Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study

BACKGROUND: Although Weber type B ankle fractures are often considered benign with a good prognosis, evidence from observational studies suggests that 17% to 24% of such patients may have less satisfactory outcomes. Although the explanation for variability in outcomes remains unclear, previous studies of other surgical procedures have suggested nonsurgery-related causes account for much of the variability in outcomes. METHODS: We conducted a prospective observational cohort study to evaluate health-related quality of life in 30 patients with unstable ankle fractures who were otherwise healthy. Only patients from 2 university-affiliated hospitals sustaining unstable type B Weber injury patterns requiring surgery were eligible. Patients provided detailed baseline information regarding alcohol consumption, smoking habits, and educational level. Patients completed the short form 36 questionnaire and a visual analogue pain scale at regular follow-up intervals. RESULTS: The average patient age was 51.6 years (SD 15.2 years), and 57% (17 out of 30) were male. The majority of fractures were the result of a fall (67%, 20 out of 30), and all were closed injuries. Almost half of all patients were smokers (47%, 14 out of 30), whereas 43% consumed alcohol on a weekly basis (13 out of 30). Forty-three percent of patients (13 out of 30) had obtained an elementary or high school level of education. Patients experienced significant improvements in all domains of the SF-36 questionnaire (P < 0.001), except general health, which remained essentially normal over the 24-month period. Study patients achieved scores similar to age-matched U.S. normative data across 6 of the 8 domains (Role Emotional, Social Function, Mental Health, Bodily Pain, Vitality, and General Health). However, patients' physical function and role physical scores remained significantly lower than US norms at 24 months (21.8 and 20.7 points lower on a 100-point scale, respectively; P < 0.001). Smoking history (P = 0.02), presence of a medial malleolar fracture (P = 0.02), and lower levels of education (P = 0.01) were significant independent predictors of lower physical function up to 3 months postoperation. Lower mental health domain scores were significantly associated with alcohol use (P = 0.02) and increasing age (P = 0.04). CONCLUSIONS: As is the case in many other areas, social factors may be important determinants of outcome in patients with traumatic fractures. Optimal orthopedic care may involve attention to modifiable risk factors, including smoking and alcohol consumption.     

Reward drive and rash impulsiveness as dimensions of impulsivity: implications for substance misuse

One of the primary personality dimensions or traits that has consistently been linked to substance abuse is impulsivity. However, impulsivity is not a homogenous construct and although many of the measures of impulsivity are correlated, the most recent review of published factor analytic studies has proposed two independent dimensions of impulsivity: reward sensitivity, reflecting one of the primary dimension of J. A. Gray's personality theory, and rash impulsiveness. These two facets of impulsivity derived from the field of personality research parallel recent developments in the neurosciences where changes in the incentive value of rewarding substances has been linked to alterations in neural substrates involved in reward seeking and with a diminished capacity to inhibit behavior due to chronic drug exposure. In this paper, we propose a model that integrates the findings from research into individual differences with recent models of neural substrates implicated in the development of substance misuse.     

Models of co‐occurring substance misuse and psychosis: are personality traits the missing link?

Traditional models of co-occurring substance misuse in psychosis, including the vulnerability and coping (self-medication) hypotheses, have tended to focus on state-specific factors, such as the severity of substance misuse or psychotic symptoms. In contrast, more recent personality models posit that co-morbidity is related to individual differences in stable trait-specific personality variables that underlie affective outcomes, coping strategies and subsequent risk for substance use. This paper reviews the current evidence base for these three models, and suggests that future research examine the inter-relationships between trait and state-specific personality, affective and behavioural variables on co-morbidity.     

Extracellular calcium level is crucial for aortic contractile response in pregnant rat

Studies of vascular reactivity during late pregnancy were performed to investigate the previously described hyporeactivity to vasopressors. Two groups of seven control (nonpregnant) and seven late pregnant (day 20) Wistar rats were used. Rubbed (E-) segments from thoracic aorta were studied for contractile studies in a Krebs solution containing either 1.25 or 2.50 mmol/L Ca concentration. Norepinephrine (NE; 10-9-3 x 10-5) or depolarization induced (KCl, 100 mmol/L) contractions are given as mN/mm2. With 2.50 mmol/L Ca, the maximal contraction to NE in E-segments is decreased in late pregnant rats compared with nonpregnant rats. However, this difference disappears when calcium concentration is set to 1.25 mmol/L Ca, the physiological value for free calcium concentration in extracellular fluid. For the contraction induced by opening of voltage operated calcium channels (KCl depolarization), a decreased maximal tension is also obtained in the pregnant rats compared with nonpregnant only with 2.50 mmol/L Ca concentration. It appears that aortic response to vasoconstrictors is modulated by extracellular calcium concentration in a different way between pregnant and nonpregnant rats.     

Efficacy of moderation-oriented cue exposure for problem drinkers: a randomized controlled trial

The effectiveness of cue exposure following a priming dose was compared with cognitive-behavioral intervention in a community sample of problem drinkers. Participants were randomly allocated to 1 of the 2 conditions and received a mean of 5.84 (SD = 2.69) sessions. A psychologist blind to treatment condition conducted an 8-month follow-up. Compared with pretreatment levels, significant decreases in alcohol consumption were evident posttreatment and maintained at follow-up for both groups. Reductions in severity of dependence, impaired control, and alcohol-related problems were also evident for both groups at follow-up. No differences in outcome associated with initial severity of alcohol dependence were apparent. The results raise the issue of the appropriateness of reserving a goal of controlled drinking for those with relatively mild alcohol problems and low alcohol dependence.     

Chromobacterium violaceum: a case of diarrhea in Senegal

A 5-year-old infant with diarrhea had heavy growth of Chromobacterium violaceum cultured from stool. This organism is restricted geographically between latitudes 35 degrees N and 35 degrees S. It can cause sepsis and various focal infections but is not a well-known cause of diarrhea.     

The relationship between sociocultural pressure to be thin and body dissatisfaction in preadolescent girls

This study investigates the relationships among sociocultural pressures to be thin, internalisation of the thin ideal, social comparison, body mass index, and body dissatisfaction in young girls. One hundred and fifty-three 10-13 year old girls completed measures assessing sociocultural pressure to be thin, media exposure, body dissatisfaction, social comparison, and internalisation of the thin ideal. Although sociocultural factors, as a group, were significantly associated with internalisation of the thin ideal, perceived media pressure was the only sociocultural influence uniquely related to internalisation of the thin ideal. Perceived pressure to be thin delivered by the media was found to be associated with body dissatisfaction via internalisation of the thin ideal. The relationship between internalisation of the thin ideal and body dissatisfaction was also partially influenced by social comparison. Body mass was found to have a direct association with body dissatisfaction. A model incorporating the relationships among media pressure, internalisation of the thin ideal, social comparison, and body dissatisfaction is proposed.