Relationship of family coping with head injury to family adaptation.

Investigated strategies families use to cope with a member's head injury and their relation to family adaptation. Participants were 150 primary caregivers of persons with head injuries who completed a family information sheet, the Frequency of Family Coping Behaviors rating form, and the General Functioning scale of the Family Assessment Device. Cluster analysis identified several family coping variables including positive appraisal, resource acquisition, family tension management, head injury demand reduction, and acquiring social support. Stepwise multiple regression indicated that positive appraisal and family tension management were predictive of family adaptation and supported the hypothesis that family adaptation can be predicted from variables measuring family coping with head injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The changing family relationships of adolescent girls.

The TAT is used to investigate the changing relationships of adolescent girls to their parents. The hypothesis posed is that the relationship between mother and daughter should be characterized by more conflict during the pubertal period, the relationship between father and daughter being more tranquil during the same period. Greater interaction, both disharmony and harmony, in the mother-off-spring relationship than in the father-offspring relationship is noted at all five age levels used in the experiment. However, the proportions of themes classified as equilibrium and disequilibrium remains the same in both relationships, suggesting the greater mother-offspring disharmony to be a function of greater interaction of mothers and daughters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of aggressive personality and family relationships in explaining family conflict.

This study investigated whether genetic and environmental influences on global family conflict are explained by parents' personality, marital quality, and negative parenting. The sample comprised 876 same-sex pairs of twins, their spouses, and one adolescent child per twin from the Twin and Offspring Study in Sweden. Genetic influences on aggressive personality were correlated with genetic influences on global family conflict. Nonshared environmental influences on marital quality and negative parenting were correlated with nonshared environmental influences on global family conflict. Results suggest that parents' personality and unique experiences within their family relationships are important for understanding genetic and environmental influences on global conflict in the home. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The impact of acquired hearing impairment on intimate relationships: implications for rehabilitation

Hearing disabilities, due to their interactive nature, strongly affect intimate relationships. This paper reviews the literature on this dimension of the experience of hearing impairment. The effects of progressive hearing loss and of the coping process within the couple are examined borrowing concepts from symbolic interaction theory. A summary of the interactive dimensions of the effects of hearing impairment on the couple is drawn from the relevant studies. Specific needs have been identified for each partner in terms of information, support and communication facilitation. Implications are drawn for the audiological rehabilitation of hearing-impaired adults.     

Sibling relationships for deaf children: The impact of child and family characteristics.

Objective: To examine factors that affect relationships between deaf children who use cochlear implants or hearing aids and their hearing siblings. Study Design: Qualitative analysis of interview data from parents of deaf children. Participants: Parents of 29 deaf children with at least 1 sibling; 20 children used cochlear implants and 9 used hearing aids. Main Outcome Measure: Quality of deaf-hearing sibling relationships as assessed by an ordinal scale developed by the authors. Results: Birth order, family size, parents' anxiety about deafness, and negative comparisons by parents of hearing and deaf siblings were key factors in sibling relationships. Conclusions: Family context is important in understanding experiences of deaf children and their hearing siblings. The model replaces assumptions of hearing loss as individual disability with an emphasis on the social determinants of managing differences in siblings' hearing status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value of CAT scanning following pediatric head injury

The CAT scan has proven invaluable in the management of severe pediatric head traumas. The most frequent findings are those of subarachnoid hemorrhage and diffuse swelling. Mass lesions are readily identified by the CAT scan, and it is easy to distinguish between hematoma and/or edema in the acute stages. Follow-up scans have produced a much better understanding of the long-term pathophysiologic effects of head trauma on the injured child.     

Cerebral hemodynamic response to CO2 after severe head injury: clinical and prognostic implications

PURPOSE: To evaluate the efficacy and safety of transcatheter oily chemoembolization therapy (TOCE) via the inferior phrenic artery (IPA) in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty patients with HCC underwent a total of 82 procedures of TOCE of the IPA, as well as of the hepatic artery. In 16 patients, additional extrahepatic collaterals were depicted and were also embolized in 10 patients. TOCE was performed with an emulsion of iodized oil and doxorubicin hydrochloride, and gelatin sponge particle embolization was added in 32 patients. RESULTS: Initial response showed complete or partial remission of the tumor in 31 patients. The cumulative survival rates after combined TOCE of the hepatic artery, IPA, and other extrahepatic arteries were 89% (6 months), 78% (1 year), 46% (2 year), and 30% (3 year), when calculated from the time of IPA chemoembolization. Liver abscess and empyema developed in one case of combined IPA and multiple intercostal artery chemoembolization. There were no serious complications after IPA chemoembolization alone. CONCLUSION: TOCE of the IPA has a potential therapeutic role as a safe adjunct to TOCE of the hepatic artery in the management of HCC supplied by the IPA.     

Imaging of closed head injury

The endocrinology of late gestation and parturition in the mare has been described, but unlike other domestic animal species, the factors that initiate parturition in the mare have not been elucidated. In contrast to ruminant species, maternal estrogen and progesterone concentrations do not change markedly, and a well-defined fetal cortisol surge is not observed just prior to parturition in the mare. Parturition is associated with large increases in prostaglandin and oxytocin concentrations, which induce uterine contractions and delivery of the foal. There are many methods of inducing parturition in term mares, but the most popular and safest method is through the administration of low-dose oxytocin.     

Dizziness from whiplash and head injury: differences between whiplash and head injury

OBJECTIVE: Large discrepancies exist in the literature regarding incidence and types of symptomatology in whiplash. This is because of the evolution of whiplash injury over the years with the advent of head rests and seat belts. Previous authors have regarded symptoms of dizziness as a result of brainstem or cerebellar injury or both. It has been difficult in those studies to ascribe a mechanism of injury, as patients with whiplash injury only have been grouped with those who have incurred mild traumatic brain injury as a result of a significant blow to the head. The authors saw the need to delineate patients who had suffered whiplash injury from those who also had suffered mild head injury, as defined in the rehabilitation-neurosurgical literature, to attempt to define differences in symptoms, abnormalities, and mechanisms of recovery in these two groups. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary-quaternary referral clinic. PATIENTS: The records of 36 patients were reviewed. Nineteen of these patients suffered a whiplash-associated disorder and 17 suffered a mild head injury as well. These patients were referred for assessment of symptoms persisting for at least 2 years after their injury. Patients were excluded if they had not completed clinical assessment, including electronystagmography (ENG) and computerized dynamic posturography (CDP). INTERVENTIONS: A full history, otolaryngologic examination, including assessment of eye movements, corneal reflexes and gait, as well as an investigation, including ENG and CDP, and history taking and detailed recording of related complaints immediately before diagnostic work-up were performed. MAIN OUTCOME MEASURES: Symptoms reported by patients who had received either whiplash alone or whiplash plus mild head trauma as defined in the literature were measured. Patients were classified according to type of accident, type of injury suffered, and degree and nature of posturographic abnormalities. RESULTS: Patients often have similar complaints regardless of whether or not they had suffered a head injury. Although CDP showed abnormalities in both groups, standard ENG assessment, including caloric testing, showed abnormalities only in the head-injured group. The posturographic abnormalities also were analyzed in both groups, and it was found that there was a correlation between the type of posturographic abnormality and the type of injury suffered. Although ENG testing is done routinely, posturography is shown to be more sensitive in picking up abnormalities. In addition, the authors have shown that posturography can delineate the type of injury suffered by exhibiting the compensation strategy used as well as the efficacy of that compensation strategy. CONCLUSIONS: Because ENG abnormalities are limited to patients who have suffered a head injury, the inference is that these two groups of patients have suffered damage at different sites along the balance system pathways, but both of these lesions can lead to similar symptoms. Although the mechanisms of whiplash injury and how they affect the vestibular system are poorly understood, posturography testing is essential in inferring how a patient is recovering by measuring how and how well the patient is overcoming his or her deficit. This has important medical legal implications regarding legitimizing a patient's problem, prognostic factors, as well as rehabilitation plans, measures, and outcomes.     

The significance of traumatic intraventricular haemorrhage in severe head injury

Since the advent of computed tomography (CT) traumatic intraventricular haemorrhage (IVH) has been diagnosed more often. It has reportedly been associated with a poor prognosis, but pure or solitary IVH is rare, suggesting that other lesions occurring concurrently with it may contribute to the poor outcome. In a series of 65 patients with severe head injury (GCS < or = 8), 14 (22%) had IVH on initial CT. Death rate in these 14 was 21%, not significantly different from that in patients without IVH (14%), although a significantly higher proportion of patients without IVH had a good outcome. These results suggest that mortality is related to other lesions associated with IVH rather than to IVH alone and that the presence of IVH does not necessarily lead to a poor outcome.     

Nonepileptic seizures after head injury

PURPOSE: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. METHODS: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. RESULTS: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. CONCLUSIONS: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.     

Minor head injury in children: current management practices of pediatricians, emergency physicians, and family physicians

OBJECTIVE: To describe variation in the clinical management of minor head trauma in children among primary care and emergency physicians. DESIGN: A survey of pediatricians, family physicians, and emergency physicians drawn from a random sample of members of the American Academy of Pediatrics, the American Academy of Family Physicians, and the appropriate American Medical Association specialty listings, respectively. Physicians were given clinical vignettes describing children presenting with normal physical examination results after minor head trauma. Different clinical scenarios (brief loss of consciousness or seizures) were also presented. Information was gathered on initial and subsequent management steps most commonly used by the physician. RESULTS: Surveys were returned by 765 (51%) of 1500 physicians. Of these, 303 (40%) were pediatricians, 269 (35%) family practitioners, and 193 (25%) emergency physicians. For minor head trauma without complications, observation at home was the most common initial physician management choice (n = 547, 72%). Observation in office or hospital was chosen by 81 physicians (11%). Head computed tomographic (CT) scan was chosen by 7 physicians (1%) and skull x-ray by 24 physicians (3%) as the first management option. Most physicians (n = 445, 80%) who initially chose observation at home would obtain a CT scan if the patient showed clinical deterioration. In the original scenario, if the patient had also sustained a loss of consciousness, 383 physicians (58%) altered management. Of these, 120 (18%) chose CT, 13 (2%) chose skull x-ray, 1 (1%) chose magnetic resonance imaging, 141 (21%) chose inpatient observation, and 125 (19%) chose a combination of CT scanning and observation. With seizures, 595 (90%) altered management, with 176 physicians (27%) choosing CT scan, 5 (1%) skull x-ray, 60 (9%) inpatient observation, and 299 (45%) a combination of radiological evaluation and observation. CONCLUSIONS: Most physicians surveyed chose clinic or home observation for initial management of minor pediatric head trauma. Clinical management was more varied when patients had sustained either loss of consciousness or seizures. Further study of the appropriate management of minor head trauma in children is needed to guide physicians in their care.     

Children's representations of attachment relationships in family drawings

Children's representational models of self and attachment figures were investigated in family drawings at age 8-9 in a high-risk, racially mixed sample. Drawings were scored using a series of specific signs and a group of theoretically derived, global rating scales. When specific signs were treated in a combined way (versus separately), they were significantly related to early attachment history in predicted ways. Similarly, specific rating scales were found to be significantly related to early relationship history. Analyses exploring the relative contributions of early attachment history and contemporary measures of child IQ, life stress, and emotional functioning revealed that even after contemporary influences were taken into account, attachment history made a significant contribution to the prediction of negative drawing outcome. Results were interpreted as supporting an organizational perspective on development where qualitative differences in early relationships are hypothesized to shape core representational models of the self and to exert an ongoing influence on later representational processes.     

Psychological implications of traumatic brain damage for the patient's family.

Discusses counseling to help families adapt to the behavioral and personality disturbances accompanying moderate to severe brain damage, namely those incurred in motor vehicle accidents. Families of brain-damaged patients often do not understand the nature and behavioral sequelae of the injury. Stresses in the family created by the patient's altered behavior can be compounded by unrealistically optimistic expectations. Family reactions to the sequelae go through 6 stages, as pleasure at the patient's return home is replaced by bewilderment and anxiety when energy and optimism wear thin; this stage is often followed by guilt, depression, despair, mourning, and reorganization and emotional disengagement. Psychological intervention can help families negotiate these stages by helping them to understand the nature and effects of the injury, facilitating more realistic expectations, and helping them work through the conflicts and pain engendered by the injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of family schema to family adaptation to brain injury

The relationship between family schema and family adaptation to brain injury was investigated. Participants were 87 primary caregivers of persons with brain injuries in Wisconsin who are part of a comprehensive, longitudinal study of family adaptation to having a member with a brain injury. Stepwise multiple regression of variables measuring family schema on family adaptation indicated that manageability and meaningfulness were predictive of family adaptation. Thus the hypothesis that family adaptation can be predicted from variables measuring family schema was supported. Family intervention and research implications are discussed.     

Learning and teaching styles: implications for teachers of family medicine

Glycine-conjugated, dihydroxy bile salts inhibit calcium hydroxyapatite (HAP) formation by binding to and poisoning nascent crystal embryos. Their taurine-conjugated counterparts bind less well to hydroxyapatite and do not inhibit its formation; but more hydrophobic, synthetic analogs of the taurine conjugated bile salts are inhibitors of hydroxyapatite formation. Because hydrophobicity is an important determinant of the ability of bile salts to inhibit hydroxyapatite crystal growth, experiments were performed to study the effect of the physiologically important mixed micelles of bile salt and phospholipid. Taurodeoxycholate/phosphatidylcholine (10:1) mixed micelles bound to HAP at lower total lipid concentrations than did pure taurodeoxycholate. At low total lipid concentrations, phosphatidylcholine (PC) binding appeared to predominate, suggesting that PC had a higher affinity than did taurodeoxycholate (TDC) for the HAP surface. Although glycodeoxycholate (3 mM) significantly (> 95%) inhibited hydroxyapatite precipitation, higher concentrations of taurodeoxycholate, either alone or mixed with phosphatidylcholine, did not affect hydroxyapatite formation. These results suggest that biliary phospholipids do not modulate the ability of bile salts to inhibit hydroxyapatite crystal growth.     

Treatment for family members in crisis after critical injury

The light-saturated rate of photosynthetic O2 evolution in Chlamydomonas reinhardtii declined by approximately 75% on a per-cell basis after 4 d of P starvation or 1 d of S starvation. Quantitation of the partial reactions of photosynthetic electron transport demonstrated that the light-saturated rate of photosystem (PS) I activity was unaffected by P or S limitation, whereas light-saturated PSII activity was reduced by more than 50%. This decline in PSII activity correlated with a decline in both the maximal quantum efficiency of PSII and the accumulation of the secondary quinone electron acceptor of PSII nonreducing centers (PSII centers capable of performing a charge separation but unable to reduce the plastoquinone pool). In addition to a decline in the light-saturated rate of O2 evolution, there was reduced efficiency of excitation energy transfer to the reaction centers of PSII (because of dissipation of absorbed light energy as heat and because of a transition to state 2). These findings establish a common suite of alterations in photosynthetic electron transport that results in decreased linear electron flow when C. reinhardtii is limited for either P or S. It was interesting that the decline in the maximum quantum efficiency of PSII and the accumulation of the secondary quinone electron acceptor of PSII nonreducing centers were regulated specifically during S-limited growth by the SacI gene product, which was previously shown to be critical for the acclimation of C. reinhardtii to S limitation (J.P. Davies, F.H. Yildiz, and A.R. Grossman [1996] EMBO J 15: 2150-2159).