The public health approach to traumatic brain injury: an overview of CDC's research and programs

Every year, 50,000 people die with a traumatic brain injury (TBI). At least 5.3 million Americans live with long-term disabilities related to TBI. Through its TBI-associated research and programs, CDC's National Center for Injury Prevention and Control (NCIPC) seeks to reduce the adverse consequences of TBIs by ensuring that data, data systems, and public awareness about TBI are in place. The public health model provides a useful framework for identifying important efforts needed to reduce the impact of this potentially disabling injury.     

Interleukin-27 in liver xenotransplantation: A rational target to mitigate ischemia reperfusion injury and increase xenograft survival

Transplantation of xenogeneic organs is an attractive solution to the existing organ shortage dilemma, thus, securing a clinically acceptable prolongation of xenograft survival is an important goal. In preclinical transplantation models, recipients of liver, kidney, heart, or lung xenotransplants demonstrate significant graft damages through the release of pro-inflammatory molecules, including the C-reactive protein, cytokines, and histone-DNA complexes that all foster graft rejection. Recent studies have demonstrated that mitigation of ischemia reperfusion injury (IRI) greatly improves xenograft survival. Organ IRI develops primarily on a complex network of cytokines and chemokines responding to molecular cues from the graft milieu. Among these, interleukin 27 (IL-27) plays an immunomodulatory role in IRI onset due to graft environment-dependent pro- and anti- inflammatory activities. This review focuses on the impact of IL-27 on IRI of liver xenotransplants and provides insights on the function of IL-27 that could potentially guide genetic engineering strategies of donor pigs and/or conditioning of organs prior to transplantation.     

Ten years national research project "familial prostate cancer": problems in identifying risk families

Background

The German national research project??familial prostate cancer?? has been recruiting prostate cancer patients nationwide since 1999. In 2009, a comprehensive data analysis of the 25,065 families recruited was performed. Of these, 77.4% were identified as sporadic, 20.0% as familial and 2.6% as hereditary cases of prostate cancer. However, obtaining comprehensive, validated information about all relatives often fails.

Results

The high average age of the patients, the lower life expectancy in further generations and the low number of first-degree male relatives hampers the classification of sporadic, familial and hereditary cases. Consequently we describe here that in our database the identification of 100 hereditary cases requires a recruitment of more than 5,000 patients with their families. For 100 sporadic patients with 2 first-degree male relatives without a case history 1,250 patients are needed.     

钙和蛋白质与儿童骨骼健康的关系

儿童期是骨骼发育的高峰时期,钙和蛋白质都是维持骨骼健康的重要营养素,目前我国儿童青少年膳食蛋白质摄入量基本得到满足,但是膳食钙缺乏情况依然普遍存在。膳食蛋白质对骨骼的作用受钙等多种因素的影响,探究膳食钙和蛋白质与骨骼的关系对儿童骨骼健康具有重要意义。笔者就国内外钙和蛋白质对儿童骨骼健康的影响与作用机理进行综述,为促进儿童及青少年获得理想的峰值骨量,促进骨骼健康成长,预防骨质疏松症提供新的思路。     

Critical review of bone health,fracture risk and management of bone fragility in diabetes mellitus

The risk of fracture is increased in both type 1 diabetes mellitus(T1DM) and type 2 diabetes mellitus(T2DM). However, in contrast to the former, patients with T2DM usually possess higher bone mineral density. Thus, there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes. Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk. Moreover, some antidiabetic medications further enhance the fragility of the bone. On the other hand, antiosteoporosis medications can affect the glucose homeostasis in these patients. It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk. Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature. With the advancement in imaging technology, newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes. The purpose of this review is to explore the patho-physiology behind poor bone health in diabetic patients. Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.     

The application of operations research methodologies to the delivery of care model for traumatic spinal cord injury: the access to care and timing project

Abstract The long-term impact of spinal cord injury (SCI) on the health care system imposes a need for greater efficiency in the use of resources and the management of care. The Access to Care and Timing (ACT) project was developed to model the health care delivery system in Canada for patients with traumatic SCI. Techniques from Operations Research, such as simulation modeling, were used to predict the impact of best practices and policy initiatives on outcomes related to both the system and patients. These methods have been used to solve similar problems in business and engineering and may offer a unique solution to the complexities encountered in SCI care delivery. Findings from various simulated scenarios, from the patients' point of injury to community re-integration, can be used to inform decisions on optimizing practice across the care continuum. This article describes specifically the methodology and implications of producing such simulations for the care of traumatic SCI in Canada. Future publications will report on specific practices pertaining to the access to specialized services and the timing of interventions evaluated using the ACT model. Results from this type of research will provide the evidence required to support clinical decision making, inform standards of care, and provide an opportunity to engage policymakers.     

Short Form health surveys and related variants in spinal cord injury research: A systematic review

Context

‘Short Form’ health surveys – such as the SF-36 and SF-12 – are widely used in medical research. Spinal cord injury (SCI) is no exception, despite oft-cited concerns regarding measurement properties for populations with physical impairment.

Objective

To provide a comprehensive overview of the use of Short Form health surveys and their variants within the SCI literature.

Methods

Papers published between database inception and September 2012 were identified from 11 electronic databases; a supplementary reference list search was also conducted. Data extraction focused on details regarding the range of different Short Form surveys and variants used in SCI research, the respective frequency of use, the nature of reporting (complete versus partial reporting) and the method of survey administration.

Results

One hundred seventy-four papers were identified. Thirty-six-item Short Form health surveys were frequently administered as complete instruments (n = 82); in 69 of these 82 studies (84%), it was not clearly stated which 36-item version had been used (e.g. SF-36v1, SF-36v2, RAND-36). Data for individual items and domains were often reported (29% of identified studies), indicating significant partial use of standardized measures. Modified variants of standardized health surveys were administered in 12 studies.

Conclusion

Although standardized Short Form health surveys are common within SCI research, attempts to add, delete, or modify items have resulted in a number of variants, often with minimal supportive psychometric evidence. Using established, generic outcome measures is appealing for a number of reasons. However, validity is paramount and requires further explicit consideration within the SCI research community.     

Cardiovascular risk in hypertensive patients: results of the Pandora project

BACKGROUND: The aim of the Pandora project is to collect epidemiological information, check diagnostic and therapeutic pathways, and assess outcomes in a large hypertensive population. This report presents the results on patients enrolled in the study between 1997-1999. METHODS: Twenty-one general practitioners working in the Ravenna Local Health Service took part in the study. They were supplied with IBM compatible PCs and were trained to enter the patient's data (age, gender, familiarity for cardiovascular diseases, smoking, hospitalisations for cardiovascular disorders, diabetes, blood pressure, total cholesterolemia, creatininemia, antihypertensive therapy) on So.Ge.Pa. software. Cardiovascular risk factors were assessed according to the WHO - ISH joint committee recommendations. RESULTS: 2,608 treated hypertensive patients were enrolled, 65% of whom showed inadequate blood pressure control. The prevalence of inadequate BP control was higher in patients on multiple-drug antihypertensive therapy compared with those on monotherapy (71.9% vs. 47.9%), in older than in younger patients (70.7% vs. 56.1%) and in patients with three cardiovascular risk factors, or diabetes, or affected target organs, compared to those with two or less risk factors (72.4% vs. 63.3%), (p < 0.001 for all). 63.6% of patients were at risk for age, 36.6% for family history of cardiovascular diseases and 31.7% for severe hypercholesterolemia. CONCLUSIONS: BP control was inadequate in a large percentage of patients, but it was particularly unsatisfactory in the elderly and in patients with high cardiovascular risk. A cluster of cardiovascular risk factors was found in both adequately and inadequately controlled hypertensive patients.     

The essential role of psychosocial risk and protective factors in pediatric traumatic brain injury research

This article builds upon Traumatic Brain Injury Common Data Elements (TBI CDE) version 1.0 and the pediatric CDE Initiative by emphasizing the essential role of psychosocial risk and protective factors in pediatric TBI research. The goals are to provide a compelling rationale for including psychosocial risk and protective factors in addition to socioeconomic status (SES), age, and sex in the study design and analyses of pediatric TBI research and to describe recommendations for core common data elements in this domain. Risk and protective factor research is based on the ecological theory of child development in which children develop through a series of interactions with their immediate and more distant environments. Home, school, religious, and social influences are conceptualized as risk and/or protective factors. Child development and TBI researchers have interpreted risk and protective variables as main effects or as interactions and have used cumulative risk indices and moderation models to describe the relationship among these variables and outcomes that have to do with development and with recovery from TBI. It is likely that the number, type, and interaction among risk and protective factors each contribute unique variance to study outcomes. Longitudinal designs in TBI research will be essential to understanding the reciprocal relationships between risk/protective factors and the recovery/outcome made by the child. The search for effective interventions to hasten TBI recovery mandates the need to target modifiable risks and to promote protective factors in the child's environment.     

Mouse models in burns research: Characterisation of the hypermetabolic response to burn injury

ObjectiveThe aim of the study is to characterise burn induced hypermetabolism in a mouse model.Summary Background DataThere are many mouse models of burn injury currently available however, their use in burns research is limited by the general assumption that post-burn hypermetabolism is difficult to study in these models.MethodsMale Balb/c mice were subjected to either a small (1 cm²) or large (4 cm²) contact burn. The hypermetabolic response to burn injury was determined by measuring changes in basal energy expenditure. The hormonal and inflammatory mediators of hypermetabolism, and the catabolic alterations secondary to hypermetabolism were also examined.ResultsPost-burn hypermetabolism was induced in both models of small and large burn. However, large burns resulted in prolonged wound healing, a more pronounced and sustained increase in basal energy expenditure, and a greater stress and systemic inflammatory response with profound catabolic consequences.ConclusionsIn the present study, we have successfully characterised the burn induced systemic hypermetabolic response in a mouse model of small and large burn. These models may prove useful for researchers studying the complex aetiology of hypermetabolism and interventions.