Changes in hemoglobin values in elite cross-country skiers from 1987-1999.

Hemoglobin data have been available from ski teams beginning from 1987, and from 1989 to 1999 we have followed hemoglobin values in elite cross-country skiers in international competitions. The mean values at the 1989 World Nordic Ski Championships were lower than population reference values, as would be expected from plasma volume expansion associated with endurance training. However, an increase, particularly in the maximal values, became obvious in 1994 and rose further in 1996. These extreme values provide both a health risk to the individual athlete and unfair competition. After a rule limiting hemoglobin values was introduced, the drop of the highest values was remarkable: among men 15 g/l (0.23 mmol/l) and among women 42 g/l (0.65 mmol/l). It would appear that the rule had achieved its goal of limiting extreme hemoglobin values. Yet the mean hemoglobin concentrations in men and women have continued to rise, suggesting the continued use of artificial methods to increase total hemoglobin mass.

Acute treatment of whiplash neck sprain injuries. A randomized trial of treatment during the first 14 days after a car accident.

STUDY DESIGN: A single-blinded, randomized treatment study with a follow-up period of 6 months. OBJECTIVE: To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident. SUMMARY OF BACKGROUND DATA: Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain. METHOD: Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period. RESULTS: There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache. CONCLUSIONS: The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury.

MRI of cerebrum and cervical columna within two days after whiplash neck sprain injury.

The present study was undertaken to evaluate if MRI within 2 days of a motor vehicle accident could reveal pathology of importance for understanding long-term disability after whiplash neck-sprain injuries. As part of a prospective study cervical and cerebral MRI was performed on 40 neck sprain patients with whiplash injury after car accidents. The imaging was done within 2 days of the injury to make sure that any neck muscle bleeding, oedema or other soft tissue injuries could be detected. The MRI findings from the patients were both correlated to reported symptoms 6 months after the accident and compared to a control group of 20 volunteers. The MRI of both brain and neck revealed no significant differences between the patients and the control group. When the patients were grouped according to the main MRI findings at intake and compared according to the development of subjective symptoms reported by the patients, the only significant difference was more headaches at 6 months in the groups with disk pathology or spondylosis when compared to the group with no pathology. In conclusion, MRI within 2 days of the whiplash neck-sprain injury could not detect pathology connected to the injury nor predict symptom development and outcome.

Personality profile among symptomatic and recovered patients with neck sprain injury, measured by MCMI-I acutely and 6 months after car accidents.

The relationships between personality and psychiatric symptoms and long-lasting physical symptoms were assessed in 88 neck sprain patients injured in car accidents. The Millon Clinical Multiaxial Inventory (MCMI-I) was completed at time of occurrence (intake) and 6 months after the injury. The neck sprain patients were divided into three subgroups according to symptoms 6 months after the accident. In addition, the total neck sprain group was compared with three other subject groups. The results indicated that the three neck sprain subgroups did not differ on the MCMI-I neither at intake nor 6 months later. The total neck sprain patients group was significantly different from patients with major depression on all scales of the MCMI-I, but not significantly different compared to patients with localized musculoskeletal pain. Compared to a group of health personnel, there were only a few significant differences. The study does not support the view that premorbid personality traits can predict outcome for neck sprain patients.

National health insurance consumption and chronic symptoms following mild neck sprain injuries in car collisions.

OBJECTIVE: To map the extent of sick leave and number of claims made for health insurance among persons who had suffered neck sprain (whiplash) injuries in traffic accidents, and to map subjective feeling of health and quality of life among patients several years after the injury. DESIGN: A retrospective study of neck sprain injuries after car accidents and a comparison to the patients' use of sick leave caused by neck pain prior to the accident. SETTING: The Emergency Clinic at The University Hospital in Trondheim, Norway. SUBJECTS: 426 patients with neck sprain injuries after car accidents during 1985-1990. MAIN OUTCOME MEASURES: Information from Trondheim Social Security office about sick leave, and results from 345 patients who answered a questionnaire with respect to quality of life measures. RESULTS: 27% had been reported sick during the period after the car accident, and 5% had claimed health insurance, 58% reported sustained symptoms linked to the accident. CONCLUSIONS: Many reported sustained symptoms after neck sprain injuries, 16% of them reported being in a bad state of health.

MR imaging and radiography of patients with cervical hyperextension-flexion injuries after car accidents.

Fifty-two patients underwent MR imaging and conventional radiography of the neck within 4 days after a hyperextension-flexion injury. The patients also had follow-up investigations during the first 2 years. The images did not reveal any serious lesions in any of them. Based on the main MR and radiographical findings the patients were divided into 4 groups; no findings, posture abnormalities, spondylosis and disc pathology (from MR images) or reduced intervertebral space (from the radiographs). The outcomes of the different groups were compared with reference to neck stiffness, neck pain and headache during a 2-year follow-up period. The patient groups did not correspond completely when diagnosed from MR imaging and radiography. However, patients with pre-existing spondylosis had more symptoms when examined by both modalities. Based on the radiographs, the group with posture abnormalities had significant fewer symptoms than the other groups.

[Abuse in marriages and living-together relationships]. / Mishandling i ekteskap og samboerforhold.

The authors have studied the type and frequency of cases of wife-battering attending an emergency outpatient clinic in Trondheim, Norway. Most patients were between 20 and 30 years old. They had multiple traumas, with a predominance of traumas near the head and neck region. Almost half (44%) of the abusers were unemployed, and most of them were 30-40 years old. Alcohol was reported as an important precipitating factor by 75% of the victims. Comparison with a corresponding study carried out ten years ago shows that the frequency of wife-battering seems to be almost unchanged.

[Sports in cold climate]. / Idrett i kaldt klima.

In winter sports, and in some summer sports as well, training and competitions take place under climatic conditions where it is necessary to be aware of the danger of hypothermia. Most of the lesions caused by hypothermia during sports activities are minor ones, but severe hypothermia may also occur. Lesions are encountered most frequently on the face, including the eyes, and on hands, feet and other frontal parts of the body. Special attention must be paid to risk of hypothermia in children. The organizers of sports competitions have a duty to provide proper rooms where athletes suffering from hypothermia can region their proper body temperature, and it should be possible for doctors or paramedics to take care of these and other injured athletes at the stadium, and if necessary accompany them to the nearest hospital.

[Sports medicine in Norway]. / Idrettsmedisin i Norge.

In Norway sports medicine is not organized as a single specialty among the medical disciplines. It involves work carried out by doctors with different specialties, dominated by physical medicine and rehabilitation, along with orthopaedic surgery, internal medicine, gynaecology and physiology. Preventive work, acute treatment and rehabilitation of injured athletes, as well as scientific work in the field of sports and sports medicine, are major elements of this field of medicine. It is important to educate medical students and doctors in sports medicine. This education started years ago at the university hospitals in Oslo and Trondheim. It is expected to be extended, and to become organized in future as an integrated part of the regular education of medical students and the post-graduate education of doctors.

[Symptoms in patients with neck injury after a car crash. A retrospective study]. / Symptomer hos pasienter med nakkeskade etter bilkollisjon. En retrospektiv undersøkelse.

139 persons who contacted The Regional Hospital, Trondheim, between 1 January and 1 September for whiplash injury caused by a car crash from behind were asked whether they still had problems six months or more after the accident. 51% reported having symptoms and 12% reported serious problems. Five persons were still out of work because of the neck injury. 63% of the questioned persons were female and the percentage of women increased with increasing symptoms. There was no correlation between age and problems. There were more persons without symptoms among office employees (70%), managers/university educated persons (53%) and students/pupils (50%) than among unskilled workers/professional drivers (35%) and housewives/retired persons/pensioners/unemployed (35%).

Accidents among children below school age. Changes of incidence after intervention.

Children aged 0 to 6 years old admitted to hospital due to an accident were registered. Registration was carried out for two yearly periods; September 1982 to September 1983 and June 1985 to June 1986. The incidence of accidents dropped from 125 per 1,000 a year to 116 accidents per 1,000 children a year. The youngest children showed the most significant decrease in incidence. Home accidents were the most common type of accidents in both registration periods. Accidents due to falling from heights and poisoning accidents increased in the second period. Children injured during the second registration period required 3.4 times fewer days of hospitalization compared with the first period. Fractures and thermal injuries demanded most hospital care in both registration periods.

Occurrence of injuries in a defined population.

A 1-year study of all registered accidents was carried out. All patients treated for an injury at the Trondheim University Hospital, Norway, were recorded. This is the only institution in the region treating injuries. Hence, this is a total injury registration in a defined population. The incidence rate was 114 injuries per 1000 inhabitants. Home accidents were the most common type. Accidents occurring at institutions, in traffic areas and at home caused the longest hospitalization. Most of the injuries were minor; 0.4 per cent of the accidents were fatal. Traffic accidents and home accidents were responsible for the highest percentage of fatal accidents. The demand for preventive measures and reduction of accidents has been based on mortality rates in comparable studies. The mortality rate is well reported for most of the civilized world but this does not tell us anything about the morbidity rate due to accidents. By reducing the accidents needing the longest hospitalization, the economic consequences for the national health system would also be decreased.

[Injuries in handball players]. / Skader hos håndballspillere.

The study involves 421 patients who had suffered injury while playing handball. It describes mechanism and trauma, the injuries and their consequences, and data on training and technical conditions. 2/3 of the injured were female and one half belonged to the younger age-classes. The incidence of injury was highest among senior players. Distortion was the most frequent type of injury, followed by contusions and fractures. Half of the injuries were to the upper limbs, but the most frequent single injury was injury to the ankle joint. Many fractures were seen in fingers, forearm, hand and ribs. Wounds occurred most frequently to the face. The most serious injuries were ruptures of the ligaments in the knee joint. Protective equipment, such as braces, was seldom used. A small minority of the players were given adequate first aid. Important measures to prevent injury include better basic training, better technical training conditions, good first aid, and some changes in the rules of competition.

[Requests for ambulances for patients with acute diseases and injuries. Are ambulance services abused?]. / Rekvirering av ambulanse til akutt syke og skadede. Misbrukes akuttambulansetjenesten?

The aim of this study was to describe the dispatch of emergency ambulance requests in Trondheim and to evaluate the medical justification of such ambulance missions. Data concerning 555 emergency ambulance missions were recorded from March to August 1986. A review of the cases shows that almost 40 per cent were unjustified. However, whether the ambulance missions were justified or not was significantly connected to the age of the patient and with the person requesting the ambulance. Missions requested by health care professionals and missions to elderly patients were the most justified ones. Furthermore, the mission was more justified in the case of internal medical problems than for surgical cases and trauma. We also discuss different ways of improving the use made of emergency medical services outside hospital.

[Grading and prognosis of abdominal injuries]. / Gradering og prognose ved abdominalskader.

The present study was carried out in order to find out the relationship between injury grading and the use of different resources and the result of the treatment in patients with intra-abdominal injuries. The injuries were graded according to two trauma scores: The Injury Severity Score and the Norwegian Injury Score. In 221 patients with intra-abdominal injuries there were good correlations between these two scores and the time of hospitalization, units of blood transfusions, need for respirator treatment and lethality.