Frequency and Correlates of Substance Use among Preadolescents and Adolescents in a Swiss Epidemiological Study

Alcohol use and nicotine use were investigated in a representative sample of 1110 study participants aged 10 to 17 years. In addition to questions on substance use, the participants responded to questionnaires covering behavior and emotions, life events, self-related cognitions, coping capacities, perceived parental behavior, perceived school environment, and the social network. The gender gap in substance use tended to close with increasing age. Parental substance use served as a model for substance use in the participants. Substance users had more abnormal scores on almost all variables as compared to abstaining controls. Lack of acceptance and control, pressure to achieve at school, and life events significantly predicted substance use. The latter served as a moderating risk variable for delinquent behavior under stress.     

Does traumatic brain injury result in accelerated fracture healing?

In patients who have sustained a traumatic brain injury with an associated extremity fracture there is often a clinical perception that the rate of new bone formation around the fracture site is increased. Whether this rapidly forming new bone is fracture callus or a variant of heterotopic ossification, a common complication of traumatic brain injury, is the subject of some debate. This review will provide a comprehensive analysis on this topic and will discuss clinical and physiological evidence as well as potential areas for future research in this field.     

Secondary effects of femoral instrumentation on pulmonary physiology in a standardised sheep model: what is the effect of lung contusion and reaming?

Intramedullary nailing is the treatment of choice for patients with femoral shaft fractures. However, there is an ongoing debate in multiple trauma patients with associated lung contusion when primary or secondary definitive stabilisation of the long bone fracture should be performed, as nailing is thought to play an important role in the pathogenesis of adult respiratory distress syndrome (ARDS). In a standardised sheep model, this study aimed to quantify the development of acute pulmonary endothelial changes, to assess the activation of polymorphonuclear leucocytes (PMNL) and to observe the effects on the coagulation system associated with the reamed nailing procedure. Furthermore, the effect of coexisting lung contusion in an experimental model was evaluated. The animals were randomly assigned to one of four different groups (6 animals/group). In control groups, only a sham operation (thoracotomy) was performed, whereas in study groups, lung contusion was induced prior to femoral stabilisation either by external fixation or reamed femoral nailing. Using bronchoalveolar lavage (BAL) pulmonary permeability changes were quantified and PMNL activation was assessed by chemiluminescence. Additionally PMNL diapedesis and interstitial lung oedema were determined by histological analysis. All animals were sacrificed 4 h after the start of the femoral instrumentation. Without an associated lung injury, instrumentation of the femoral canal with the reamed nailing technique induced a transient increase in pulmonary permeability. In the face of an induced lung contusion, reamed femoral nailing resulted in significant increases in PMNL activation, pulmonary permeability and interstitial lung oedema, compared with external fixation. Without pulmonary contusion, reaming of the femoral canal was associated with a transient increase in pulmonary permeability. This was exacerbated in the presence of lung contusion along with increased PMNL activation. External fixation did not provoke similar changes. The findings of this study support the view that reaming of the femoral canal should be avoided in polytrauma patients with severe chest trauma as it could act as an additional stimulus for adverse outcome. Temporary external fixation appears to be a safe method for fracture stabilisation until inflammatory and coagulatory disturbances after trauma have been normalized.     

Assessment of the test–retest reliability of a foot placement accuracy protocol in assisted-living older adults

IntroductionThis study assessed the test–retest reliability of a foot placement accuracy protocol in a population of assisted-living elderly. The goal was to evaluate the execution of foot placement performance with increasing complexity of the walking condition.MethodsTwenty-five elderly participants (5 males, 20 females, 80.4 ± 8.6 years) were assessed by one observer in two sessions with 48 h between the measurements. Participants walked at self-selected pace along a pathway with three different walking conditions composed of two rectangular foam target locations and an obstacle on the walking surface. The main outcome measures were foot placement distance error, intra-class correlation coefficients (ICC), and the smallest detectable difference (SDD).ResultsMean absolute values of the foot placement distance errors were 14.0 ± 4.5 mm for medio-lateral deviation and 27.2 ± 2.1 mm for anterior–posterior deviation, respectively. ICC values for test–retest reliability showed ‘fair to good’ to ‘excellent’ reliability across all conditions with values ranging from 0.63 to 0.94. SDD values were between 3.6 and 37.3 mm.ConclusionThe protocol showed good reliability for test–retest measurements of foot placement accuracy, thus making this protocol a reliable and location-independent tool to assess performance of foot placement in elderly in assisted-living settings. In the future, measurements with elderly fallers and non-fallers should be conducted to assess validity of the protocol.     

When should we operate on major fractures in patients with severe head injuries?

BACKGROUND: The widely accepted practice of early fracture fixation (EFF) in multiply injured patients has recently been challenged in the presence of head injury. DATA SOURCES: English and German language articles on the subject were searched using Medline. Keywords included head trauma, intracranial trauma, brain injuries, fractures, fracture fixation, timing, femur fracture, and tibia fracture. CONCLUSIONS: The available literature does not provide clear-cut guidance on the management of fractures in the presence of head injuries. The trend is toward a better outcome if the fractures are fixed early. Treatment should therefore be tailored to the individual patient, with the assumption that full neurologic recovery will take place.     

Risk stratification by injury distribution in polytrauma patients – does the clavicular fracture play a role?

Background

Thoracic and extremity injuries are common in polytraumatized patients. The clavicle limits the upper thoracic cage and connects the body and upper extremities. It is easy to examine and is visible on standard emergency room radiographs. We hypothesize that clavicular fracture in polytrauma patients indicates the presence of further injuries of the upper extremities, head, neck and thorax.

Material and methods

Retrospective study including patients admitted between 2008 and 2012 to a level-I trauma center. Inclusion criteria: ISS?>?16, two or more injured body regions, clavicular fracture. Control group: patients admitted in 2011, ISS?>?16, two or more injured body regions, no clavicular fracture. Patient information was obtained from the patients’ charts; evaluation of radiographic findings was performed; scoring was based on the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) AIS/ISS; data were analyzed using Pearson’s correlation and the Mann–Whitney U-test in SPSS (version 11.5.1); graphs were drawn using EXCEL®.

Results

Thirty-four patients with clavicular fracture (C+) and 40 without (C-) were included; the mean ISS was 25 (range 16–57), m?=?70%, f?=?30%; age 43.3 years (range 9–88); clavicular fractures were positively correlated with severe thoracic (p?=?0.011, OR 4.5: KI 1.3–15.3), external (p?<?0.001, OR 9.2: KI 2.7–30.9) and upper extremity injuries (p?<?0.001, OR 33.2: KI 6.9–16.04 resp. p?=?0.004, OR 12.5: KI 1.5–102.9). C?+?showed a lower head/neck AIS (p?=?0.033), higher thorax AIS (p?=?0.04), arm/shoulder AIS (p?=?0.001) and external AIS (0.003) than C-. Mean hospital stay and ICU treatment time were longer in the C?+?group (p?=?0.001 and p?=?0.025 respectively).

Conclusion

A clavicular fracture can be diagnosed easily and may be used as a pointer for further thoracic and upper extremity injuries in polytrauma patients that might have been otherwise missed. Special attention should be paid on second and tertiary survey.

     

Long-Term Outcome of Children with Fetal Alcohol Syndrome: Psychopathology, Behavior, and Intelligence

Within an interdisciplinary research project, the long-term outcome of children with fetal alcohol syndrome was studied. Methods for the assessment of psychopathology, behavior, and intelligence included psychiatric interviews, behavior checklists for parents and teachers, and intelligence tests. The children were assessed during preschool age, early school age (6 to 12 years), and late school age (≥ 13 years). An excess of psychopathology, (including hyperkinetic disorders, emotional disorders, sleep disorders, and abnormal habits and sterotypies) with a strong persistence over time was found. Cognitive functioning was marked by a large proportion of mentally retarded children and also did not change considerably over time. This long-term outcome study reflects the handicapping effects of fetal alcohol syndrome.