Psychological and family functioning and quality of life in adolescents with cystic fibrosis.

BACKGROUND: The life expectancy of individuals with CF has increased to 33 years. Thus, issues such as quality of life and psychological well-being, previously thought to be of lesser importance than physical well-being, are now recognised as significant factors. This study examined the interrelationships between quality of life, family functioning, individual psychopathology and optimism of adolescents with CF. METHODS: Adolescents attending the CF clinic completed a number of questionnaires. Quality of Life was measured using the Cystic Fibrosis Questionnaire, family functioning by the Family Environment Scale (3rd edition), general psychopathology with the Symptom Checklist-90-Revised and optimism for the future by the Hunter Opinions and Personal Expectations Scale. Disease severity was assessed using the Shwachman score and spirometry at the time of questionnaire completion. RESULTS: The level of psychopathology (12.5% of those 13 years and over) in the group was lower than that reported for young people in Australia (15-20%). The results indicated that young people with a delayed diagnosis and those who are alienated from their families may be in need of additional psychosocial support. The group was hopeful and positive about their future and these attributes were independent of clinical measures of disease severity. In general, these young people scored relatively highly on the quality of life scale. For example the mean standardised score for physical functioning was 70 points, for respiratory symptoms was 63 points and for emotional state was 78 points. Increased levels of psychopathology and lack of hope for the future were however associated with lower ratings on a number of quality of life measures. Family cohesiveness, expressiveness and organization were associated with better psychological functioning in the young people. CONCLUSIONS: Adolescents with CF appear to be a psychologically well functioning and well-adjusted group. These findings support the importance of a more sophisticated model of well-being for adolescents with CF, which explores the young person's views on their quality of life and wider support frameworks rather than relying solely on measures of physical health to gauge well-being.     

The role of head injury in cognitive functioning, emotional adjustment and criminal behaviour

In two investigations, 50 of non violent convicted felons, who avoided incarceration by participating in a day reporting programme, reported a prior history of head injury and current problems in cognitive and emotional functioning. Only 5 of a college sample in the first investigation and 15 of a community sample in the second investigation reported prior head injury. In a third investigation, 83 of felons who had reported a history of head injury also reported a date for their head injury that preceded the date of their first encounter with law enforcement. Some participants reported no trouble with the law until after experiencing a head injury that occurred in their late thirties. Considering the research reported here and elsewhere in the literature, it appears that many serious crimes follow a head injury. One implication of the findings reported here is that many crimes might not occur if people with head injury were given prompt and comprehensive treatment after the injury.     

Quality of life after lobectomy for adult liver transplantation

INTRODUCTION: Adult-to-adult living donor liver transplants are being increasingly performed. Although considerable data are available on the quality of life after kidney donation, there is little comparable information on liver donors. METHODS: Between August 1998 and July 2000, 48 adults received liver grafts from living donors. At least 2 months after donation, donors were mailed a structured questionnaire and the standardized Medical Outcomes Study Short-Form Health Survey (SF-36), a generic measure assessing health-related quality of life outcomes using eight scales: mental health, emotional limits, vitality, social function, physical function, physical limits, pain, general health. RESULTS: Thirty donors (62.5%) responded at a mean of 280+/-157 days after donation. Fifteen (50%) of their recipients had major complications (two deaths, four retransplants, nine biliary complications). Regarding overall satisfaction, all said they would donate again. Compared to published U.S. norms (n=2474), our group of donors scored higher than the general population in seven of eight domains on the SF-36. Donors whose recipients had no complications scored significantly higher in mental health (P<0.007) and general health (P<0.008) compared with U.S. norms. Donors whose recipients had major complications scored significantly lower on the mental health scale than those with recipients without major complications. CONCLUSIONS: Donors did not regret their decision to donate; several felt the experience had changed their lives for the better. Donors scored as well as or better than U.S. norms in general health. Quality of life after donation must remain a primary outcome measure when we consider the utility of living-donor liver transplants.     

The injury trajectory for young people 16–24 years in the six months following injury: A mixed methods study

BackgroundAdolescents and young people are the population at greatest risk of injury and therefore injury-related mortality and morbidity. Inquiry into the injury trajectory of young people is needed to identify this group’s specific needs for healthcare. This paper reports the integration of quantitative and qualitative findings from a sequential explanatory mixed methods study examining young people aged 16-24 years’ experience and trajectory of traumatic physical injury in the initial six months. The aim of integration was to address the question: In what ways are injured young peoples’ experiences and self-management during the initial six months of the injury trajectory impacted by their injury, family support, and provision of healthcare?MethodsKey findings from epidemiological datasets on young person injuries from hospital and coronial databases (Phase 1) were combined with key findings from qualitative interviews with 12 injured young people and 10 family members (Phase 2).ResultsThe integration of findings from Phase 1 and Phase 2 resulted in three new findings; [1] (Alfred Health, 2014). A young person’s perception of the severity of their injury, as well as the amount of time spent in hospital, impacts substantially on the way in which they experience injury, and this is managed differently between genders; [2] (Newnam et al., 2014). Admission to an Intensive care unit, including the intensity and duration of care, is the primary influence on how a family will provide support to the young person in the inpatient period; and [3] (Lyons et al., 2010). Young people's perception and understanding of their recovery from injury is in contrast with how healthcare systems are structured to provide rehabilitation and recovery care.ConclusionThe injury trajectory and recovery process of young people in the six months following injury have been have conceptualised. These trajectories of recovery can inform the development of anticipatory guidance frameworks for clinicians and guide the provision of and planning for clinical services for injured young people.     

Anaesthesia for extra-cranial surgery in patients with traumatic brain injury

Severe head injury remains common and patients who survive theinitial insult are often left with a major neurological deficit.This has serious economic implications both for health careresources and for society, as most of the patients affectedare young adults early in their working lives. Intensive careof patients who suffer traumatic brain injury aims to preventsecondary neuronal damage. Up to 75% of blunt trauma victimssuffer some degree of head injury, which has been linked tohigher mortality. Despite widespread compliance with publishedguidelines regarding the management of the head injury per se,the optimal timing for dealing with extra-cranial injury inpatients with associated brain trauma remains unclear and isdiscussed in this article.     

Tocolysis with ritodrine worsens cerebral oedema in a patient with brain injury

In a 33-weeks pregnant patient with a head injury, neurological status severely deteriorated after introduction of tocolytic treatment with ritodrine. On admission to the intensive care unit she scored 10 points on the Glasgow coma scale. She gradually recovered and on day 7 there was no neurological deficit, apart from slight confusion. The same day tocolytic treatment with ritodrine was recommended because of imminent premature labour. Fourteen hours after ritodrine infusion was started, the neurological status deteriorated severely. Urgent CT scan showed signs of transtentorial herniation. Ritodrine infusion was stopped and therapy for brain oedema was introduced. The patient made a good neurological recovery. A caesarean section was performed on day 11, because of placenta praevia, and a healthy girl was delivered. The patient was discharged without neurological sequelae. The clinical course and CT findings imply that tocolytic treatment with ritodrine can worsen brain oedema in a patient with a disrupted blood-brain barrier, as in head injury. The mechanism is probably analogous to the one by which ritodrine causes pulmonary oedema, a well-known complication.     

Psychosocial outcome in patients with moderate to severe head injury: 2-year follow-up

Psychosocial outcome and recovery of a group of 31 consecutive adult patients with moderate to severe head injuries were prospectively investigated over a 2-year period. A friend control group was used for comparison purposes. We conclude that moderate and severe head injuries have a significant long-term impact on psychosocial functioning. More specifically, although there is an increase over time in the number of subjects who resume former levels of activity, many moderate to severely head-injured people remain unable to work, support themselves financially, live independently and participate in pre-injury leisure activities at least up to 2 years post-injury. Initially, self-perceived limitations in everyday functioning are widespread, with physical functioning being of primary concern. Over time, there is improvement in both physical and psychosocial areas. However, in spite of improvement, difficulties in psychosocial functioning become dominant later due to greater improvement in the physical area. This study gives no evidence of general increase in emotional distress with increasing time since injury.     

Flexyx Neurotherapy System in the treatment of traumatic brain injury: an initial evaluation

OBJECTIVE: To conduct a preliminary experimental evaluation of the potential efficacy of Flexyx Neurotherapy System (FNS), an innovative electroencephalography (EEG)-based therapy used clinically in the treatment of traumatic brain injury (TBI). PARTICIPANTS: Twelve people aged 21 to 53 who had experienced mild to moderately severe closed head injury at least 12 months previously and who reported substantial cognitive difficulties after injury, which interfered with their functioning. DESIGN: Participants were randomly assigned to an immediate treatment group or a wait-list control group and received 25 sessions of FNS treatment. They were assessed at pretreatment, posttreatment, and follow-up with standardized neuropsychological and mood measures. RESULTS: Comparison of the two groups on outcome measures indicated improvement after treatment for participants' reports of depression, fatigue, and other problematic symptoms, as well as for some measures of cognitive functioning. Most participants experienced meaningful improvement in occupational and social functioning. CONCLUSION: On the basis of these results, FNS appears to be a promising new therapy for TBI and merits more extensive evaluation.     

Employment after severe head injury: do the Manpower Services Commission schemes help?

This paper describes the use of Manpower Services Commission (MSC) employment rehabilitation schemes by a series of severely head injured people. Most of those who achieved employment did so without making use of MSC schemes. A majority of those using MSC schemes remained unemployed at last follow-up. Those attending MSC schemes were more likely to have been in education at the time of injury. Some of those previously in work used schemes, but only after they had already failed at work or had had a long period out of work. MSC schemes may fail to meet the needs of the head-injured because many are too short or use is made of them at too long an interval after the injury. They do not cater well for special training and the flexible approach that is necessary for successful employment rehabilitation of those suffering from brain injury. The priority is for training schemes that can be carried out within the workplace and for support and incentives to employers to help head-injured people return to their previous work.     

Health outcomes and costs for injured young people hospitalised with and without chronic health conditions

BackgroundThe prevalence of chronic health conditions such as diabetes among young people is increasing. Limited information is known about the impact of these conditions on young people who have been traumatically injured. Injury is the global leading cause of death and disability in young people. The aim of this study is to compare health outcomes for injured young people with and without chronic health conditions.MethodA retrospective examination of injury in young people aged ≤25 years with and without a chronic health condition using linked hospitalisation and mortality records during 1 January 2010 to 30 June 2014 in New South Wales, Australia. Health outcomes, including hospital length of stay (LOS), 28-day unplanned hospital readmission, hospital treatment costs, and 30-day and 12-month mortality were examined. A 1:1 matched design was used to determine excess mean hospital LOS and cost for young people with a chronic health conditions versus no health condition.ResultsThere were 184,819 injury-related hospitalisations of young people; 13.8% had a chronic health condition. Compared to young people who did not have a chronic health condition, those with one were found to have double the mean hospital cost, higher unplanned hospital readmission, and a higher rate of mortality. Injured young people had a three times higher likelihood of having a prolonged LOS if they had a chronic health condition (Adjusted odds ratio: 3.89; 95% CI: 3.69–4.11). Renal conditions, anaemia, coagulation defects, hypertension, and mental health conditions had the highest excess LOS and anaemia, hypertension, coagulation defects and renal conditions had the highest excess mean cost for matched injured individuals with and without the health condition.ConclusionsHealth outcomes following injury are worse for young people with a chronic health condition. The increasing prevalence of young people with a chronic health condition has implications for treatment, resource use, provision of support services, and survival following traumatic injury.     

Association between patient report of symptoms after mild head injury and neurobehavioural performance

Patients with closed-head injuries may have physical, affective, behavioural and memory problems that persist for weeks, months or years. Even patients with minor head trauma have been found to exhibit deficits in neurobehavioural performance. However, very little research has been done to examine the association between patient symptoms after minor head injury and neurobehavioural performance. The associations between five sets of symptoms (memory problems, neurological problems, confusion, neurasthenia and co-ordination) and five neurobehavioural areas (simple motor speed, response speed and attention, complex perceptual motor performance, visual memory, and learning) were examined in a group of 32 adults who had suffered mild to moderate head injury. Patients reported their symptoms with a four-point rating scale. Neurobehavioural functioning was assessed using computerized tests. Memory difficulties were the problems most frequently experienced by the patients and most closely associated with performance deficits.     

Psychosocial functioning of young adults with cystic fibrosis and their families.

BACKGROUND--The psychosocial functioning of adolescents and young adults with cystic fibrosis still living in the parental home was investigated. With its proven genetic aetiology cystic fibrosis is an ideal model with which to assess the impact of a chronic and life threatening disorder on family and individual psychological and social functioning. METHODS--Twenty nine patients with cystic fibrosis and their families were compared with those of 27 patients with anorexia nervosa and 31 well controls. Assessments were made using self reporting, interview, and observational methods. RESULTS--Most patients with cystic fibrosis were in robust psychological health and only differed from their healthy peers in that they were much less likely to be in employment. Mothers of patients with cystic fibrosis or anorexia nervosa were more likely than the mothers of the well group to be emotionally distressed, although this was not so for fathers. Young people in both illness groups were more likely to have parents with high levels of expressed emotion. Most families of patients with cystic fibrosis had good problem solving abilities. CONCLUSIONS--In spite of the burden of illness in cystic fibrosis psychological functioning in many respects matches that of well young people.     

The epidemiology of logging injuries in the northwest

Logging is among the most hazardous forms of employment. However, a comprehensive review of severe logging injuries and their outcome has apparently not been previously undertaken. In the present study we review 51 consecutive injured loggers requiring transfer to a regional Level I trauma center. The average age was 34 years and the mode of injury in 67% was being struck by a falling or rolling log. Orthopedic intervention was required most frequently (49%), with neurologic injury in 43%. Two patients died (4%), both secondary to severe head injury, and both survived less than 24 hours. Importantly, while most severely injured patients survived, they required long hospitalizations and had a 58% permanent disability, with more than half of these being brain or spinal cord related. Although the overall number of workers involved in logging is small, the young average age, the work years lost, and the high risk of permanent disability support continued strong efforts to improve overall safety. Particularly, the high incidence of head injury argues strongly for improved and increased use of safety helmets, which may significantly impact the mortality and morbidity of logging accidents.     

Circulating levels of interleukin-6 and its soluble receptor in patients with head injury and fracture

There is evidence that fractures heal more rapidly in patients with head injury. We measured the circulating level of interleukin-6 (IL-6) and its soluble receptor (sIL-6R) and soluble glycoprotein 130 (sgp130) in serum from patients who had sustained a head injury with and without fracture and compared these with levels found in control subjects. Within 12 hours of injury the serum level of IL-6 was significantly higher in patients with head injury and fracture compared with the control group. Levels of IL-6 were also significantly higher in patients with head injury and fracture compared with fracture only. While there was no significant difference in circulating levels of sIL-6R in the initial samples they were increased one week after surgery in patients with head injury and fracture and with head injury only. In addition, reduced levels of sgp130 in patients with head injury with and without fracture indicated a possible reduction of the inhibitory effect of this protein on the activity of IL-6. Our study suggests that IL-6 may be involved in altered healing of a fracture after head injury.     

Impact of traumatic brain damage on family dynamics and functioning: A review

The purpose of this paper is to review the dynamics and functioning of families with a severely head-injured member. In order to stress the unique problems faced by persons with brain damage and their families, a comparison with spinal cord-injured persons is presented. The review's major conclusion is that a head injury exposes the family to a complex of problems that are unique to this disability and, therefore, necessitates the delivery of special family support services focused on the family, rather than on the head-injured person.     

A clinical survey of head injuries sustained in the M1 Boeing 737 disaster: recommendations to improve aircrash survival

On 8 January 1989 at 20:25 h, a British Midland Boeing 737/400 on approach to East Midlands Airport crashed across the M1 motorway with the immediate loss of 39 lives from the 126 people on board. In the aftermath of the accident a clinical review was commenced to determine the mechanisms of injury in the 87 initial survivors and hopefully provide data to improve commercial aircraft safety in the future. Seventy-seven survivors sustained head and facial trauma in the crash, 45 of whom had periods of amnesia surrounding the event. Twenty-one received injuries from behind, including five of the six severely head-injured adults. Loss of consciousness and duration of amnesia were directly related to the degree of superficial head trauma. Adoption of the fully flexed brace position for crash-landing offered significant protection from head injury and concussion, and possibly reduced injuries from behind. Suggestions are made for potentially improving the survivability of aircraft accidents.     

Early tracheostomy versus prolonged endotracheal intubation in severe head injury

BACKGROUND: To see if early tracheostomy (fifth day) reduces duration of mechanical ventilation, ICU stay, incidence of pneumonia and mortality in comparison with prolonged intubation (PI) in patients with head injury. METHODS: Patients were prospectively included in this study if they met the following criteria: isolated head injury, Glasgow coma scale (GCS) score < or =8 on first and fifth day, with cerebral contusion on CT scan. On the fifth day, randomization was done in two groups: early tracheostomy group (T group, n = 31) and prolonged endotracheal intubation group (I group, n = 31). We evaluated total time of mechanical ventilation, ICU stay, pneumonia incidence and mortality. Complications related to each technique were noted. Analysis of data were performed using Yates and Kruskall Walis tests. p < 0.05 was considered significant. RESULTS: The two groups were comparable in term of age, sex, and Simplified Acute Physiologic Score (SAPS). The mean time of mechanical ventilatory support was shorter in T group (14.5 +/- 7.3) versus I group (17.5 +/- 10.6) (p = 0.02). After pneumonia was diagnosed, mechanical ventilatory time was 6 +/- 4.7 days for ET group versus 11.7 +/- 6.7 days for PEI group (p = 0.01). There was no difference in frequency of pneumonia or mortality between the two groups. CONCLUSION: In severe head injury early tracheostomy decreases total days of mechanical ventilation or mechanical ventilation time after development of pneumonia.     

Exploring the social lives of young adults with disabilities

This article explores the social lives of young adults with disabilities as they were transitioning from school to adult life. The young adults were former participants of the Access to Community Employment and Education Program (ACEE) in Halifax, Nova Scotia, Canada, a program, which focuses on the transition of young people with disabilities from school and youth to adulthood, employment, and independent living. The data in the article were drawn from a mixed method research project that explored, through a survey and follow-up focus groups and interviews, the impact of the ACEE program and the lived experiences of its alumni in the years after having completed the program. The study highlights the alumni's social lives, their leisure activities and their relationships and the different ways the participants are living their lives in the community several years after having completed the ACEE program. The data shows that the program is playing an important role in creating lasting friendships and a sense of belonging amongst its peers.     

Incremental contribution of reported previous head injury to the prediction of diagnosis and cognitive functioning in older adults

Background: Severe brain injuries may be a risk factor for the development of dementia in later life. Less severe incidents with relatively short or even no loss of consciousness may not carry the same prognosis. Objectives: This study used data from the first two waves of the Canadian Study of Health and Ageing (CSHA-1 and CSHA-2) to investigate two questions. (1) Does a history of head injury improve the prediction of the diagnosis of dementia? This analysis was based on the 921 elderly individuals who underwent a clinical assessment in CSHA-2 and, 5 years earlier, had reported whether or not they had had a head injury. (2) Does adding information about a history of head injury improve the prediction of neuropsychological test scores? This second analysis included 585 elderly people who underwent neuropsychological assessment in both waves and who also reported whether or not they had had a history of mild or moderate-to-severe head injury. Results: Results showed that the inclusion of head injury information did not improve the prediction of diagnostic outcome of dementia. Age and overall cognitive status were associated with most neuropsychological test scores, more so than the more limited influence of chronic health problems, which was associated with about half of the neuropsychological measures.     

Treatment of femoral fracture in the child with head injury

The outcome of various types of treatment for femoral fracture in children with head injury was studied retrospectively in 51 patients with 56 fractures. Of these, 36 patients (71 per cent) were in deep coma and scored 5 to 7 on the Glasgow scale. Forty-three children (84 per cent) were eventually able to walk freely. Open reduction and internal fixation proved an attractive solution for femoral fractures in children with head injury who could tolerate general anaesthesia: intramedullary nailing was safe and gave satisfactory results in 16 fractures but infection complicated three of the five fractures which were plated.