One year psychosocial outcome in head injury

Dermatoglyphic traits in an endogamous community of the village Chmelnica (North-Eastern part of Slovakia) are reported and their frequency is compared with an average Slovak population. The results of this study demonstrate the regional variability and the particular dermatoglyphic specificity of the investigated population. The most conspicuous are the increased intergender differences in the course of the main lines on the palms, their consequently higher quantitative expression by indices, and the higher quantitative values of total line numbers on fingers that was observed for females of our sample.     

Cochlear implants in children: an analysis of use over a three-year period

OBJECTIVE: This study aimed to determine whether children continue to wear their cochlear implant systems 1 and 3 years after implantation. STUDY DESIGN: The design was a prospective study based on the analysis of forced-choice questionnaires on implant use completed independently by parents and teachers. SETTING: The study was performed at a dedicated pediatric cochlear implant program in a tertiary referral center in the United Kingdom. PATIENTS: All 85 consecutively implanted children who had reached the 1-year interval after implantation and 37 children who had reached the 3-year assessment interval after implantation participated. The patients represented all socioeconomic status groups, the entire range of educational settings, and often lived at a considerable distance from the implant center. MAIN OUTCOME MEASURES: Parents and local teachers were asked to describe implant use in the following categories: 1) all of the time; 2) most of the time; 3) some of the time; and 4) none of the time. RESULTS: One year after implantation, parents and teachers, respectively, rated 79 (93%) and 82 (96%) children as full-time users (category 1). Parents rated six children (7%) as users most of the time (category 2), and teachers rated three children (4%) as users most of the time. No child was rated as an occasional or nonuser (category 3 or 4). At 3 years after implantation, 33 (89%) and 34 (95%) children were rated as full-time users (category 1) by parents and teachers, respectively. Parents judged four children (11%) and teachers rated two children (5%) to be users most of the time (category 2). Again, no child was rated in category 3 or 4 as an occasional or nonuser. CONCLUSIONS: The majority of implanted children use their implant systems all of the time over a 3-year period after implantation when selected appropriately and given appropriate follow-up.     

Splenic injury in children: a 10 year experience

The aim of this report was to review retrospectively the management of splenic trauma at a major Australian tertiary referral centre (Westmead Hospital) over a 10 year period. Forty-nine patients (0-15 years of age) with documented blunt splenic trauma were identified. The causes of splenic injury were road trauma (73%) and falls (27%). There were 22 minor injuries (Injury severity score [ISS] < 16) and 27 severe injuries (ISS > or = 16). All nine deaths were related to road trauma (mean ISS = 59). The investigation most commonly used was CT scanning (47%). Peritoneal lavage was performed in six patients (12%). Management involved non-operative care in 29 patients (57%), exploratory laparotomy alone in 5 (10%), splenic salvage in 2 (4%) and splenectomy in 13 (26%). This experience supports the view that non-operative management of splenic injury in haemodynamically stable children is safe and is the preferred treatment. Experienced assessment and meticulous observation is necessary. Laparotomy is indicated if there is continuing haemodynamic instability despite resuscitation. Operative management is aimed at splenic salvage with splenectomy being reserved for uncontrolled haemorrhage.     

Clinical evaluation of four dental amalgams over a three year period

The aim of this study was to compare the clinical durability of four dental amalgams. In each of eighty-two patients one class 2 cavity was restored with Dispersalloy (Johnson and Johnson) which served as the control and all the other class 2 cavities were randomly restored with one of the following amalgams: Amalgaphase, Amalga 43 (Amalgam Alloys-South Africa) or Permite C (Southern Dental Industries). Matrix bands were placed and Kalzinol bases and Polyvar varnishes applied in all cavities. The amalgams were mixed according to the manufacturers' instructions, the cavities overpacked with amalgam, condensed by hand, carved and then burnished with a ball burnisher. Twenty-four hours later all restorations were polished and colour photographs taken. The restorations were evaluated using the Ryge and Snyder (1973) evaluation system, as well as comparison of the colour photographs. The Fisher's Exact Test was used for the statistical analysis. The two South African manufactured amalgams compared well with the two imported amalgams. However, at the end of the third year the score for the marginal integrity of Amalgaphase, one of the local products, was significantly different (p < 0.083) and inferior to that of the control, Dispersalloy. Evidence is produced to suggest that over a three year period Amalgaphase performed better than Dispersalloy, Amalga 43 and Permite C.     

Aetiological and epidemiological aspects of acute head injury in Malawi

One hundred and four patients (88 males and 16 females) with acute head injuries admitted to the Queen Elizabeth Central Hospital, Blantyre from July 1st to December 31st 1995 were prospectively studied using a questionnaire. Forty seven (45.2%) of the injuries were caused by road traffic accidents, 42(40.4%) by assaults, nine (8.7%) resulted from falls from heights, two (1.9%) from occupational injuries and the remaining four (3.8%) were of miscellaneous origins. RTA associated head injuries involved 17 (36.2%) pedestrians; 14 (29.8%) vehicular passengers, 10 (21.3%) pedal cyclists; five (10.6%) drivers and one motor cyclist. Malawi males aged between 20 and 29 were mostly involved. Assault related head injuries occurred also in young adult males commonly at the weekend with more than 50% occurring on Saturday and Sunday. Fifty per cent were sustained at home, a quarter on the streets and surprisingly few at drinking houses making them the safest place to be in Malawi to avoid assaults! Alcohol usage was not statistically significant among those assaulted; it was not possible to define its aetiological role among assailants. The head injuries associated with falls from heights (FFH) involved eight males and one female; five were children. Strategies for the prevention of assaults, the various types of road traffic accidents and falls from heights are discussed.     

Trend of bacterial meningitis in children over a 14 year period (1981 through 1994) in Japan--an analysis based on studies in 27 institutions]

We observed 266 children with purulent meningitis in 27 institutions in Japan during the 14 years from 1981 on dividing these years into 3 periods, 1981-1985, 1986-1990 and 1991-1994, and studied the trend of causative organisms identified in 254 among the 266 patients. Their ages were less than 3 months after birth in 50 children and 3 months or older in 216: there were 141 boys and 125 girls. The causative organisms were H. influenzae in 134 patients and S. pneumoniae in 50, most of them being aged 3 months or older. Next to the above bacteria ranked S. agalactiae in 29 and E. coli in 12, many of the patients were aged less than 3 months. Staphylococcus spp. was found in 7 patients and about 70% of them were aged 3 months or older. L. monocytogenes was found in 4 patients and N. meningitidis in 3 and they were aged 3 months or older in both patient groups. S. pyogenes, Enterococcus spp., Peptostreptococcus spp., P. Mirabilis and Enterobacter spp. were detected each in 1 patient. The causative organism was unknown in 21 patients and there was no double infection. H. influenzae were detected in 18 patients in 1981-1985 period (36.7%), in 56 in 1986-1990 (54.9%) and in 60 in 1991-1994 (63.8%) showing an increasing tendency, but S. pneumoniae exhibited neither an increasing nor decreasing tendency. There was a decreasing tendency with S. agalactiae and E. coli, but the details were not clear because there were few patients aged less than 3 months. Although the period of coexistence of 4 main bacterial species was not made clear in this study. Listeria is considered to develop mainly in the early childhood, and we believe that the conventional way of using a cephem preparation and ampicillin combined for patients under 6 years need not be altered. However, panipenem (phonetic) is likely to be effective for insensible S. pneumoniae for the time being.     

Verbal rehearsal and memory in children with closed head injury: a quantitative and qualitative analysis

Nine closed head injured (CRI) children (mean age = 11.4 years) with post-onset intervals of seven months to eight years were studied. The CRI children ranged from mild-moderate to severely impaired. Nine normally developing children (mean age = 10.9 years) served as controls. An overt rehearsal free recall task was used. Subjects were instructed to "think aloud" following presentation of each item to-be-recalled. Quantitative analyses suggested impaired verbal recall and inefficient, passive rehearsal strategy use in severely injured subjects. Mild-moderate subjects performed similarly to controls and exhibited active rehearsal strategy use. Qualitative analysis revealed differences between CRI subjects and controls' range of rehearsal strategies, monitoring and metamemory. Implications for clinical assessment and intervention with respect to use of rehearsal strategies are discussed.     

Changes in psychiatric admission MMPI profiles over a period of 15 to 20 years

An attempt was made to compare admission MMPI profiles of a matched sample of psychiatric inpatients over a 15- to 20-year period. For both males and females, significant decreases in MMPI indices of psychopathology occurred. Possible reasons for this decrease are presented.     

Central pontine myelinolysis at autopsy; a twelve year retrospective analysis

Central pontine myelinolysis (CPM) was first described in 1959 and only later was associated with a rapid, sustained rise in serum sodium from a hyponatremic baseline. This discovery in 1981 led to modifications in recommendations for clinical treatment of hyponatremia. Our interest has been in tracking the incidence of CPM found at autopsy by year to see whether changes in medical treatment in hyponatremia have resulted in a decrease in CPM over time. Clinically asymptomatic CPM found at autopsy has always been at least as frequent as cases diagnosed premortem and serves as a reasonable indicator for the incidence of the disease. In over 3,000 autopsies, on most of which the brain was examined macroscopically and microscopically by the same neuropathologist, we have discovered 15 cases of asymptomatic, small pontine CPM. Of these 15, 6 were active lesions and 9 were remote; in the active group, 5 of the 6 cases were associated with a rapid, sustained rise in serum sodium during the appropriate time period. The incidence of asymptomatic CPM has remained steady over the 13-year time period. In contrast, we have encountered no cases of CPM diagnosed premortem that have come to autopsy in the same time period. These cases emphasize that CPM still occurs, but most often as an asymptomatic disorder with small, midline pontine lesions. When small active CPM is found, it still is associated with a rapid sustained rise in serum sodium.     

Discourse after closed head injury in young children

This study examined narrative discourse in 23 children, ages 6 to 8 years, who sustained a severe closed head injury (CHI) at least 1 year prior to assessment. Narratives were analyzed at multiple levels using language and information structure measures. Results revealed significant discourse impairments in the CHI group on all measures of information structure, whereas differences in the linguistic domain failed to reach significance. In addition, effects of age at injury and lateralization of lesion on discourse were considered. Although no significant differences were found according to age at injury, a consistent pattern of generally poorer discourse scores was found for the early injured group (< 5 years). With regard to lesion focus, the group findings were unimpressive. However, preliminary examination of individual CHI cases with relatively large lateralized lesions suggested that the late injured children may show the language-brain patterns reported in brain-injured adults, whereas early injured children may not.     

Musculoskeletal symptoms and job strain among nursing personnel: a study over a three year period

OBJECTIVES: To examine the variation of symptoms from the neck, shoulders, and back over a three year period among female nursing personnel and the relation between job strain and musculoskeletal symptoms. METHODS: At a county hospital the female nursing personnel answered a questionnaire at baseline and then once a year over a period of three years. There were 565, 553, 562, and 419 subjects who answered the questionnaire at the first, second, third, and fourth survey, respectively. Of the study group, 285 nursing personnel answered the questionnaire on four occasions. Ongoing symptoms of the neck, shoulders, and back were assessed by means of a 10 point (0-9) scale with the verbal end points "no symptoms" and "very intense symptoms." Cases were defined as nursing personnel reporting ongoing symptoms, score > 6, from at least one of the body regions. For assessments of job strain, a Swedish version of Karasek and Theorell's model was used. RESULTS: Of the 285 subjects, 13% were defined as cases at all four assessments, and 46% varied between cases and not cases during the study period. In the repeated cross sectional surveys the estimated rate ratio (RR) for being a case was between 1.1 and 1.5 when comparing the group with job strain and the group without job strain. For the combination of job strain and perceived high physical exertion the estimated RR was between 1.5 and 2.1. When the potential risk factors were assessed one, two, or three years before the assessment of symptoms the estimated RR for becoming a case was between 1.4 and 2.2 when comparing the group with job strain and the group without job strain. CONCLUSION: Almost half of the healthcare workers varied between being a case and not, over a three year period. The analysis indicated that job strain is a risk factor for musculoskeletal symptoms and that the risk is higher when it is combined with perceived high physical exertion.     

Behavioral changes after closed head injury in children.

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective indications of skull radiography after head injury in children

The Permanent Working Group of European Junior Hospital Doctors (PWG) conducted a survey among surgical trainees in member countries with the aim of describing postgraduate training in surgery throughout Europe. In each country, 10 trainees with surgical training of 2-5 years and 10 trainees with surgical training of 6-9 years answered a questionnaire, completed a diary and kept a log book of operations for 1 week. A total of 165 surgeons from 12 countries completed the survey. A trainee had to care for an average patient load varying from 30 to 80 patients at any one time. The average number of working hours ranged from 52 to 88 h per week, including up to 18 h of unpaid work. The different tasks carried out within these working hours varied considerably, as did the proportion of tasks with educational value. Trainees participated in four to 11 major operations each week, but the number of operations a week did not reflect the number of operations conducted under supervision. In some countries, the majority of the trainees stated that they received their training mainly through unsupervised experience. The average number of days spent on courses and congresses varied from 4 to 15 days per year, with great variation in the percentage of expenses paid. Countries with favourable working conditions, such as fewer working hours, shorter shifts and a day off after being on duty, seemed to have gained these advantages by a reduction in working hours with educational value, rather than by a reduction in routine work. It is concluded that conditions of surgical training vary greatly between the European countries in relation to duration, working hours, tasks undertaken, and resources used on training. Every country is capable of improving its surgical training.     

Changes in nature and antibiotic resistance of bacteria causing peritonitis in cirrhotic patients over a 20 year period

A 77-year-old woman with myelodysplastic syndrome required platelet transfusion. However, she complained of facial flushing and dyspnea immediately after the initiation of an infusion of platelet concentrations (PC) utilizing a Pall PL-PXL8H filter with a negatively charged surface. The same symptoms recurred following a transfusion of washed PC with saline. However, an infusion utilizing a Sepacell PLX5A-W with a positively charged surface caused no problems. Furthermore, the patient demonstrated the same adverse reaction after administration of prostaglandin F2 alpha. This case suggested that special caution is warranted when patients who have an allergic history receive PC infusions through leukocyte-reduction filters with negatively charged surfaces.     

Change in the management of per-subtrochanteric femoral fractures--a retrospective 10 year analysis

Renin-angiotensin system is present in mammalian ovarian follicular fluid and follicles. The demonstration of specific binding sites for angiotensin II in the follicular structures of rats suggests that angiotensin II may be related to the regulation of steroid biosynthesis in the mammalian ovary. Little is known about the presence and the action of angiotensin II in nonmammalian ovaries. An immunocytochemical investigation of angiotensin II in developing ovarian follicles of trout has been carried out. The specific antiserum was raised against (Val5)-angiotensin II of the trout. There was strong immunoreactivity in the ooplasm of endogenous vitellogenic follicles. Angiotensin II immunoreactive material was present in the follicular cells, but not within oocytes at the end of vitellogenesis. Immunocytochemically angiotensin II-like material in the ovary of rainbow trout fluctuates during the cycle of development.     

A prospective analysis of the recovery of attention following pediatric head injury

Free radical-mediated oxidation of proteins results in the formation of carbonyl groups in quantities that reflect the intensity of the oxidative stress. We have developed an immunochemical technique for the quantification of carbonyl groups in protein samples prepared from small tissue samples and cell cultures. Protein samples were slot-blotted onto a polyvinylidene difluoride membrane, which was sequentially treated with 2,4-dinitrophenylhydrazine (DNPH), a primary antibody specific for the 2,4-dinitrophenol group, and a peroxidase-labeled second antibody. After the blots were developed with a chemiluminescent substrate and exposed to X-ray film, the level of immunostaining was quantitated by densitometry. Using oxidized bovine serum albumin as a standard and loading 5 microg of protein per slot, the minimum detectable carbonyl content was approximately 60 pmol carbonyl/mg protein. When necessary, nonspecific staining by noncarbonyl constituents in complex sample matrices was accounted for by using sodium borohydride-treated blanks. Results by the new method were highly correlated (r = 0.932, P < 0.0001) with those of the standard DNPH-based spectrophotometric technique. The coefficient of variation at a carbonyl level of 1.5 nmol/mg protein was 9.7%. The utility of this new method was demonstrated by measuring protein oxidation in cultured human colon cells (SW620) that were briefly exposed to H2O2.     

Referential communication and reading performance in learning disabled children over a 3-year period.

Examined the ability of 30 learning disabled (LD) and 30 non-LD (NLD) 6- and 7-yr-olds to understand a sequence of instructions, communicate the steps in a sequence to others, and rephrase their verbal messages across a 3-yr period using a referential communication task. In order to perform the puzzle-box task correctly, Ss had to execute 6 steps in an invariant sequence. After Ss demonstrated a perfect nonverbal enactment of the sequence, they were asked to communicate all information about how to open the box to a puppet. Upon completion, the puppet feigned poor memory and asked the Ss to explain the step-by-step process again. Subsequently, the puppet requested that Ss rephrase their explanation of each step by either a verbal or nonverbal rephrase request. Results reveal that LD children differed from NLD peers consistently on referential communication over the 3-yr period in terms of listener competence and speaker competence. For LD Ss, the ability to produce competent verbal messages was highly related to reading comprehension both concurrently and 3 yrs later. By the 3rd yr, NLD Ss were better able to rephrase information, indicating a growing awareness of the speaker's responsibility in communication. Findings suggest that the communication measures studied play very different roles for LD and NLD Ss with regard to reading achievement. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for cardiorespiratory and all cause mortality in men and women in urban Scotland: 15 year follow up

STUDY OBJECTIVE: To describe the relationship between risk factors, risk behaviours, symptoms and mortality from cardiorespiratory diseases in an urban area with high levels of socioeconomic deprivation. A cohort study of 15,411 men and women aged 45-64, comprising 80% of the general population of Paisley and Renfrew, Scotland. OUTCOMES: Mortality after 15 years from coronary heart disease(ICD 410-4), stroke(ICD 430-8), respiratory disease(ICD 460-519) and all causes. MAIN RESULTS: Mortality rates from all causes were 19% in men aged 45-49, 31% in men aged 50-54, 42% in men aged 55-59 and 57% in men aged 60-64. The rates are considerably higher than those reported in previous UK prospective studies. For women the rates were 12%, 18%, 25% and 38% respectively. In general men and women showed similar relationships between risk factor levels and mortality rates. People in manual occupations had higher mortality rates. Raised levels of systolic and diastolic blood pressure were associated with increased coronary, stroke and all cause mortality rates. Plasma cholesterol had no such association with all cause mortality rates. High and low levels of body mass index were associated with higher mortality rates than intermediate levels. A relationship between short stature and increased mortality rates was observed in men and women. FEV1 expressed as a percentage of the expected value showed the strongest relationship with mortality rates, particularly for respiratory disease, but also for deaths from coronary heart disease, stroke and all causes. CONCLUSIONS: A similar pattern of relationship between risk factor levels and mortality rates exists in men and women in Renfrew and Paisley. Respiratory impairment as measured by FEV1% predicted appears to be the most likely explanation of the observed high all cause mortality rates in this population.