Incidence of mild and moderate brain injury in the United States, 1991

The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46761 households and weighted to reflect all non-institutionalized civilians. The report of one or more occurrences of head injury resulting in loss of consciousness in the previous 12 months was the main outcome measure. Each year an estimated 1 5 million non-institutionalized US civilians sustain a non-fatal brain injury that does not result in institutionalization, a rate of 618 per 100000 person-years. Motor vehicles were involved in 28 of the brain injuries, sports and physical activity were responsible for 20 , and assaults were responsible for 9 . Medial care was sought by 75 of those with brain injury; 14 were treated in clinics or offices, 35 were tretaed in emergency departments, and 25 were hospitalized. The risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone. The incidence of mild and moderate brain injury in the United States is substantial. The National Health Interview Survey is an important national source of current outpatient brain-injury data.     

The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer

We found that a cohort of patients with lung cancer first treated in 1977 had higher six-month survival rates for the total group and for subgroups in each of the three main TNM stages (tumor, nodes, and metastases) than a cohort treated between 1953 and 1964 at the same institutions. The more recent cohort, however, had undergone many new diagnostic imaging procedures. According to the "old" diagnostic data for both cohorts, the recent cohort had a prognostically favorable "zero-time shift." In addition, by demonstrating metastases that had formerly been silent and unidentified, the new technological data resulted in a stage migration. Many patients who previously would have been classified in a "good" stage were assigned to a "bad" stage. Because the prognosis of those who migrated, although worse than that for other members of the good-stage group, was better than that for other members of the bad-stage group, survival rates rose in each group without any change in individual outcomes. When classified according to symptom stages that would be unaltered by changes in diagnostic techniques, the two cohorts had similar survival rates.     

Internal fixation with bone cement in reconstruction of bone defects due to bone metaseses

Background. Retrospective evaluation of surgical technique, clinical and radiological results and mechanical sufficiency internal fixation with bone cement in treatment of bone defect due to metastatic lesions. Material and methods. 66 patients treated operatively due to pathologic fractures becuase of the bone metastases. Mean age of the patients was 65,5 y. o. There were 40 women and 26 men. In 53 cases (80%) origin of primary tumor was known. Localisation secondary tumors was as follow: femur - 52 cases, humerus - 13 cases and tibia - 1 case. Bone defects after curettage of metastasis were recunstrucated by bone cement and fixations were made by plate technique - 54 cases or intramedullary nail techique - 12 cases. Evaluation of the mechanical suffifciency of applicated recunstuction techniques in treatment of bone metastatic lesions was made accornig to athors' own scale: grade I - good stabilisation, grade II - fair destabilisation, grade III - advanced destabilisation and grade IV - complete destabilisation. Results. There were 2 deaths in early postoperative period (3%). Mean survial time after surgery was 13 months. In 64 cases excellent or good results were achived: good mechanical fixation and no pain. In left 2 cases partial and complete destabilisation of fixation occurred. Conclusions. Mechanical sufficiency of reconstruction techniques in metastatic bone lesions was good in study group. Incidence of local and systemic complications in study group was 3-time higher than in normal trauma fracture population, because of more sever general health status of patients with advaced neoplastic disease.     

Service Intensity and Organizational Attributes: A Preliminary Inquiry

Service intensity can vary dramatically across the clients who are served within a psychosocial intervention. But studies of the determinants of intensity are disappointing, and examinations of its impacts on key client behaviors tend to be biased by unaccounted for reciprocal relations. The author argues that it may be useful to take into account organizational attributes. Service intensity may be more fully explained by attributes such as program life-cycles and learning routines, administrative reforms, worker attention spans, worker dispositions, and caseloads. Data from an intervention for adults with homeless experience and substance abuse problems (n=136) support the author's argument. Results suggest that intervention leaders must become aware of and capable of manipulating the organizational context of treatment.     

Carpal instability after fractures of the distal end of the radius]

Evaluation of the scapho-lunate angle (SLA) was made on the lateral X-rays of 335 cases after Colles' fracture. Value of SLA over 65 degrees was accepted as the sign of the dorsal intercaleted segmental instability of the wrist (DISI). In the material was stated 84 cases (25%) of the DISI. Frequency of the incidence of the DISI was analysed according to fracture type and the age of the patient. More frequent incidence of the DISI was discovered in the intraarticular fractures (44%) than in the extraarticular (20%). The difference between fractures with or without dislocation was not so great (27% tp 21%). Increasing percent of the DISI was stated in the older age-groups (the greatest--49%--in the group after 70-years old).