Current health status and history of traumatic brain injury among Ohio adults

Prevention of Traumatic Brain Injury in the United States: Significance, New Findings, and Practical Applications

Traumatic brain injury (TBI) prevention programs aim to reduce trauma-related head injuries across the United States. In addition to epidemiological challenges, patients with TBI have a greater burden of disease and worse health outcomes than the general population. In these circumstances, the prevention of TBI is an important element in reducing the occurrence of post-traumatic health consequences in all settings and beyond. We completed a high-quality overview of TBI prevention programs using the public health approach to identify the most compelling risks to individuals through surveillance, data analysis, and field assessment. We explored the evidence-based programs that are proven to help individuals reduce the risk of TBI. To date, TBI programs have been very efficient, as evidenced by a sustained downturn in TBI incidence. However, recent socioeconomic and epidemiological challenges in the United States are affecting state and local TBI prevention efforts. This article is focused on strategies and solutions to reduce risks and/or consequences associated with head injuries from motor vehicle accidents in New York City. We believe this report is essential to guide the design and implementation of adequate preventive strategies and providing safe and high-quality patient care across all settings where healthcare is delivered.

A Tilted Axis: Maladaptive Inflammation and HPA Axis Dysfunction Contribute to Consequences of TBI

Each year approximately 1.7 million people sustain a traumatic brain injury (TBI) in the US alone. Associated with these head injuries is a high prevalence of neuropsychiatric symptoms including irritability, depression, and anxiety. Neuroinflammation, due in part to microglia, can worsen or even cause neuropsychiatric disorders after TBI. For example, mounting evidence demonstrates that microglia become “primed” or hyper-reactive with an exaggerated pro-inflammatory phenotype following multiple immune challenges. Microglial priming occurs after experimental TBI and correlates with the emergence of depressive-like behavior as well as cognitive dysfunction. Critically, immune challenges are various and include illness, aging, and stress. The collective influence of any combination of these immune challenges shapes the neuroimmune environment and the response to TBI. For example, stress reliably induces inflammation and could therefore be a gateway to altered neuropathology and behavioral decline following TBI. Given the increasing incidence of stress-related psychiatric disorders after TBI, the degree in which stress affects outcome is of particular interest. This review aims to highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis as a key mediator of stress-immune pathway communication following TBI. We will first describe maladaptive neuroinflammation after TBI and how stress contributes to inflammation through both anti- and pro-inflammatory mechanisms. Clinical and experimental data describing HPA-axis dysfunction and consequences of altered stress responses after TBI will be discussed. Lastly, we will review common stress models used after TBI that could better elucidate the relationship between HPA axis dysfunction and maladaptive inflammation following TBI. Together, the studies described in this review suggest that HPA axis dysfunction after brain injury is prevalent and contributes to the dynamic nature of the neuroinflammatory response to brain injury. Experimental stressors that directly engage the HPA axis represent important areas for future research to better define the role of stress-immune pathways in mediating outcome following TBI.