: The study provides evidence for the effectiveness of a multi-factor TLR program for direct-care health workers, and emphasizes their implementation, especially in smaller hospitals.

No description available.

Injuries are considered to be a major public health issue. More than 4600 people die each year and 10 % of all hospitalization in Sweden is related to injuries. The cost in a societal perspective is estimated to 59 billion a year. Injuries are possible to prevent. However it needs knowledge that the injury has occurred and the surrounding circumstances. This study used data from an accident and injury registration in outpatient health care, in the Swedish municipality of Gotland. The purpose of this study was to describe the injury patterns regarding place and cause of injury focused on age and gender differences. Data from the registration were categorized and statistically processed in SPSS after content analysis of narrative text.  Statistical measures used where frequencies, incidences and significances. The results show that there are more men than women who are injured in the ages 0-63 years. The largest number of injuries was found in the age group 0-19 years. Fall was the leading cause of injuries. Home was the most common place where injuries occurred. Existing statistics on a national level may have limited use in local injury prevention program. There could be specific determinants of injuries locally that have to be addressed. Local injury registration and analyzes that include demographic and socioeconomic factors could increase the potential for effective injury prevention. / Skador är ett stort folkhälsoproblem, drygt 4 600 personer dör varje år och 10 % av all sjukhusvård i Sverige är orsakade av skador. Samhällskostnaderna uppskattas till 59 miljarder kronor på år. En förutsättning för att kunna förebygga skador är att få vetskap om dem. Det krävs även kunskap kring hur olyckan har gått till. Denna studies data inhämtades från en olycks- och skaderegistrering, inom den öppna hälso- och sjukvården, på Gotland. Syftet med studien var att beskriva kontaktorsak, skadeplats och skadeorsak med fokus på ålders- och könsskillnader. Data från registreringsblanketter kategoriserades och behandlades statistiskt i SPSS efter att fritextbeskrivningar tolkats innehållsanalytiskt.  Statistiska mått som användes vid bearbetning av materialet var frekvenser, incidenser och signifikanser. Resultatet visar att det är flera män än kvinnor som skadar sig i åldrarna 0-63 år. Störst antal skadade återfanns i åldersgruppen 0-19. Fall var den främsta orsaken till skador. De flesta olyckor skedde i bostaden. Existerande statistik på riksnivå kan ha begränsad användning lokalt eftersom det kan finnas specifika bestämningsfaktorer för skador som påverkar skademönster. Lokala skaderegistreringar och analyser som innefattar demografiska och socioekonomiska faktorer kan öka möjligheterna till ett effektivt skadepreventivt arbete.