Outcome and quality of life 5 years after major trauma

BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome. METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey. RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later. CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.     

The Effects of Neuromuscular Electrical Stimulation Training on Abdominal Strength,Endurance, and Selected Anthropometric Measures

We studied the effects of self-administered neuromuscular electrical stimulation (NMES) on changes in strength, endurance, selected anthropometric measures, and subject’s perceived shape and satisfaction of the abdominal wall. Twenty-four adults (experimental group) stimulated their abdominals 5 days per week (20-40 minutes per session) for 8 weeks and refrained from engaging in any additional exercise during the study. A control group (N=16) refrained from exercising the abdominals or engaging in any other exercise training during the study. Subjects were tested at the beginning, mid-point, and end of the study. Isometric strength of the abdominal muscles was tested using a isokinetic dynamometer, endurance was measured using the ACSM curl-up test, abdominal circumference was measured using a steel tape measure, and body shape and satisfaction were assessed via questionnaire. The stimulation group had a 58% increase in abdominal strength, whereas the control group did not change. The stimulation group also had a 100% increase in abdominal endurance versus a 28% increase in the control group. Waist circumference decreased by of 3.5 cm in the stimulation group compared to no significant change in the control group. All 24 subjects in the stimulation group felt that their midsections were more “toned” and “firmed” and 13/24 (54%) felt that their posture had improved as a result of the stimulation. None of the control group subjects reported changes in these parameters. There were no significant differences in body weight, BMI, or skinfold thickness over the course of the study in either group. NMES, as used in the current study, resulted in significant improvements in the muscular strength and endurance of the abdominal region, as well as subject’s perceived shape and satisfaction of the mid-section.

Key Points

• Electrical muscle stimulation (EMS) was effective in increasing muscle strength and endurance
• All subjects perceived their abdominal muscles to be firmer and more toned as a result of EMS
• Abdominal and waist girth was also significantly reduced, despite no changes in body weight or subcutaneous fat

Key Words: Fitness, training, isometric     

The additive erectile recovery effect of brain-derived neurotrophic factor combined with vascular endothelial growth factor in a rat model of neurogenic impotence

OBJECTIVE: To test the hypothesis that combined intracavernosal injection with vascular endothelial growth factor (VEGF) with adeno-associated virus-mediated brain-derived neurotrophic factor (AAV-BDNF) synergistically facilitates the neural regeneration and erectile function after cavernosal nerve injury. MATERIALS AND METHODS: Forty Sprague-Dawley male rats were randomly divided into five equal groups: eight had a sham operation while 32 had bilateral cavernosal nerve freezing followed by an immediate intracavernosal injection with either phosphate-buffered saline (PBS), VEGF, AAV-BDNF, or AAV-BDNF + VEGF. Erectile function was assessed by cavernosal nerve electrostimulation at 3 months, and samples of the major pelvic ganglia and penile tissue were evaluated histologically. RESULTS: In this animal model of impotence from nerve injury, the recovery of erectile function was greatest in those receiving AAV-BDNF + VEGF; the mean (sd) maximal intracavernosal pressure in this group was 87.2 (20.78) cmH2O, compared with 37.3 (11.39) for VEGF alone and 49.8 (29.58) for AAV-BDNF alone. No erectile dysfunction was identified in the sham group, with a pressure of 100.7 (22.70) cmH2O, while all treatment groups significantly outperformed the PBS (control) group, at 29.3 (13.52) cmH2O. Furthermore, all animals receiving monotherapy or combined treatment had more NADPH-diaphorase-positive nerve fibres than controls but less than in the sham group. CONCLUSION: Bilateral cavernosal nerve freezing causes erectile dysfunction with accompanying neurological changes. Intracavernosal injection with either VEGF or AAV-BDNF alone enhances nerve regeneration, with combined therapy (VEGF and AAV-BDNF) promoting neural and erectile recovery additively.     

Observed environmental features and the physical activity of adolescent males

BACKGROUND: It has recently been reported that adult physical activity was associated with environmental features. The aim of this study was to determine whether environmental features were associated with physical activity among male adolescents. METHODS: Physical activity levels of 210 Boy Scouts were assessed for 3 days by accelerometry during 2003 and 2004. Mean minutes of sedentary, light, and moderate-to-vigorous intensity activity were calculated. Environmental features within a 400-meter radius of each participant's home address were assessed by direct observation using the Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument. Principal component factor analysis reduced the 35 SPACES items to four factors. Hierarchical and spatial regressions were conducted with physical activity as the dependent variable and environmental factors, age, body mass index, and ethnicity as independent variables. RESULTS: Four factors were obtained: walking/cycling ease, tidiness, sidewalk characteristics, and street access and condition. Sidewalk characteristics were negatively associated with minutes of sedentary behavior while age was positively associated. Sidewalk characteristics were positively associated with minutes of light-intensity physical activity and age negatively associated. No environmental factor correlated with moderate-to-vigorous physical activity. CONCLUSIONS: A sidewalk characteristics factor, composed of sidewalk location, sidewalk material, presence of streetlights, and number and height of trees, was positively associated with light-intensity physical activity among male adolescents.     

Cambridge Health's outreach earns alliance an AHA NOVA Award

Cambridge Health Alliance, (CHA), Somerville, Mass., has been named for one of the five NOVA Awards given this year by the American Hospital Association. It is recognized for leading a program to improve community health by extending help to low-income and uninsured children and adults, as well as to the chronically ill and racial and ethnic minorities.     

Adequacy of health and safety training among young Latino construction workers

OBJECTIVES: This study aimed to assess the adequacy of safety training provided to young Latino immigrant construction workers. The study posited that, because of their youth and immigrant status, these workers would be less likely to receive adequate training. METHODS: We interviewed 50 youths aged < or =21 who had worked at least 10 days in construction in the previous year. The in-person interview included 140 questions covering a range of construction work and health and safety experiences. RESULTS: Participants reported performing a range of hazardous tasks, some while under the age of 18. Of these, 68% to 72% reported receiving some training, but median training time was only 1 hour. Only 24% reported receiving written training material. Those with less English ability received less training. CONCLUSIONS: Young Latino immigrants in this study received inadequate training given the hazardous work they performed. CLINICAL SIGNIFICANCE: Results of this research, especially the relatively low level of English communication skills among young Latino workers, point to the need for increased bilingual services not just in worker safety training programs, but also in medical clinics and emergency rooms that treat Latino workers.