Britt-Marie Stålnacke

Community integration, social support and life satisfaction in relation to symptoms 3 years after mild traumatic brain injury

Primary objective: To investigate the relation between psychosocial functioning (community integration, life satisfaction and social support) and symptoms (post-concussion, post-traumatic stress and depression) in persons with mild traumatic brain injury (MTBI) 3 years after the trauma. Methods: Population-based follow-up study of 163 patients. At follow-up, an assessment of community integration, social support, life satisfaction and symptoms was made. Results: Total score of Community Integration Questionnaire (CIQ) was negatively correlated to total score of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ, r = −0.270, p < 0.001) and to total score of the Beck Depression Inventory (BDI, r = −0.332, p < 0.001). Life satisfaction (LiSat-11) was negatively correlated to the RPQ (r = −0.459, p < 0.001), to total score of the Impact of Event Scale (IES, r = −0.365, p < 0.001) and to the BDI (r = −0.642, p < 0.001). Low levels of life satisfaction were common at follow-up. Conclusions: A large proportion of the individuals with MTBI experienced both psychosocial difficulties, with low levels of life satisfaction in particular and symptoms (post-concussion, post-traumatic stress and depression) 3 years after trauma. Since the possibility of pre-injury factors contributing to the condition at follow-up cannot be ruled out, the study indicates that all these factors should be taken into consideration in the management of persons with MTBI.

Playing soccer increases serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase in elite players : a pilot study

Primary objective: To analyse serum concentrations of two biochemical markers of brain tissue damage, S-100B and NSE (neurone-specific enolase), in male soccer players in connection to the game. Methods: Blood samples were taken in players before and after a competitive game and the numbers of headers and of trauma events during soccer play were assessed. Results: Both S-100B and NSE were significantly raised in serum samples obtained after the game in comparison with the pre-game values (S-100B: 0.118 ± 0.040 µg L−1 vs 0.066 ± 0.025 µg L−1, p < 0.001; NSE: 10.29 ± 2.16 µg L−1 vs 8.57 ± 2.31 µg L−1, p < 0.001). Only changes in S-100B concentrations (post-game minus pre-game values) were statistically significantly correlated to the number of headers (r = 0.428, p = 0.02) and to the number of other trauma events (r = 0.453, p = 0.02). Conclusion: Playing competitive elite soccer was found to cause increase in serum concentrations of S-100B and NSE. Increases in S-100B were significantly correlated to the number of headers, and heading may accordingly have contributed to these increases.

Playing ice hockey and basketball increases serum levels of S-100B in elite players: a pilot study

ObjectiveTo investigate changes in serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase (NSE) in ice hockey and basketball players during games. DesignDescriptive clinical research. SettingCompetitive games of the Swedish Elite Ice Hockey League and the Swedish Elite Basketball League. ParticipantsTwenty-six male ice hockey players (from two teams) and 18 basketball players (from two teams). InterventionsNone. Main Outcome MeasuresS-100B and NSE were analyzed using two-site immunoluminometric assays. The numbers of acceleration/deceleration events were assessed from videotape recordings of the games. Head trauma–related symptoms were monitored 24 hours after the game using the Rivermead Post Concussion Symptoms Questionnaire. ResultsChanges in serum concentrations of S-100B (postgame − pregame values) were statistically significant after both games (ice hockey, 0.072 ± 0.108 &mgr;g/L, P = 0.00004; basketball, 0.076 ± 0.091 &mgr;g/L, P = 0.001). In basketball, there was a significant correlation between the change in S-100B (postgame − pregame values) and jumps, which were the most frequent acceleration/deceleration (r = 0.706, P = 0.002). For NSE, no statistically significant change in serum concentration was found in either game. For one ice hockey player who experienced concussion during play, S-100B was increased more than for the other players. ConclusionsS-100B was released into the blood of the players as a consequence of game-related activities and events. Analysis of the biochemical brain damage markers (in particular S-100B) seems to have the potential to become a valuable additional tool for assessment of the degree of brain tissue damage in sport-related head trauma and probably for decision making about returning to play.

Serum concentrations of two biochemical markers of brain tissue damage S-100B and neurone specific enolase are increased in elite female soccer players after a competitive game

Background: It is a matter of debate whether or not ordinary heading of the ball in soccer causes injury to brain tissue. Objective: To analyse concentrations of the biochemical markers of brain tissue damage S-100B and neurone specific enolase (NSE) in serum of female elite soccer players in association with a competitive game. Methods: Venous blood samples were obtained from 44 female soccer players before and after a competitive game for analysis. The number of headers and trauma events (falls, collisions, etc) was assessed from videotape recordings for each player. Results: Concentrations of both brain damage markers were increased after the game (S-100B, 0.18 (0.11) v 0.11 (0.05) μg/l (p  =  0.000); NSE, 10.14 (1.74) v 9.05 (1.59) μg/l (p  =  0.001)). There was a significant correlation between changes in S-100B concentrations and both the number of headers (r  =  0.430, p  =  0.004) and the number of other trauma events (r  =  0.517, p<0.001). Conclusion: The concentrations of both S-100B and NSE were increased by game associated activities and events. The increases in S-100B concentration were significantly related to the number of headers and other trauma events, which indicates that both these factors may have contributed to these increases.

Low Bone Mass Density at Multiple Skeletal Sites, Including the Appendicular Skeleton in Amenorrheic Runners

Abstract. The aim of this study was to investigate any difference in bone mass at different sites between female long-distance runners with amenorrhea and those with eumenorrhea. We compared 10 amenorrheic and 10 eumenorrheic athletes to determine whether athletes with amenorrhea have lower BMD in multiple skeletal regions, including weight-bearing lower limbs. The amenorrheic group had experienced menstrual dysfunction ranging from 3 to 43 months. As a further control group, 16 eumenorrheic soccer players were compared with the former two running groups regarding their BMD measurements. The two groups were matched for age, height, and amount of training. Areal bone mineral density (BMD) was measured and was found to be significantly lower in the total body, humerus, spine, lumbar spine, pelvis, femoral neck, trochanter, total femur, femur diaphysis, tibia diaphysis and in the nonweight-bearing head of the femur in the amenorrheic group. Body weight, BMI, fat mass, and body fat percent were significantly lower in the amenorrheic group. The differences in the BMD of the head, humerus, femoral neck, total femur, femur diaphysis, and tibia diaphysis disappeared when adjusted for body weight. Compared with the soccer group, the amenorrheic subjects had significantly lower BMD values at all sites except for the head, Wards triangle, and femur diaphysis. Blood samples were obtained in the two running groups for analysis of osteocalcin, carboxy terminal telopeptide (ICTP), procollagen I (PICP), and estradiol. There were no significant differences between the groups but there was a strong tendency towards a lower estradiol level and a higher osteocalcin level in the amenorrheic group. A free estradiol index (FE2) was derived as the ratio of estradiol to sex hormone binding globulin (SHBG) and was significantly lower in the amenorrheic group. No difference in their daily intake of total energy, protein, carbohydrates, fiber, calcium, and vitamin D was observed. However, both groups showed a surprisingly low energy intake in relation to their training regimens. Stepwise regression analyses revealed that weight was the best predictor of spine BMD in both groups. Estradiol and FE2 were significant predictors of the BMD of the proximal femur in the eumenorrheic group, but did not predict any BMD site in the amenorrheic group. In conclusion, amenorrhea in athletic women affects trabecular and cortical bone in both axial and appendicular skeleton. However, some of the discrepancy can be explained by a lower body weight. Physical weight-bearing activity does not seem to completely compensate for the side effects of reduced estrogen levels even in weight-bearing bones in the lower extremity and spine.

One-year follow-up of patients with mild traumatic brain injury: Occurrence of post-traumatic stress-related symptoms at follow-up and serum levels of cortisol, S-100B and neuron-specific enolase in acute phase

Objective: To investigate serum levels of cortisol (a biochemical marker of stress), S-100B and neuron-specific enolase (two biochemical markers of brain tissue injury), in acute phase in mild traumatic brain injury patients and the occurrence of post-traumatic stress-related symptoms 1 year after the trauma. Methods: Blood samples were taken in patients (n = 88) on admission and ∼7 hours later for analysis. Occurrence of post-traumatic stress-related symptoms was assessed for 69 patients using items from the Impact of Event Scale questionnaire (IES) at follow-up at 15 ± 4 months after the injury. Results: Serum levels of cortisol were more increased in the first sample (cortisol/1, 628.9 ± 308.9 nmol L−1) than in the second blood sample (cortisol/2, 398.2 ± 219.4 nmol L−1). The difference between these samples was statistically significant (p < 0.001). Altogether 12 patients (17%) showed post-traumatic stress related symptoms at the time of the follow-up. Stepwise forward logistic regression analysis of symptoms and serum concentrations of markers revealed that only S-100B in the second sample was statistically significantly (p < 0.05) associated to symptoms (three symptoms of the avoidance sub-set of IES). Conclusion: A major increase in serum concentrations of cortisol indicates that high stress levels were reached by the patients, in particular shortly (∼3 hours) after the trauma. The association between the occurrence of post-traumatic stress related symptoms and serum levels of S-100B (generally considered as a biochemical marker of brain injury) seem to reflect the complexity of interactions between brain tissue injury and the ensemble of stress reactions.

Systematic Review of the Clinical Course, Natural History, and Prognosis for Pediatric Mild Traumatic Brain Injury : Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

OBJECTIVE To synthesize the best available evidence on prognosis after pediatric mild traumatic brain injury (MTBI). DATA SOURCES We searched MEDLINE, Embase, PsycINFO, CINAHL, and SPORTDiscus (2001-2012), as well as reference lists of eligible articles, and relevant systematic reviews and meta-analyses. STUDY SELECTION Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI pediatric cases. After 77,914 records were screened for the entire review, 299 studies were eligible and assessed for scientific rigor. DATA EXTRACTION Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from accepted articles into evidence tables. DATA SYNTHESIS Evidence from 25 accepted articles was synthesized qualitatively according to SIGN criteria, and prognostic information was prioritized according to design as exploratory or confirmatory. Most studies show that postconcussion symptoms and cognitive deficits resolve over time. Limited evidence suggests that postconcussion symptoms may persist in those with lower cognitive ability and intracranial pathology on neuroimaging. Preliminary evidence suggests that the risk of epilepsy is increased for up to 10 years after MTBI; however, there is insufficient high-quality evidence at this time to support this link. CONCLUSIONS Common post-MTBI symptoms and deficits in children are not specific to MTBI and appear to resolve with time; however, limited evidence suggests that children with intracranial pathology on imaging may experience persisting symptoms or deficits. Well-designed, long-term studies are needed to confirm these findings.

Long-term Follow-up of Patients with Mild Traumatic Brain Injury: A Mixed-method Study

OBJECTIVE To characterize the long-term consequences of mild traumatic brain injury regarding post-concussion symptoms, post-traumatic stress, and quality of life; and to investigate differences between men and women. DESIGN Retrospective mixed-methods study. SUBJECTS/PATIENTS AND METHODS Of 214 patients with mild traumatic brain injury seeking acute care, 163 answered questionnaires concerning post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire; RPQ), post-traumatic stress (Impact of Event Scale; IES), and quality of life (Short Form Health Survey; SF-36) 3 years post-injury. A total of 21 patients underwent a medical examination in connection with the survey. The patients were contacted 11 years later, and 10 were interviewed. Interview data were analysed with content analysis. RESULTS The mean total RPQ score was 12.7 (standard deviation; SD 12.9); 10.5 (SD 11.9) for men and 15.9 (SD 13.8) for women (p = 0.006). The 5 most common symptoms were fatigue (53.4%), poor memory (52.5%), headache (50.9%), frustration (47.9%) and depression (47.2%). The mean total IES score was 9.6 (SD 12.9) 7.1 (SD 10.3) for men and 13.0 (SD 15.2) for women (p = 0.004). In general, the studied population had low scores on the Short Form Health Survey (SF-36). The interviews revealed that some patients still had disabling post-concussion symptoms and consequences in many areas of life 11 years after the injury event. CONCLUSION Long-term consequences were present for approximately 50% of the patients 3 years after mild traumatic brain injury and were also reported 11 years after mild traumatic brain injury. This needs to be taken into account by healthcare professionals and society in general when dealing with people who have undergone mild traumatic brain injury.

Relationship between symptoms and psychological factors five years after whiplash injury.

OBJECTIVE The aims of this study were: to describe the frequency of whiplash-related symptoms and psychological factors in persons 5 years after a whiplash injury; to study the relationship between symptoms and psychological factors; to examine gender differences; and to investigate the cause of sick leave. METHODS Questionnaires addressing neck pain, pain intensity, whiplash-related symptoms, post-traumatic stress, depression, social support and life satisfaction were used. RESULTS Neck pain was reported by 59% of subjects, whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ) by 76%, depression (Becks Depression Inventory, BDI) by 22%, and post-traumatic stress (Impact of Event Scale, IES), by 38%. The scores of pain intensity and RPQ were correlated to BDI, IES and LiSat-11 scores. Men reported a lower level of quality of social support than women. Men reporting many symptoms also reported reduced availability of social interaction, whereas women with many symptoms reported reduced availability of attachment (i.e. lack of intimate partner, close family and friends). A multivariate logistic regression showed an association between sick leave and depression. CONCLUSION These findings indicate the importance of assessing possible relationships between symptoms, depression and post-traumatic stress in persons with long-term problems after whiplash injury, and of treating existing symptoms, especially depression. Because social support may play a role in recovery, social relationships should also be examined.

One-year follow-up of mild traumatic brain injury : cognition, disability and life satisfaction of patients seeking consultation.

OBJECTIVE To investigate cognitive function, symptoms, disabilities and life satisfaction of patients with mild traumatic brain injury who accepted consultation one year post-trauma. DESIGN Prospective study. PATIENTS Sixty-nine patients (16 accepted the consultation offered, 53 declined). METHODS At follow-up, the patients answered questionnaires about symptoms, disabilities (RHFUQ) and life satisfaction (LiSat-11). The patients who underwent consultation and their healthy control subjects were administered a neuropsychological evaluation. RESULTS In the group undergoing consultation, the number of cognitive tests with outcomes below cut-off limits (-1.5 SD) was statistically significantly higher compared with a control group (21 tests in 11 patients vs 8 tests in 7 control subjects; p=0.025). The number of patients with one or more disability was statistically significantly higher among patients with consultation than without (94% and 34%, respectively; p<0.001). Total RHFUQ score was statistically significantly higher for the group with consultation than without (5.9 +/- 3.7 and 1.1 +/- 2.3, respectively, p<0.001). The group with consultation exhibited a lower level of life satisfaction (41.5 +/- 10.4 vs 45.8 +/- 13.8 for the non-consulting group; p=0.057). CONCLUSION The high frequency of occurrence of disabilities and lower cognitive functioning, together with the lower level of life satisfaction, appear to characterize patients choosing consultation 1 year post-injury. This highlights the importance of offering consultation for persons suffering mild head injuries.