National Institute of Neurological Disorders and Stroke (NINDS)
TBI is a major public health problem, especially among male adolescents and young adults ages 15 to 24, and among elderly people of both sexes age 75 and older. Children age 5 and younger are also at high risk for TBI. TBI, a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.
This section provides examples of recent scientific advances from National Institutes of Health (NIH)-sponsored research and is not intended to be a comprehensive list.
U.S. Army soldiers hospitalized with a psychiatric disorder have a significantly elevated suicide risk in the year following discharge from the hospital, according to research from the Army Study to Assess Risk and Resilience in Service members (Army STARRS ), a partnership between the Army and the NIMH. The yearly suicide rate for this group, 264 per 100,000 soldiers, was far higher than the rate of 18.5 suicides per 100,000 in the Regular Army for the same study period. Administrative data show that 40,820 soldiers (0.8% of all Regular Army soldiers) were hospitalized with a psychiatric disorder in 2004–2009. Suicides occurring in this group during the year after a hospital discharge accounted for 12% of all Regular Army suicides during this period. Some of the strongest predictors of suicide include being male, having enlisted at an older age, having a history of criminal offenses during Army service, having had prior suicidal thoughts or actions, having disorders diagnosed during hospitalization, and having prior psychiatric treatment. This is the first publication from Army STARRS that demonstrates that Army/Department of Defense data can be used to identify specific subgroups within the Army that have very significantly elevated suicide risk. The high concentration of suicide risk among this study group, and particularly in the smaller highest-risk groups, might justify targeting expanded post-hospital interventions for such people.
Studies in Pakistan have shown that young children face a high burden of lifelong disability or death due to accidental injury in their homes, where they spend most of their time. Much harm could be avoided if adults were aware of the danger inherent in hazards such as uncovered water vats, unattended knives, open fires, and accessible toxins. A team of scientists led by Dr. Uzma Rahim Khan, a senior instructor at Aga Khan University, used assessment and education tools tailored to a low-income community to investigate whether disseminating risk information to caregivers of a child aged 1 to 5 years reduced hazards around the home. In a community-based pilot study, the team visited homes to assess hazards and to educate caretakers on how to lower injury risk by providing safety pamphlets and verbal tutorials during the home assessment. The team found that tutorials were more effective than pamphlets in mitigating the numbers of hazards. The applicability of the study's tools to low-income settings has inspired similar research projects in Malaysia and Nepal.
Bullying is a serious issue with lasting emotional, physical, and behavioral consequences. A new study found that bullying among students in grades six through ten declined significantly between 1998 and 2010. Fighting among students also declined, although less dramatically. Increased attention to bullying and responses by anti-bullying campaigns may be connected to the observed decline in bullying. The study focused on bullying in school and did not capture the impact of cyber-bullying, which may show a different trend, particularly as technology is increasing. An important future goal would be to investigate the consequences of bullying and the different forms it can take.
A new NIAAA- and NIDA-funded study shows an increased number of marijuana-positive Colorado drivers involved in fatal motor vehicle crashes since Colorado's legalization of medical marijuana in 2009. By comparison, no similar increase was seen in the 34 states that did not have medical marijuana laws when this study was conducted. During the same time period, there was no change in the number of alcohol-impaired drivers in fatal motor vehicle crashes in either Colorado or the 34 states with no legalization of marijuana. Although this study did not determine a cause-and-effect relationship between the marijuana use and the vehicle accidents, research shows that both alcohol and marijuana impair driving. The authors suggest that these findings underscore the need for enhanced education about the dangers of driving under the influence of drugs, including marijuana.
The largest study of mental health risk and resilience ever conducted among U.S. military personnel today released its first findings related to suicide attempts and deaths in a series of three JAMA Psychiatry articles. Findings from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) include: the rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed; nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment; and soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.
Drivers eat, reach for the phone, text, or otherwise take their eyes off the road about 10 percent of the time they are behind the wheel, according to a study using video technology and in-vehicle sensors. Risks of distracted driving were greatest for newly licensed teen drivers, who were substantially more likely than adults to be involved in a crash or near miss while texting or engaging in tasks secondary to driving, according to the researchers from the NIH and Virginia Tech. "Anything that takes a driver's eyes off the road can be dangerous," said study co-author Bruce Simons-Morton, Ed.D., M.P.H., of the NICHD. "But our study shows these distracting practices are especially risky for novice drivers, who haven't developed sound safety judgment behind the wheel."
There is more than meets the eye following even a mild traumatic brain injury. While the brain may appear to be intact, new findings reported in Nature suggest that the brain's protective coverings may feel the brunt of the impact. Using a newly developed mouse trauma model, senior author Dorian McGavern, Ph.D., scientist at the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, watched specific cells mount an immune response to the injury and try to prevent more widespread damage. Notably, additional findings suggest a similar immune response may occur in patients with mild head injury. In this study, researchers also discovered that certain molecules, when applied directly to the mouse skull, can bypass the brain's protective barriers and enter the brain. The findings suggested that, in the mouse trauma model, one of those molecules may reduce effects of brain injury.
Many adults and teens suffer tears to their anterior cruciate ligament (ACL) while playing sports. The American Academy of Orthopaedic Surgeons estimates that more than 100,000 ACLs are repaired each year. Some are for first-time patients, but others have reinjured their repaired knee or have torn the ACL in their other leg. NIAMS-funded researchers recently reported that within 6 years of their first surgery, approximately 19% of the 900 patients in the Multicenter Orthopaedic Outcomes Network (MOON) cohort study underwent at least one additional operation on the knee that already had been repaired, while 10% of patients needed surgery on the other knee. Younger patients were more likely to require subsequent surgeries. The rate of repeat surgery also was higher in patients treated with a cadaver (allograft) ligament than one from their own body. While the results of this study support the orthopaedic literature showing that ACL reconstruction is a safe and effective procedure in active people, they provide patients, parents, providers, coaches, and trainers with additional valuable information. Allograft tissue has long been associated with risk of rejection due to immuno-incompatibility and risk of infectious disease transmission. The identification of another potential complication further emphasizes the importance of discussing the tissue source for ACL reconstruction with patients. Moreover, healthcare providers also now have data that they can refer to when discussing the possibility of needing subsequent surgeries with patients who are planning to return to their previous activities.
Soldiers preoccupied with threat at the time of enlistment or with avoiding it just before deployment were more likely to develop post-traumatic stress disorder (PTSD) in a study of Israeli infantrymen. Such predeployment threat vigilance and avoidance, interacting with combat experience and an emotion-related gene, accounted for more than a third of PTSD symptoms that emerged later, say NIH scientists, who conducted the study in collaboration with American and Israeli colleagues. Soldiers performed a computerized task that required paying attention to locations of neutral words, such as "data," or threatening words, such as "dead." A faster reaction time for identifying the location of threat words indicated increased threat vigilance. Slower reaction times to such word locations indicated attention away from threat, or threat avoidance. As expected, soldiers who experienced higher combat exposure—for example, served in units operating outside Israel's security fence—tended to show more threat vigilance than those with less stressful assignments. Compared with soldiers who were neither vigilant nor avoidant on the eve of deployment, soldiers with greater vigilance at recruitment or avoidance at 6 months had more PTSD symptoms at the end of their first year of service.
A set of four questions that takes emergency department (ED) nurses or physicians less than 2 minutes to administer can successfully identify youth at risk for attempting suicide, reported a study. Most individuals who die by suicide have visited a healthcare provider 3 months to 1 year before their death. Typically, these patients saw an ED nurse and physician for some other health concern such as abdominal pain or headaches. These at-risk individuals often go unrecognized by ED staff who either lack the time or training to properly screen patients. To date, there are no screening instruments to assess suicide risk in children and adolescents who visit EDs for medical or surgical reasons. Based on results from the new questionnaire, 18.7% of the ED patients (98 of the 524) screened positive for suicide risk, most of whom had come to the ED with psychiatric concerns (84 of the 524). Elevated suicide risk was detected in 4.1% of the ED patients (14 of the 344) with medical/surgical concerns. Had it not been for the new screening tool, the suicide risk in these 14 patients most likely would have gone undetected.
Violence is the second leading cause of death for American adolescents and young adults. Such violence is alarmingly higher in racial and ethnic minorities. In the southwestern United States, Latino youth violence is particularly high. Therefore, effective violence prevention strategies for youth in Latino communities is critical, especially as the proportion of Latin youth throughout the country continues to rise. Researchers compared two different programs aimed at Latino adolescents to assess their effect on violence prevention. El Joven Noble is a culturally tailored character development program that focuses on maintaining healthy relationships with self, intimate partners, family, and community. It addresses relationship issues and violence prevention directly, using educational strategies including storytelling, crafts, and small group discussions. The Teen Medical Academy is a health career promotion program that focuses on common medical conditions and teaches human anatomy and pathology using hands-on diagnostic and therapeutic equipment. This program does not address violence prevention directly. Surprisingly, at 9 months after enrollment, high school students who participated in the Teen Medical Academy reported fewer acts of nonphysical aggression and fewer acts of physical violence than high school students who participated in the El Joven Noble program. Teen Medical Academy participants also reported fewer acts of intimate partner violence. The results suggest that an effective approach to decreasing youth violence may be to focus on promoting youth access to positive life options such as health-related careers.