Datasets:

clinicalnlplab

/

MS2_1shot_test

like 0

MS2_1shot100

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Temporom and ibular pain has multiple etiologies and a range of therapeutic options . In this pilot study , the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporom and ibular disorders ( TMDs ) . METHODS The authors assigned 80 participants r and omly into one of the following four groups , all of which included a comprehensive self-care program : reversible interocclusal splint therapy ( RIST ) , Activator Method Chiropractic Technique ( AMCT ) ( Activator Methods International , Phoenix ) , sham AMCT and self-care only . They made assessment s at baseline and at month 2 and month 6 , including use of the Research Diagnostic Criteria for Temporom and ibular Disorders . RESULTS The authors screened 721 potential participants and enrolled 80 people ; 52 participants completed the six-month assessment . The adjusted mean change in current pain over six months , as assessed on the 11-point numerical rating scale , was 2.0 ( 95 percent confidence interval , 1.1 - 3.0 ) for RIST , 1.7 ( 0.9 - 2.5 ) for self-care only , 1.5 ( 0.7 - 2.4 ) for AMCT and 1.6 ( 0.7 - 2.5 ) for sham AMCT . The authors also assessed bothersomeness and functionality . CONCLUSIONS The authors found the study design and methodology to be manageable . They gained substantial knowledge to aid in conducting a larger study . AMCT , RIST and self-care should be evaluated in a future comparative effectiveness study . PRACTICAL IMPLICATION S This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD The aim of this study was to compare the effectiveness of three treatment methods for unilateral temporom and ibular joint ( TMJ ) disc displacement without reduction ( DDwoR ) . One hundred and twenty patients with unilateral TMJ DDwoR were assigned r and omly to one of three treatment groups ( 40 patients in each ) : group 1 received arthrocentesis , group 2 received stabilization splint therapy following arthrocentesis , and group 3 received splint therapy only . The groups were compared in terms of pain ( visual analogue scale ) , joint function ( maximum mouth opening and laterotrusive movements ) , disability and psychological status ( vali date d question naire ) , and success rates . These were recorded before treatment and during follow-up after treatment ( 1 , 3 , and 6 months ) . The between-group and within-group differences in the data were analyzed statistically . The baseline characteristics were similar in all groups ( P>0.05 ) . Significant improvements were noted in all parameters compared to baseline values in all groups ( all P<0.01 ) . Groups 1 and 2 showed comparable outcomes that were superior to those of group 3 . Arthrocentesis reduces pain and functional impairment more rapidly and effectively than splint therapy . Simultaneous splint application has no additional effect on the effectiveness of arthrocentesis for the treatment of unilateral PURPOSE The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism . METHOD A r and omized , controlled , blinded , clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism . Quality of life and pain assessment s were performed . RESULTS Significant differences ( p < 0.05 ) were found on the physical functioning , general health state , vitality , role emotional and mental health subscales . A large effect size was found for all treatment protocol s with regard to pain . The largest effect was found in the combined treatment group . CONCLUSIONS The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism . Moreover , both treatments ( occlusal splint usage and massage therapy on the masticatory muscles ) led to a reduction in pain The evidence supporting the use of stabilisation splints in the treatment of temporom and ibular disorders ( TMD ) is scarce and a need for well-controlled studies exists . The aim of this r and omised , controlled trial study was to assess the efficacy of stabilisation splint treatment on TMD . The sample consisted of 80 consecutive referred patients who were r and omly assigned to the splint group ( n = 39 ) and the control group ( n = 41 ) . Subjects in the splint group were treated with a stabilisation splint , whereas subjects in the control group did not receive any treatment except counselling and instructions for masticatory muscle exercises which were given also to the subjects in the splint group . Outcomes were visual analogue scale ( VAS ) on facial pain intensity and clinical findings for TMD which were measured at baseline and after 1-month follow-up . The differences in change between the groups were analysed using regression models . Facial pain decreased and most of the clinical TMD findings resolved in both of the groups . The differences in changes in VAS or clinical TMD findings between the groups were not statistically significant . The findings of this study did not show that stabilisation splint treatment in combination with counselling and masticatory muscle exercises has additional benefit in relieving facial pain and increasing the mobility of the m and ible than counselling and masticatory muscle exercises alone in a short time-interval Sixty-three patients with an arthrographic diagnosis of disk displacement with reduction were r and omly assigned to three treatment groups : ( I ) onlays to maintain disk repositioning , ( II ) flat occlusal splint , or ( III ) untreated controls . Guidance for construction of the disk-repositioning onlays was established during arthrography to obtain a recaptured disk position relative to the condyle . The onlays were cemented to the teeth and maintained the new intercuspal position anteriorly and inferiorly . The flat occlusal splint was used at night only and was adjusted to maintain a maximal occlusal contact in centric relation and centric occlusion . Clinical examinations were performed before and after 6 months of treatment . The disk-repositioning onlays improved joint function and reduced joint and muscle pain when compared with the flat occlusal splint and with nontreatment . The signs and symptoms in the flat occlusal splint group were no different from those in the control group . It is concluded that disk-repositioning onlays are effective in reducing pain and dysfunction associated with disk displacement with reduction in patients in whom the disk can be maintained in a normal relationship to the condyle with the aid of such onlays . The symptoms , however , returned when the onlays were removed after 6 months ; this raises the question of whether a permanent change in the intercuspal position is necessary for long-term success Forty-five individuals with long-st and ing facial pain or headache of muscular origin were r and omly allocated into three groups . The first group was treated with acupuncture , the second group received an occlusal splint , and the third group served as controls . Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system . No differences between these two groups were found with regard to treatment effects . It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniom and ibular disorders of muscular origin BACKGROUND Treatment recommendations for patients with painful temporom and ibular disorders ( TMDs ) range from conservative treatments such as physiotherapy to aggressive and irreversible treatments such as restorative reconstruction and joint surgery . METHODS The authors r and omized 200 subjects diagnosed with TMD into three groups : usual conservative , dentist-prescribed self-care treatment without any intraoral splint appliance ( UT ) ; UT plus a conventional flat-plane hard acrylic splint ( HS ) ; and UT plus a soft vinyl ( a low-cost athletic mouth guard ) splint ( SS ) . Subjects completed question naires and clinical examinations at three , six and 12 months . RESULTS The authors observed no significant differences among the groups in TMD-related pain levels or other common signs and symptoms of TMD at baseline ( BL ) or at any follow-up . The changes from BL were comparable for all three groups . The authors did not note any significant differences at any follow-up for compliance with study protocol s or for occurrences of adverse effects from either splint type . For HS versus SS , there were significant differences in rates of splint use , but these differences were not accompanied by differences in either self-reported symptoms or in clinical findings . CONCLUSIONS All patients improved over time , and traditional splint therapy offered no benefit over the SS splint therapy . Neither splint therapy provided a greater benefit than did self-care treatment without splint therapy . CLINICAL IMPLICATION S These findings suggest that clinicians who treat patients with TMD should consider prescribing low-cost nonsplint self-care therapy for most patients Objective The benefit of the use of some intraoral devices in arthrogenous temporom and ibular disorders ( TMD ) patients is still unknown . This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction ( DDWR ) and arthralgia . Material s and Methods A total of 60 DDWR and arthralgia patients were r and omly divided into three groups : group I ( n=20 ) wore anterior repositioning occlusal splints ( ARS ) ; group II ( n=20 ) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices ( NTI-tss ) ; and group III ( n=20 ) only received counseling for behavioral changes and self-care ( the control group ) . The first two groups also received counseling . Follow-ups were performed after 2 weeks , 6 weeks and 3 months . In these sessions , patients were evaluated by means of a visual analogue scale , pressure pain threshold ( PPT ) of the temporom and ibular joint ( TMJ ) , maximum range of motion and TMJ sounds . Possible adverse effects were also recorded , such as discomfort while using the device and occlusal changes . The results were analyzed with ANOVA , Tukey ’s and Fisher Exact Test , with a significance level of 5 % . Results Groups I and II showed improvement in pain intensity at the first follow-up . This progress was recorded only after 3 months in Group III . Group II showed an increased in joint sounds frequency . The PPT values , m and ibular range of motion and the number of occlusal contacts did not change significantly . Conclusion The simultaneous use of intraoral devices ( partial time ) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR . The use of NTI-tss could increase TMJ sounds . Although intraoral devices with additional counseling should be considered for the management of painful DDWR , dentists should be aware of the possible side effects of the intraoral device ’s design Introduction Painful temporom and ibular disorders ( TMDs ) are usually treated with physiotherapy , self-exercises , medication-based therapy and splint therapy . For splint therapy different types of splints are available . Therefore this r and omized controlled study compared the effectiveness of a semi-finished occlusal appliance ( SB ) with a laboratory-made occlusal appliance ( SS ) in myofascial pain patients . Method The trial subjects allocated to the experimental groups with the ( SB ) occlusal appliance and those provided with a laboratory-made occlusal appliance ( SS ) did , in addition , receive conservative treatment ( self-exercises , drug-based and manual therapy ) . The control group was given conservative therapy ( CO ) only . Overall , a total of 63 patients participated in the study with each group consisting of 21 subjects . Results When the first follow-up examination took place ( 14 days after splint insertion ) mouth opening within the SB group was significantly enlarged . When the second examination was conducted ( 2.5 months after splint insertion ) mouth opening was significantly enlarged in both splint groups when compared with the initial value . In the control group , no significant enlargement of mouth opening was detected . At no point there was a significant reduction in the number of pressure-sensitive areas of the TMJ . On palpation of the masticatory muscles however , a significant reduction in the number of pressure-sensitive areas could be observed within the CO group and the SS group after 2.5 months . When comparing pain reduction ( muscle/joint pain ) and mouth opening , no significant differences could be detected between the treatments . Conclusion The results suggest that TMD should be treated conservatively . In cases of restricted mouth opening , the additional use of occlusal appliances can eliminate the patient ’s discomfort more quickly . In this context , the tested , semi-finished occlusal appliance appears to offer an immediately available , temporary alternative to laboratory-made splints Introduction Temporom and ibular disorder ( TDM ) is the most common source of orofacial pain of a non-dental origin . Sleep bruxism is characterized by clenching and /or grinding the teeth during sleep and is involved in the perpetuation of TMD . The aim of the present study was to investigate the effects of massage therapy , conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism . Methods Sixty individuals with severe TMD and sleep bruxism were r and omly distributed into four treatment groups : 1 ) massage group , 2 ) conventional occlusal splint group , 3 ) massage + conventional occlusal splint group and 4 ) silicone occlusal splint group . Block r and omization was employed and sealed opaque envelopes were used to conceal the allocation . Groups 2 , 3 and 4 wore an occlusal splint for four weeks . Groups 1 and 3 received three weekly massage sessions for four weeks . All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index . The Wilcoxon test was used to compare the Output:

There was no evidence that any other outcomes improved when using splints . There was no evidence of adverse events associated with splints , but reporting was poor regarding this outcome . No trials measured tooth wear in patients with bruxism . Sensitivity analyses based on these factors did not indicate a reduction in pain . Conclusions The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions . There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism

MS2_1shot101

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: In addition to modern medicinal therapy , many cancer patients in Taiwan are treated regularly with herbal medicines or prescribed a traditional herbal diet . In this paper , the effect of a Taiwanese traditional herbal diet ( TTHD ) on pain in terminal cancer patients was investigated . A total of 2,466 patients diagnosed with a variety of cancers were included . The most common patient-reported symptoms included troublesome pain ( 79.2 % ) , weakness ( 69.0 % ) , anorexia ( 46.4 % ) , fever ( 36.5 % ) , dyspnea ( 31.1 % ) , and leg edema ( 30.9 % ) . The 2,466 terminal cancer patients included in the study were r and omly divided into three groups . The TTHD group ( n=1044 ; 42.3 % ) were given the TTHD consisting of analgesic herbs ( paeony root : licorice root=1:1 ) and a Taiwanese tonic vegetable soup ( Lilii bulbus , Nelumbo seed , and Jujube fruit ) . The remaining patients were divided into a reference group , given the regular hospital diet , ( n=909 , 36.9 % ) and a control group , given the Taiwanese tonic vegetable soup without analgesic herbs , ( n=513 , 20.8 % ) . All patients maintained their assigned diets for one week . A verbal numerical scale was used to assess pain . Results revealed that the patients given TTHD reported enhanced pain relief ( p<0.05 ) compared to the reference and control groups . We found that TTHD could alleviate the pain among terminal cancer patients thereby supporting the supposition that Eastern and Western medicines can be effectively co-administered to enhance terminal patient 's quality of life . Further research is warranted BACKGROUND This study aim ed to evaluate traditional Chinese medicine ( TCM ) in improving quality of life ( QOL ) , reducing chemotoxicity and modulating immune function in patients undergoing chemotherapy . PATIENTS AND METHODS Patients with ovarian cancer were r and omized to receive either TCM or placebo in addition to st and ard chemotherapy . The primary outcome was global health status ( GHS ) score , assessed by European Organization for Research and Treatment of Cancer question naire , while the secondary outcomes were other QOL items , chemotoxicity according to World Health Organization criteria and alterations in immune function as measured by immune cells count and the numbers of cytokines-secreting cells . RESULTS There was no significant difference in the GHS between the two groups . With adjustment for stage , chemotherapy type , disease status , age and baseline value , emotional function , cognitive function and nausea and vomiting were found to be worse or less improved in the TCM group compared with placebo group after six cycles of chemotherapy . The TCM group had less neutropenia after three cycles ( 0 % grade 4 neutropenia versus 28.6 % ) . There were no other significant differences in terms of chemotoxicity . Lymphocyte counts and cytokine activities decreased less in the TCM group . CONCLUSIONS TCM did not improve QOL but did have some effects in terms of maintaining immune function CONTEXT A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient OBJECTIVE To observe the effect and safety of Zhiling Capsule ( ZC ) in treating lung cancer of middle/advanced stage . METHODS With the multi-center , r and omized , double-blinded and parallel controlled method , the patients were divided into 4 groups , the 104 patients in the group A were treated with the whole recipe of ZC , the 52 in the group B with the disassembled recipe 1 ( Western medicines ) of ZC , the 46 in the group C with the disassembled recipe 2 ( Chinese medicines ) of ZC , and the 48 in the control group with Pingxiao Capsule , all the drugs were administered orally for 2 weeks . The changes of syndrome of qi-yin deficiency , symptoms , quality of life ( QOL ) , body weight and adverse reactions occurred in patients were observed . RESULTS The effective rate in alleviating syndrome in the groups A-D was 91.3 % , 80.8 % , 37.0 % and 14.6 % respectively ; in remitting stuffiness and chest pain 86.9 % , 60.5 % , 20.0 % and 10.0 % ; in improving appetite was 80.4 % , 47.9 % , 23.7 % and 10.3 % . QOL in the groups A-C was significantly elevated after treatment ( P < 0.05 or P < 0.01 ) , the improvement of group A was superior to that of other treatments ( P < 0.01 ) . Body weight in the group A was significantly increased and superior to that of others ( P < 0.05 ) . The whole recipe of ZC showed the therapeutic effect superior to that of the other treatments ( P < 0.05 ) . No obvious adverse reaction was found in all the 4 groups . CONCLUSION ZC can improve the symptoms and QOL in patients with lung cancer of middle/advanced stage OBJECTIVE To observe the effects ot Guben Yiliu II ( GY II ) combined with arterial perfusion with chemotherapeutic agent on advanced pancreatic cancer ( APC ) . METHODS Sixty-five APC patients were r and omly assigned to the treated group ( 35 cases ) given GY II and arterial perfusion with chemotherapeutic agent and the control group ( 30 cases ) with chemotherapeutic agent alone . RESULTS The clinical beneficial rate was 54.2 % in the treated group and 40.0 % in the control group , with significant difference between them ( P < 0.05 ) , the overall effective rate being 17.1 % and 13.3 % , and the effective rate in relieving pain being 64.5 % and 59.2 % in the treated and the control group respectively , all showed insignificant difference between groups ( P > 0.05 ) . Furthermore , in the treated group after treatment , the blood hypercoagulation state ameliorated , cellular immunity elevated , the toxic and side- effects of chemical medicine relieved , and the quality of life improved . CONCLUSION GY II is effective in enhancing clinical effects and relieving toxic and side-effects of chemotherapy , and so , better efficacy could be obtained by therapy of GY II and arterial perfusion with chemotherapeutic agent for treatment of APC Objective To observe the efficacy of Chinese medicine comprehensive therapeutic project in treating the middle/late stage primary hepatic carcinoma ( PHC ) . Methods With prospect i ve r and omized controlled design , 97 patients with PHC were assigned to the test group ( 49 cases ) treated with Chinese medicine comprehensive therapy using Oleum fructus bruceas intervention combining oral intake of Ganji Decoction ( 肝积方 ) and external application of Ailitong ( 癌理通 ) , and the control group ( 48 cases ) treated with chemotherapeutic agents combining iodized oil chemo-embolization and analgesics . The immediate and long-term efficacy , adverse reaction , pain-relieving initial time ( PRIT ) and pain-relieving sustained time ( PRST ) of the treatment , as well as the change in relieving patients ’ quality of life ( QOL ) were observed . Results The difference between the two groups in illness control rate was statistically insignificant ( P>0.05 ) , but the adverse reaction occurence rate in the test group was lesser than that in the control group ( P<0.05 ) . PRIT was insignificantly different in the two groups ( P>0.05 ) , but the PRST was significantly superior in the test group than that in the control group ( 10.37±2.18 h vs 7.78±1.95 h , P<0.01 ) . After treatment , the increased Karnofsky scores in the test group indicated that the patients ’ somatic activity , symptoms and QOL were improved significantly , which were significantly superior to those in the control group ( P<0.05 ) . The survival rate in the two groups was similar at the 3rd month after treatment , but the test group did show superiority in terms of half- and 1-year survival rate ( 65.9 % vs 42.5 % and 38.6 % vs 18.1 % , respectively , P<0.05 ) . The median survival time in the test group was 8.9 months and that in the control group was 5.3 months . Conclusion Chinese medicine comprehensive therapy is an effective treatment for the middle/late stage patients of PHC , and it could extend the PRST , improve the patients ’ QOL and long-term survival with less adverse reaction Objective To observe the clinical effectiveness of a topical application of Xiaozheng Zhitong : Paste ( 消癥止痛方 , XZP ) in alleviating the cancerous pain of patients with middle/late stage cancer Methods By : adopting a r and om number table , 124 patients enrolled were r and omized into the treatment group ( 64 patients ) and the control group ( 60 patients ) . In addition to the basic therapy [ including the three-ladder ( 3L ) analgesia ] used in both groups , topical application of XZP was given to patients in the treatment group for pain alleviation . The analgesic efficacy was recorded in terms of pain intensity , analgesia initiating time and sustaining time , and the optimal analgesic effect revealing time . Meanwhile , the quality of life ( QOL ) and adverse reactions that occurred in patients were recorded as well . Results The total effective rate in the treatment group was : 84.38 % ( 54/64 ) , and in the control group it was 88.33 % ( 53/60 ) , showing no significant difference between them ( P>0.05 ) , but the analgesia initiating time and the optimal analgesia effect revealing time in the treatment group were significantly shorter ( both P<0.01 ) . Moreover , XZP was better in improving patients ’ QOL , showing more significant improvements in the treatment group than those in the control group in aspects of mental condition , walking capacity , working capacity , social acceptability , sleep and joy of living ( P<0.05 or P<0.01 ) . Lower incidence of adverse reactions , such as nausea , vomiting , mouth dryness , dizziness , etc . , especially constipation , was noted in the treatment group ( P<0.05 or P<0.01 ) . Conclusion Applying an external compress : of XZP showed a synergistic action with 3L analgesia for shortening the initiating time and the optimal effect revealing time , and could evidently enhance patients ’ QOL with fewer adverse reactions OBJECTIVE To observe the effects of ginsenosides ( GS ) and low dose glucocorticoid for preventing and treating the post-transcatheter arterial chemoembolization ( TACE ) syndrome . METHODS Adopting r Output:

The results of these studies suggest that THM combined with conventional therapy is efficacious as an adjunctive therapy for patients with cancer pain .

MS2_1shot102

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Aim : Mucopolysaccharidosis VI ( Maroteaux – Lamy syndrome ) is a lysosomal storage disease caused by a deficiency of the enzyme N‐acetylgalactosamine 4‐sulphatase ( ASB ) . Enzyme replacement therapy with recombinant human ASB ( rhASB ) has been studied in a r and omized , double‐blind , two‐dose ( 0.2 and 1.0 mg/kg/week ) phase I/II study ( n=7 ) followed by an open‐label single dose ( 1.0 mg/kg/week ) extension study . We report the pharmacokinetic profile of rhASB and the impact of antibody development . Methods : Pharmacokinetic analysis was performed at weeks 1 , 2 , 12 , 24 , 83 , 84 and 96 . Infusions were administered over 4 hours using a ramp‐up protocol . Plasma ASB and rhASB antibody concentrations and urine glycosaminoglycan ( GAG ) concentrations were determined . Results : The area under the plasma concentration – time curve ( AUC0−t ) for the high‐dose group increased from week 1 to week 2 , but remained unchanged at weeks 12 and 24 . A large difference in mean AUC0−t was observed between the low‐ and high‐dose groups . Pharmacokinetic results at weeks 83 , 84 and 96 were similar to those at week 24 . Six patients developed antibodies to rhASB . One patient developed high antibody levels in combination with a high ASB concentration , while a second patient also developed high antibody levels with undetectable ASB concentrations . Antibodies from the second patient blocked detection of ASB . By week 72 , antibody levels had decreased in all patients . The high‐dose rhASB produced a more rapid and greater percentage reduction in urinary GAG concentrations than the lower dose ( 70 % versus 55 % at 24 weeks ) . Antibody levels did not appear to influence urinary GAG concentrations OBJECTIVES To evaluate the safety and efficacy of weekly treatment with human recombinant N-acetylgalactosamine 4-sulfatase ( rhASB ) in humans with mucopolysaccharidosis type VI ( MPS VI ) . STUDY DESIGN An ongoing Phase I/II , r and omized , two-dose , double-blind study . Patients were r and omized to weekly infusions of either high ( 1.0 mg/kg ) or low ( 0.2 mg/kg ) doses of rhASB . Six patients ( 3 male , 3 female ; age 7 - 16 years ) completed at least 24 weeks of treatment , five of this group have completed at least 48 weeks . RESULTS No drug-related serious adverse events , significant laboratory abnormalities , or allergic reactions were observed in the study . The high-dose group experienced a more rapid and larger relative reduction in urinary glycosaminoglycan that was sustained through week 48 . Improvements in the 6-minute walk test were observed in all patients with dramatic gains in those walking < 100 meters at baseline . Shoulder range of motion improved in all patients at week 48 and joint pain improved in patients with significant pain at baseline . CONCLUSIONS rhASB treatment was well-tolerated and reduced lysosomal storage as evidence d by a dose-dependent reduction in urinary glycosaminoglycan . Clinical responses were present in all patients , but the largest gains occurred in patients with advanced disease receiving high-dose rhASB Objective . Mucopolysaccharidosis VI ( MPS VI ; Maroteaux-Lamy syndrome ) is a lysosomal storage disease caused by a deficiency of the enzyme N-acetylgalactosamine 4-sulfatase ( ASB ) . This enzyme deficiency leads to a progressive disorder with multiple tissue and organ involvement . The disease is rare and is heterogeneous in its clinical presentation and progression . A potential treatment for this disease exists in the form of enzyme-replacement therapy ( ERT ) with recombinant human ASB ( rhASB ) , and a phase 1/2 r and omized , double-blind , 2-dose ( 0.2 and 1 mg/kg ) study in 6 patients showed the treatment at 48 weeks to be well tolerated . Greater biochemical efficacy based on a urine glycosaminoglycan occurred in the high-dose ( 1 mg/kg ) group , and functional improvement seemed greater in patients in the high-dose group with rapidly advancing disease . On the basis of the phase 1/2 results , a phase 2 , open-label study in patients with rapidly advancing disease was initiated primarily to evaluate efficacy variables that measure endurance , mobility , and joint function in a larger group of patients . Methods . This was an open-label , multinational study of 10 MPS VI patients who received 48 weekly intravenous treatments with 1.0 mg/kg rhASB and had assessment s of biochemical and clinical responses at regular intervals . Results . After 24 weeks of treatment , each patient on average experienced a 155-m ( 98 % ) improvement in the 12-minute walk , a 64-m ( 62 % ) improvement at the 6-minute time point of the 12-minute walk , and a 48-stair ( 110 % ) gain in the 3-minute stair climb versus the baseline mean values . Additional improvements after 48 weeks of treatment were observed , including mean values of 211 m ( 138 % ) in the 12-minute walk , 75 m ( 80 % ) at the 6-minute time point of the 12-minute walk , and 61-stair ( 147 % ) gain in the 3-minute stair climb versus the baseline mean values . Joint Pain and Stiffness Question naire scores improved by at least 50 % by week 24 and were maintained at week 48 , whereas there were only small improvements in active shoulder range of motion ( < 10 ° ) and in the time taken to st and , walk , and turn starting from a seated position ( Exp and ed Timed Get-Up and Go test ) . Improvement in pulmonary function based on forced vital capacity and forced expiratory volume at 1 minute in the absence of growth was observed in 3 of 6 patients , and the observed gains occurred in the 24- to 48-week treatment interval . A mean decrease of 76 % in urinary excretion of glycosaminoglycans indicated that a satisfactory biochemical response was achieved and the ERT was well tolerated . Conclusions . The results suggest that a 12-minute walk extends the dynamic range of the conventional 6-minute walk and , along with the 3-minute stair climb , provide a robust approach to documenting the improvement in endurance in MPS VI patients who undergo ERT with rhASB UNLABELLED The objective of this study was to evaluate the long-term clinical benefits and safety of recombinant human arylsulfatase B ( rhASB ) treatment of mucopolysaccharidosis type VI ( MPS VI : Maroteaux-Lamy syndrome ) , a lysosomal storage disease . Fifty-six patients derived from 3 clinical studies were followed in open-label extension studies for a total period of 97 - 260 Weeks . All patients received weekly infusions of rhASB at 1 mg/kg . Efficacy was evaluated by ( 1 ) distance walked in a 12-minute walk test ( 12MWT ) or 6-minute walk test ( 6MWT ) , ( 2 ) stairs climbed in the 3-minute stair climb ( 3MSC ) , and ( 3 ) reduction in urinary glycosaminoglycans ( GAG ) . Safety was evaluated by compliance , adverse event ( AE ) reporting and adherence to treatment . RESULTS A significant reduction in urinary GAG ( 71 - 79 % ) was sustained . For the 12MWT , subjects in Phase 2 showed improvement of 255+/-191 m ( mean+/-SD ) at Week 144 ; those in Phase 3 Extension demonstrated improvement from study baseline of 183+/-26 m ( mean+/- SE ) in the rhASB/rhASB group at Week 96 and from treatment baseline ( Week 24 ) of 117+/-25 m in the placebo/rhASB group . The Phase 1/2 6MWT and the 3MSC from Phase 2 and 3 also showed sustained improvements through the final study measurements . Compliance was 98 % overall . Only 560 of 4121 reported AEs ( 14 % ) were related to treatment with only 10 of 560 ( 2 % ) described as severe . CONCLUSION rhASB treatment up to 5 years results in sustained improvements in endurance and has an acceptable safety profile OBJECTIVE The objective of this Phase 3 study was to confirm the efficacy and safety of recombinant human arylsulfatase B ( rhASB ) treatment of mucopolysaccharidosis type VI ( MPS VI ; Maroteaux-Lamy syndrome ) , a rare , fatal lysosomal storage disease with no effective treatment . STUDY DESIGN Thirty-nine patients with MPS VI were evaluated in a r and omized , double-blind , placebo-controlled , multicenter , multinational study for 24 weeks . The primary efficacy variable was the distance walked in a 12-minute walk test ( 12MWT ) , whereas the secondary efficacy variables were the number of stairs climbed in a 3-minute stair climb ( 3MSC ) and the level of urinary glycosaminoglycan ( GAG ) excretion . All patients received drug in an open-label extension period for an additional 24 weeks . RESULTS After 24 weeks , patients receiving rhASB walked on average 92 meters ( m ) more in the 12MWT ( p=.025 ) and 5.7 stairs per minute more 3MSC ( p=.053 ) than patients receiving placebo . Continued improvement was observed during the extension study . Urinary GAG declined by -227+/-18 microg/mg more with rhASB than placebo ( p<.001 ) . Infusions were generally safe and well tolerated . Patients exposed to drug experienced positive clinical benefit despite the presence of antibody to the protein . CONCLUSION rhASB significantly improves endurance , reduces GAG , and has an acceptable safety profile Output:

Long-term follow-up will be required to ascertain full clinical benefit , on both event-free survival and quality of life measures .

MS2_1shot103

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE The objective of this systematic review is to identify educational content and techniques that lead to successful patient self-management and improved outcomes in congestive heart failure education programs . METHODS MEDLINE , CINAHL and the Cochrane Central Register of Controlled Trials , as well as reference lists of included studies and relevant review s , were search ed . Eligible studies were r and omised controlled trials evaluating congestive heart failure self-management education programs with outcome measures . Two of the investigators independently abstract ed descriptive information , education content topics and outcomes data . RESULTS A total of 7413 patients participated in the 35 eligible congestive heart failure self-management education studies . The congestive heart failure self-management programs incorporated 20 education topics in four categories : ( i ) knowledge and self-management ( diagnosis and prognosis , pathophysiology of how congestive heart failure affects the body , aims of treatment , management and symptoms , medication review and discussion of side-effects , knowing when to access/call the general practitioner , communication with the physician , follow up for assessment or reinforcement ) ; ( ii ) social interaction and support ( social interaction and support , stress , depression ) ; ( iii ) fluids management ( sodium restriction , fluid balance , daily measurement of weight , ankle circumference , self-monitoring and compliance relative to fluids ) ; and ( iv ) diet and activity ( dietary assessment and instructions , physical activity and exercise , alcohol intake , smoking cessation ) . A total of 113 unique outcomes in nine categories ( satisfaction , learning , behaviour , medications , clinical status , social functioning , mortality , medical re source utilisation and cost ) were measured in the studies . Sixty ( 53 % ) of the outcomes showed significant improvement in at least one study . CONCLUSION Educational interventions should be based on scientifically sound research evidence . The education topic list developed in this review can be used by patients and clinicians to prioritise and personalise education AIM This paper is a report of a study to explore the views , concerns and experiences of doctors ' assistants of case management for patients with chronic heart failure , while experiencing the new role of being a case manager within the Heidelberg Integrated Case Management trial . BACKGROUND Case management is being investigated as part of a r and omised controlled trial aim ing to improve care for patients with chronic systolic heart failure . In a complex , multifaceted intervention , trained doctors ' assistants ( equivalent to a nursing role ) adopted new tasks using st and ardised case management involving telephone monitoring , home visits and diagnostic screening . METHOD In April 2007 , 3 months after implementation of the intervention programme , 27 doctors ' assistants participated in four focus group interviews discussing their views on , and experiences of , case management . Thematic analysis of the data was undertaken . FINDINGS Participants believed that the most positive factors in case management were about interaction with patients , including opportunities for identifying disease and psychosocial problems . However , barriers included lack of time allocated to perform case management in addition to their normal role and poor cooperation within the practice team . According to the doctors ' assistants , the routine implementation of case management was acceptable , feasible and effective in improving the management of patients with chronic systolic heart failure . CONCLUSION Case management enhanced the role of doctors ' assistants , leading to increased awareness of the perspective of patients with chronic disease . In the wider international primary care practice nursing context , the orchestrated delegation of tasks using specific case management may be a promising strategy for improving the quality of care of chronically ill patients and enabling patient self-management Output:

This synthesis showed that case management provides positive quality of care for patients , increases perceived access to services and creates more time to ask questions and develop trusted relationships . For health professionals , case management enhanced care by improved relationships with both patients and colleagues although concerns remained around re sources , training and inter-professional conflict . This synthesis emphasizes the importance of the quality of being cared for as a patient and caring as a health professional . Case management enhances communication between patients and health professionals , supports patient self-care and self-management and can be an important contributing factor in reducing unplanned admissions for patients with heart failure

MS2_1shot104

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND AND OBJECTIVES Caesarean section ( c-section ) scars can be pose functional and cosmetic challenges and ablative fractional laser ( AFXL ) treatment may offer benefit to patients . We evaluated textural and color changes over time in AFXL-treated versus untreated control scars . MATERIAL S AND METHODS A r and omized , controlled , intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars . Setting s of AFXL were adjusted to each individual scar . End-points were blinded on-site clinical evaluations at 1 , 3 , and 6 months follow-up ( Patient and Observer Scar Assessment Scale [ POSAS ] and Vancouver Scar Scale [ VSS ] ) , blinded photo-evaluations , reflectance measurements , tissue histology , and patients satisfaction . RESULTS Eleven of 12 patients completed the study . At 1 month follow-up , AFXL-treated scars were significantly improved in pliability ( POSAS P = 0.01 VSS P = 0.02 ) and smoother in surface relief ( POSAS P = 0.03 ) compared to control scars . At 1 - 3 months , overall scar appearance was dominated by transient erythema and hyperpigmentation , confirmed by reflectance measurements ( erythema% and pigmentation% peaked at 1 and 3 month follow-up , respectively ) . At 6 months follow-up , AFXL-treated scars improved on POSAS-total score though not significantly ( P = 0.06 ) . Correspondingly , blinded photo-evaluation found AFXL-treated scars significantly improved compared to controls ( VAS P = 0.02 ) . Histology indicated new dermal collagen and elastic fibers on AFXL-treated scars . At 6 months follow-up , a majority of patients ( 64 % ) favored subsequent AFXL-treatment of their untreated control scar tissue . CONCLUSIONS Scar remodeling is initiated 1 month after AFXL treatment , but overall scar improvement is concealed until laser-induced color changes resolve . At 6 months follow-up , the benefit of AFXL treatment on c-section scars emerges . Lasers Surg . Med . 49:189 - 197 , 2017 . © 2016 Wiley Periodicals , The aim of this study was to compare the effects of the pulsed-dye laser ( PDL ) at a wavelength of 585 nm with those at 595 nm in the treatment of post-surgical scars , starting on the day of suture removal . The study was a prospect i ve , non-r and omized , double-blind , controlled , clinical trial , set in an outpatient clinic . Fifteen out patients with 21 post-operative scars at least 3 cm long were recruited , and 14 patients with 19 scars completed the study . Scars were divided into three equal portions . Each outer portion was r and omly allocated to PDL at 585 nm or at 595 nm ( 3.5 J/cm2 , 450 μs , 10 mm spot size ) , and the center was an untreated control ; treatment was composed of three laser sessions at 4-week intervals . A blinded examiner evaluated the three scar sections using the Vancouver scar scale for pigmentation , vascularity , pliability , and height . Cosmetic appearance was evaluated with a visual analog scale . Punch biopsies of three r and omly selected scars were evaluated . Pigmentation : more scars after laser treatments were of normal color than in the control , but the difference was not statistically significant . Vascularity : after treatment , more scars had normal vascularity in all three groups than at baseline ( P < 0.05 ) ; the largest increase was with a wavelength of 585 nm ( 10.5–94.7 % ) , then 595 nm ( 15.8–78.9 % ) , then control ( 5.2–36.6 % ) . Pliability : there was more normal pliability in all three groups than at baseline ( P < 0.05 ) , with greater improvements in the laser-treated groups . Height : significantly more flat scars after 585 nm PDL ( 63.2 % ) than at baseline ( 21.1 % ) ( P < 0.05 ) . We observed a slight but non-significant decrease in the scar heights with 595 nm PDL in comparison with the control . Histology : after laser irradiation , the treated sections were more similar to a non-scarring process than the control . Cosmetic outcome : visual analog scales increased in all groups ( P < 0.05 ) , but the greatest increases were observed in the 585 nm and 595 nm laser-treated groups ( 50 % and 60 % , respectively ) compared with controls ( 30 % ) . There were significantly higher scores with the lasers than for the control ( P < 0.001 ) at each visit after baseline . Both the 585 nm and 595 nm PDL treatments were effective in improving the appearance and normalizing the vascularity and pliability of post-operative scars . Both wavelengths improved the scars ’ visual appearance more than controls . We found that 585 nm appears to be the preferred wavelength , as it substantially normalized the height in addition to the vascularity and pliability in a significant number of scars More than 70 million surgical procedures are performed annually in the USA with the majority involving a skin lesion and almost all individuals in their lifetime will have one or more surgical procedures result ing in scars . Patients and physicians alike are thereby motivated to improve the cosmetic outcome of scars . Prior studies have shown that the pulsed dye laser ( PDL ) is effective in improving the quality and appearance of the scar when using the 585-nm PDL immediately after the removal of sutures . Most published studies used a pulse duration of 450 µs , which along with the other study parameters , has led to an overall improvement of the scars . However , a pulse duration of 1.5 ms is also available when using the pulsed dye laser and it should theoretically cause fewer side-effects . To our knowledge , there are no other studies comparing the effectiveness of different pulse duration s in the treatment of surgical scars starting on the day of suture removal . The purpose of this study is to compare the effect of different pulse duration s ( 450 µs vs. 1.5 ms ) in the treatments of postsurgical linear scars immediately after suture removal when using the 585-nm pulsed dye laser ( PDL ) . Twenty non-hospitalized male and female patients ( older than 18 years of age ) with skin types I – IV and with postoperative linear scars measuring at least 2.1 cm were enrolled in this prospect i ve study . Scars were r and omly divided into three equal sections . The different fields were r and omly chosen to receive treatment ( two out of three fields ) or remain as control ( one field ) . The two fields chosen to be treated received treatment with the 585-nm PDL using a 7-mm spot size at 4.0 J. One of the treated sections was r and omly selected to receive a pulse duration of 450 µs , and the other section to receive a 1.5-ms pulse . The remaining scar section was design ated as control ( no treatment ) . The three sections were mapped and recorded . The patient received treatment immediately after the sutures were removed from the wound and then monthly for 3 months . Evaluations were performed before each treatment and 1 month after the last treatment . The short-pulse and long-pulse 585-nm PDL-treated sections demonstrated a statistically significant overall average improvement of the VSS of 92 and 89 % , respectively , compared to 67 % for the control site ( Fig. 1 ) . Further , for individual parameters of the Vancouver scar scale ( VSS ) , there were significant ( p < 0.05 ) differences between control and treatment groups for all parameters , but there were no differences between the short- and long-pulse treatment groups for any parameter . Both short-pulse and long-pulse PDL are safe and effective in improving the quality and cosmetic appearance of surgical scars in skin type ’s I – IV starting on the day of suture removal with no significant difference between the two pulse duration BACKGROUND AND OBJECTIVES Laser treatment in the early phases of wound healing may reduce scar formation . However , little is known on when in the early wound healing phases laser exposure most optimally should be provided and at which fluence levels . This study investigates the clinical effect of non-ablative-fractional-laser ( NAFL ) performed at three early time points at a range of fluence levels versus untreated control scars . MATERIAL S AND METHODS A r and omized , controlled , intra-individual trial with erbium-glass 1,540 nm NAFL versus no laser treatment on sixteen subjects receiving 10 st and ardized full-thickness punch-biopsy wounds . A single NAFL-exposure was applied to test-wounds 1 day before , immediately after , or 2 weeks after wounding . Three fluence levels provided deep and superficial energy depositions ( range 30 - 70 mJ/microbeam ) . Primary outcome comprised the total-score of the observer part of Patient-Observer-Scar- Assessment -Scale ( POSAS ) , performed by blinded on-site assessment at 3 months follow-up . Secondary outcomes were clinical evaluation on visual-analogue-scale ( VAS ) , reflectance measurements , and histology . RESULTS NAFL-treatment applied 1 day before , immediately after or 2 weeks after wounding had the potential to offer subtle but detectable improvement in clinical scar appearance compared to untreated controls . Thus , NAFL-exposure 1 day before wounding ( POSAS-total : median of 15 vs. control-median of 16 , P = 0.03 , VAS : median 4.1 vs. control-median 5.5 , P = 0.03 , medium-fluence ) , as well as immediately- , and 2 weeks after wounding ( POSAS-total : P ≤ 0.05 , low-fluence ) induced improvement compared to untreated controls . No significant differences in dyschromia were detected between NAFL-treated and control scars . Histology showed subtle changes towards more mature interwoven bundles of collagen in NAFL-treated scars as compared to controls . CONCLUSIONS This study indicates that a single NAFL-treatment at low to medium fluence performed 1 day prior , or in the early phases of wound healing , may have the potential to optimize scar formation in full thickness wounds . Lasers Surg . Med . 50:28 - 36 , 2018 . © 2017 Wiley Periodicals , Background The use of lasers has been proposed for scar revision . A recent pilot clinical study demonstrated that lasers could also be used immediately after surgery to reduce the appearance of scars . The LASH ( Laser-Assisted Skin Healing ) technique induces a temperature elevation in the skin which modifies the wound-healing process . We report a prospect i ve comparative clinical trial aim ed at evaluating an 810-nm diode-laser system to accelerate and improve the healing process in surgical scars immediately after skin closure . Methods Twenty-nine women and 1 man ( mean age = 41.4 years ; Fitzpatrick skin types I-IV ) were included to evaluate the safety and performance of the laser system . The laser dose ( or fluence in J/cm² ) was selected as a function of phototype and skin thickness . Each surgical incision ( e.g. , abdominoplasty ) was divided into two parts . An 8-cm segment was treated with the laser immediately after skin closure . A separate 8-cm segment was left untreated as a control . Clinical evaluations ( overall appearance ratings , comparative scar scale ) of all scars were conducted at 10 days , 3 months , and 12 months by both surgeon and patients . Profilometry analysis from silicone replicas of the skin was done at 12 months . Wilcoxon signed-rank test analyses were performed . Results Twenty-two patients were treated using a high dose ( 80–130 J/cm² ) and 8 patients with a low dose ( < 80 J/cm² ) . At 12 months in the high-dose group , both surgeon and patients reported an improvement rate of the laser-treated segment over the control area of 72.73 and 59.10 % , respectively . For these patients , profilometry results showed a decrease in scar height of 38.1 % ( p = 0.027 ) at 12 months for the laser-treated segment versus control . Three patients treated with higher doses ( > 115 J/cm² ) experienced superficial burns on the laser-treated segment , which resolved in about 5–7 days . For the eight patients treated at low dosage ( < 80 J/cm² ) , there was no significant difference in the treated segment versus the control segment . No side effects were observed . Conclusion This prospect i ve comparative trial demonstrates that an 810-nm diode laser treatment , performed immediately after surgery , can improve the appearance of a surgical scar . The dose plays a great role in scar improvement and must be well controlled . There is interest in LASH for hypertrophic scar revision . LASH can be used to prevent and reduce scars in plastic surgery BACKGROUND Many studies have examined laser treatment of scars , but cosmetic results have been variable . Although no studies have examined the effect of purpura on scar improvement using the pulsed dye laser ( PDL ) , many clinicians believe inducing purpura results in better and quicker improvement . OBJECTIVE To determine whether PDL treatment of fresh surgical scars with purpura‐inducing setting s improves clinical appearance more than non‐purpura‐inducing setting s or no treatment . METHODS Twenty‐six subjects with surgical scars enrolled Output:

In general , laser-treated wounds and scars showed benefit from laser intervention , though not always reaching significance . In conclusion , laser intervention when introduced in inflammation , proliferation or remodelling phase has the potential to reduce cutaneous scar formation .

MS2_1shot105

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This study compared the effects of a resistance training protocol and a moderate-impact aerobic training protocol on bone mineral density ( BMD ) , physical ability , serum osteoprotegerin ( OPG ) , and receptor activator of nuclear factor kappa B lig and ( RANKL ) levels . Seventy-one older women were r and omly assigned to resistance exercise ( RE ) , aerobic exercise ( AE ) or a control group ( CON ) . Both interventions were conducted 3 times per week for 8 months . Outcome measures included proximal femur BMD , muscle strength , balance , body composition , serum OPG , and RANKL levels . Potential confounding variables included dietary intake , accelerometer-based physical activity ( PA ) , and molecularly defined lactase nonpersistence . After 8 months , only RE group exhibited increases in BMD at the trochanter ( 2.9 % ) and total hip ( 1.5 % ) , and improved body composition . Both RE and AE groups improved balance . No significant changes were observed in OPG and RANKL levels , and OPG/RANKL ratio . Lactase nonpersistence was not associated with BMD changes . No group differences were observed in baseline values or change in dietary intakes and daily PA . Data suggest that 8 months of RE may be more effective than AE for inducing favourable changes in BMD and muscle strength , whilst both interventions demonstrate to protect against the functional balance control that is strongly related to fall risk In this r and omized controlled trial , we examined the effects of a 3-month therapeutic lifestyle modification ( TLM ) intervention on knowledge , self-efficacy , and health behaviors related to bone health in postmenopausal women in rural Korea . Forty-one women ages 45 or older were r and omly assigned to either the intervention ( n = 21 ) or control ( n = 20 ) group . The intervention group completed a 12-week , 24-session TLM program of individualized health monitoring , group health education , exercise , and calcium-vitamin D supplementation . Compared with the control group , the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks , providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis Output:

RESULTS Exercise training increased BMD of LS , FN , WT , and Tro . According to the type of exercise training , combined exercise training ( aerobic + resistance ) showed improvements in BMD of LS , FN , WT , and Tro . However , aerobic exercise training alone and resistance exercise training alone showed inconsistent results . CONCLUSION Exercise training can improve the BMD of LS , FN , WT , and Tro in Korean postmenopausal women . The type of exercise training may be a crucial factor for maintaining or improving bone health of this population

MS2_1shot106

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Dry eye syndrome ( DES ) is a prevalent condition , but information on risk or protective factors is lacking . OBJECTIVE We aim ed to determine the association between the dietary intake and ratio of n-3 and n-6 fatty acids ( FAs ) and DES occurrence . DESIGN Of the 39876 female health professionals in the Women 's Health Study ( WHS ) , 32470 women aged 45 - 84 y who provided information on diet and DES were cross-sectionally studied . We assessed FA intakes by using a vali date d food-frequency question naire and assessed DES by using self-reports of clinical ly diagnosed cases . Of the sample , 1546 ( 4.7 % ) subjects reported DES . We used logistic regression models to estimate the odds ratios ( ORs ) and 95 % CIs to describe the relation of FA intake with DES . RESULTS After adjustment for demographic factors , hormone therapy , and total fat intake , the OR for the highest versus the lowest quintile of n-3 FAs was 0.83 ( 95 % CI : 0.70 , 0.98 ; P for trend = 0.05 ) . A higher ratio of n-6 to n-3 FA consumption was associated with a significantly increased risk of DES ( OR : 2.51 ; 95 % CI : 1.13 , 5.58 ) for > 15:1 versus < 4:1 ( P for trend = 0.01 ) . In addition , tuna consumption [ 1 serving was 113 g ( 4 oz ) ] was inversely associated with DES ( OR : 0.81 ; 95 % CI : 0.66 , 0.99 for 2 - 4 servings/wk ; OR : 0.32 ; 95 % CI : 0.13 , 0.79 for 5 - 6 servings/wk versus < or = 1 serving/wk ; P for trend = 0.005 ) . CONCLUSIONS These results suggest that a higher dietary intake of n-3 FAs is associated with a decreased incidence of DES in women . These findings are consistent with anecdotal clinical observations and postulated biological mechanisms BACKGROUND Prostagl and in F(2alpha ) analogues are effective intraocular-pressure-lowering drugs . Dietary fatty acids affect endogenous prostagl and in F(2alpha ) concentrations and may thus influence intraocular pressure . OBJECTIVE We prospect ively examined dietary fat consumption in relation to primary open-angle glaucoma ( POAG ) . DESIGN Women ( n = 76 199 in the Nurses ' Health Study ) and men ( n = 40 306 in the Health Professionals Follow-Up Study ) free of POAG in 1980 and 1986 , respectively , were followed until 1996 if they were > or = 40 y old and reported receiving eye exams during follow-up . Potential confounders were assessed on biennial question naires , and energy-adjusted cumulative averaged fat intakes were measured by using vali date d food-frequency question naires . We analyzed 474 self-reported POAG cases confirmed by medical chart review . Cohort-specific multivariate rate ratios ( RRs ) were obtained by using proportional hazards models and were then pooled . RESULTS Major fats and fat subtypes were not independently associated with POAG risk . Pooled multivariate RRs ( 95 % CI ) for POAG comparing the highest with the lowest quintile of fat intake were as follows : 0.90 ( 0.67 , 1.21 ) for total fat , 1.03 ( 0.77 , 1.38 ) for saturated fat , 0.76 ( 0.56 , 1.03 ) for monounsaturated fat , and 0.87 ( 0.66 , 1.16 ) for polyunsaturated fat , none of which were statistically significant . We found a suggestive positive association between a higher ratio of n-3 to n-6 polyunsaturated fat and risk of POAG [ RR = 1.49 ( 1.11 , 2.01 ) ; P for trend = 0.10 ] , which was stronger for high-tension POAG [ RR = 1.68 ( 1.18 , 2.39 ) ; P for trend = 0.009 ] . CONCLUSION A high ratio of n-3 to n-6 polyunsaturated fat appears to increase the risk of POAG , particularly high-tension POAG . Further studies are needed Purpose : Alcohol intake reduces intraocular pressure , a risk factor for primary open-angle glaucoma ( POAG ) . We investigated whether alcohol consumption is associated with a reduced risk of POAG . Methods : We followed female nurses from 1980 and male health professionals from 1986 to 2002 . Eligible participants were 40 + years old , did not have POAG , and reported receiving eye examinations during follow-up . Information on alcohol consumption , potential confounders and POAG diagnoses were up date d by using biennial question naires . We identified 856 self-reported POAG cases that were confirmed with medical record review . Cohort-specific and pooled analyses across cohorts were conducted to calculate multivariable rate ratios ( RR ) of POAG . Results : Alcohol consumption < 30 g/day did not influence POAG risk : compared with non-drinkers , the pooled RRs were 0.99 ( 95 % Confidence Interval [ CI ] : 0.83–1.19 ) for drinking < 10 g/day , 0.96 ( 95 % CI : 0.76–1.22 ) for 10–19 g/day , and 0.95 ( 95 % CI : 0.68–1.33 ) for 20–29 g/day . Although there were suggestive inverse associations with drinking > 30 g/day ( RR = 0.71 ) , this was not significant ( 95 % CI : 0.49–1.04 ) , and no significant linear associations were detected . Risks of POAG did not differ by type of alcoholic beverage consumed . To evaluate the potential for detection bias , we controlled for additional factors , such as frequency of eye exams , but results were similar . Conclusion : In this large prospect i ve study of men and women , alcohol consumption did not influence the risk of POAG Objective : To determine whether vitamin E supplementation influences the incidence or rate of progression of age related maculopathy ( AMD ) . Design : Prospect i ve r and omised placebo controlled clinical trial . Setting : An urban study centre in a residential area supervised by university research staff . Participants : 1193 healthy volunteers aged between 55 and 80 years ; 73 % completed the trial on full protocol . Interventions : Vitamin E 500 IU or placebo daily for four years . Main outcome measures : Primary outcome : development of early age related macular degeneration in retinal photographs . Other measures included alternative definitions of age related macular degeneration , progression , changes in component features , visual acuity , and visual function Results : The incidence of early age related macular degeneration ( early AMD 3 ) was 8.6 % in those receiving vitamin E versus 8.1 % in those on placebo ( relative risk 1.05 , 95 % confidence interval 0.69 to 1.61 ) . For late disease the incidence was 0.8 % versus 0.6 % ( 1.36 , 0.67 to 2.77 ) . Further analysis showed no consistent differences in secondary outcomes . Conclusion : Daily supplement with vitamin E supplement does not prevent the development or progression of early or later stages of age related macular degeneration CONTEXT Despite nutrition information and guidelines that advise against depriving diabetic patients of the potential benefit of moderate alcohol intake against cardiovascular events , the association between alcohol consumption and risk of cardiovascular outcomes in diabetic individuals has not been determined . OBJECTIVE To examine the relationship between alcohol intake and coronary heart disease ( CHD ) mortality in persons with older-onset diabetes . DESIGN Population -based , prospect i ve cohort study conducted from 1984 through 1996 , with a follow-up of up to 12.3 years . SETTING AND PARTICIPANTS A total of 983 older-onset diabetic individuals ( mean [ SD ] age , 68.6 [ 11.0 ] years ; 45.2 % male ; 98.5 % white ) were interviewed about their past-year intake of alcoholic beverages during the 1984 - 1986 follow-up examination of a population -based study of diabetic persons in southern Wisconsin . MAIN OUTCOME MEASURE Time to mortality from CHD by category alcohol intake . RESULTS Alcohol use was inversely associated with risk of CHD mortality in older-onset diabetic subjects . The CHD mortality rates for never and former drinkers were 43.9 and 38.5 per 1000 person-years , respectively , while the rates for those with alcohol intakes of less than 2 , 2 to 13 , and 14 or more g/d were 25.3 , 20.8 , and 10.0 per 1000 person-years , respectively . Compared with never drinkers and controlling for age , sex , cigarette smoking , glycosylated hemoglobin level , insulin use , plasma C-peptide level , history of angina or myocardial infa rct ion , digoxin use , and the presence and severity of diabetic retinopathy , former drinkers had a relative risk ( RR ) of 0.69 ( 95 % confidence interval [ CI ] , 0.43 - 1.12 ) ; for those who drank less than 2 g/d ( less frequent than 1 drink a week ) , the RR was 0.54 ( 95 % CI , 0.33 - 0.90 ) ; for 2 to 13 g/d , it was 0.44 ( 95 % CI , 0.23 - 0.84 ) ; and for 14 or more g/d ( about 1 drink or more a day ) , it was 0.21 ( 95 % CI , 0.09 - 0.48 ) . Further adjustments for blood pressure , body mass index , education , physical activity , diabetes duration , hypertension history , overt nephropathy , peripheral neuropathy , lipid measures , or intake of medications such as aspirin and antihypertensive agents did not change the associations observed . CONCLUSION Our results suggest an overall beneficial effect of alcohol consumption in decreasing the risk of death due to CHD in people with older-onset diabetes The relation between dietary antioxidant intake and primary open-angle glaucoma risk was examined in participants aged over 40 years in the Nurses ' Health Study ( n = 76,200 ) and the Health Professionals Follow-up Study ( n = 40,284 ) . They were followed biennially from 1980 and 1986 , respectively , to 1996 , during periods when they received an eye examination . Dietary intakes were measured repeatedly from 1980 in the Nurses ' Health Study and from 1986 in the Health Professionals Follow-up Study using vali date d food frequency question naires . The authors analyzed 474 self-reported glaucoma cases confirmed by medical chart review to have primary open-angle glaucoma with visual field loss . The authors used Cox proportional hazards models for cohort-specific multivariate analyses , and results were pooled using r and om effects models . The pooled multivariate rate ratios for primary open-angle glaucoma comparing the highest versus lowest quintile of cumulative up date d intake were 1.17 ( 95 % confidence interval ( CI ) : 0.87 , 1.58 ) for alpha-carotene , 1.10 ( 95 % CI : 0.82 , 1.48 ) for beta-carotene , 0.95 ( 95 % CI : 0.70 , 1.29 ) for beta-cryptoxanthin , 0.82 ( 95 % CI : 0.60 , 1.12 ) for lycopene , 0.92 ( 95 % CI : 0.69 , 1.24 ) for lutein/zeaxanthin , 1.05 ( 95 % CI : 0.59 , 1.89 ) for vitamin C , 0.97 ( 95 % CI : 0.62 , 1.52 ) for vitamin E , and 1.11 ( 95 % CI : 0.82 , 1.51 ) for vitamin A. In conclusion , the authors did not observe any strong associations between antioxidant consumption and the risk of primary open-angle glaucoma OBJECTIVE To determine the prevalence of glaucoma in a population -based sample of Hispanic adults older than 40 years . METHODS Using 1990 census data for Arizona , groups of persons living in sections of the city in Nogales and Tucson were r and omly selected with a probability proportional to the Hispanic population older than 40 years . We tried to recruit all eligible adults in homes with 1 self-described Hispanic adult . Detailed ocular examinations at a local clinic included visual acuity testing , applanation tonometry , gonioscopy , an optic disc evaluation , and a threshold visual field test . Open-angle glaucoma ( OAG ) was defined using a proposed international system for prevalence surveys , including threshold visual field defect and optic disc damage . Angle Output:

RESULTS Data suggest that some lifestyle exposures ( e.g. , smoking ) are significantly associated with risk of several different diseases , suggesting that altering behaviors may decrease risk . Where risk is inherent to an occupational or recreational activity , eye protection is likely to decrease risk . Although data are imperfect , it seems that some lifestyle alterations may decrease the risk of eye diseases at little or no risk to the individual

MS2_1shot107

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIMS To evaluate a parental question naire as a means of providing outcome measures for a multicentre r and omised controlled trial of treatment for post-haemorrhagic ventricular dilatation . METHODS The parents of 88 survivors were sent a question naire before a paediatric assessment at the age of 30 months . The parents ’ responses to individual questions taken mainly from the Griffiths ’ mental development scales and their perception of the child ’s ability to see and hear were compared with the paediatric findings . A model , based on the parents ’ responses to particular questions , allowed the categorisation of the children as normal , impaired , moderately or severely disabled ; this was compared with similar categorisation based on the full paediatric assessment . RESULTS Agreement on items concerning gross motor function ranged between 81 and 99 % , concerning dressing between 77 and 80 % , concerning feeding between 91 and 99 % , and concerning language between 85 and 93 % . Similar proportions of children were identified as disabled by the parents ( 60 % ) and by the paediatrician ( 66 % ) . Of 29 children who had developmental quotients less than 70 , parents identified 28 as disabled , 18 of them as severely disabled . They were not so good at identifying children with impairments without functional loss . CONCLUSIONS Further work is required but there is sufficient encouragement from the results to pursue this methodology further for use in comparing groups in r and omised trials Seventy three preterm infants weighing less than 1500 g or less than 32 weeks ' gestation , or both , were allocated r and omly to treatment ( fresh frozen plasma 10 ml/kg on admission and at 24 hours of age ) or control groups . Fifteen ( 41 % ) out of 37 control patients sustained intraventricular haemorrhage compared with five ( 14 % ) of 36 patients receiving treatment ( X2 = 5.24 , P = 0.022 ) . No difference was found in coagulation factors measured at birth or at 48 hours of age in both groups . Fresh frozen plasma appears to have a beneficial effect in the prevention of intraventricular haemorrhage Colloid infusions are often given to treat hypotension in preterm infants . The aim of this work was to assess whether it was the amount of protein or the volume of the colloid infused which accounted for the observed increase in blood pressure . Sixty preterm infants were r and omised ( 20 in each group ) to receive 5 ml/kg 20 % albumin , 15 ml/kg fresh frozen plasma , or 15 ml/kg 4.5 % albumin . All infusions were given at a rate of 5 ml/kg/hour in addition to maintenance fluids . The infants were r and omised when hypotensive ( systolic blood pressure less than 40 mm Hg for two hours ) . There was no significant difference in the blood pressure of the three groups before or one hour after beginning the infusion . The mean increase in blood pressure one hour after completing the infusion , however , was significantly lower in infants receiving 20 % albumin : 9 % compared with 17 % in the group receiving 4.5 % albumin , and 19 % in the group receiving fresh frozen plasma . It is concluded that the volume infused rather than albumin load is important in producing a sustained increase in blood pressure The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns ( birth weight 1.26 + /- 0.1 kg [ mean + /- SEM ] and gestational age 30 + /- 0.8 weeks [ mean + /- SEM ] ) compared with a control group of 12 premature newborns ( birth weight 1.17 + /- 0.2 kg and gestational age 29 + /- 0.1 weeks ) who received total parenteral nutrition . All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation . Albumin supplementation of total parenteral nutrition result ed in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group . Slow albumin infusion had no observed effect on the severity of respiratory distress . Study group infants regained birth weight earlier than control group infants . These data suggest that the concurrent administration of albumin may be clinical ly beneficial in critically ill newborn infants To test the hypothesis that restriction of sodium intake during the first 3 to 5 days of life will prevent the occurrence of hypernatremia and the need for administration of large fluid volumes , we prospect ively and r and omly assigned 17 babies ( mean + /- SD : 850 + /- 120 gm ; 27 + /- 1 weeks of gestation ) to receive in blind fashion either daily maintenance sodium or salt restriction with physician-prescribed parenteral fluid intake . Maintenance-group infants received 3 to 4 mEq of sodium per kilogram per day ; restricted infants received no sodium supplement other than with such treatments as transfusion . Sodium balance studies conducted for 5 days demonstrated that maintenance salt intake result ed in a daily sodium balance near zero , whereas sodium-restricted infants continued to excrete urinary sodium at a high rate , which promoted a more negative balance ( average daily sodium balance -0.30 + /- 1.78 SD in maintenance group vs -3.71 + /- 1.47 mEq/kg per day in restriction group ; p less than 0.001 ) . Care givers tended to prescribe daily increases in parenteral fluids for the salt-supplemented infants , perhaps because serum sodium concentrations were elevated in these infants after the first day of the study ( p less than 0.001 ) . Hypernatremia developed in two sodium-supplemented infants ( greater than 150 mEq/L ) , and hyponatremia developed in two sodium-restricted infants ( less than 130 mEq/L ) ; however , the restricted infants were more likely to have normal serum osmolality ( p less than 0.05 ) . Both groups of infants produced urine that was neither concentrated nor dilute , with a high fractional excretion of sodium ; renal failure was not observed . The mortality rate was not affected , but the incidence of bronchopulmonary dysplasia was significantly less in the sodium-restricted babies ( p less than 0.02 ) . We conclude that in tiny premature infants , a fluid regimen that restricts sodium may simplify parenteral fluid therapy targeted to prevent hypernatremia and excessive administration of parenteral fluids AIM To examine the effect of intravascular volume expansion for the treatment of hypovolaemia in sick preterm neonates . METHODS An intravenous infusion of 20 ml per kg of 4.5 % albumin was given to 14 preterm neonates . The effects on systolic blood pressure , central peripheral temperature difference ( c-pT ) , and plasma arginine vasopressin concentration ( pAVP ) were measured . RESULTS Thirteen babies showed a rise in systolic blood pressure . The six babies with the highest initial values of pAVP and c-pT showed a fall in both of these after infusion . The babies with lower initial pAVP ( below 4 pmol/l ) showed either a rise ( two ) or no change ( six ) after albumin infusion . There was a significant correlation between c-pT and log pAVP before ( r2=0.61 ; p<0.05 ) and after infusion ( r2=0.45 ; p<0.05 ) . CONCLUSIONS Plasma AVP concentration is related to c-pT in unwell preterm newborns . This study suggests that clinical assessment of hypovolaemia in preterm newborns is poor and could be improved by using OBJECTIVE Our purpose was to determine if dobutamine or dopamine results in greater improvements in systemic blood flow in very preterm infants with low flow during the first 24 hours of life . STUDY DESIGN A 2-center , r and omized , double-blind study . Infants ( n = 42 ) with low superior vena cava ( SVC ) flow ( < 41 mL/kg/min ) in the first 12 hours were r and omly assigned to receive 10 mL/kg normal saline solution , followed by 10 microg/kg/minute of dobutamine or dopamine . If low flow persisted or recurred , the inotrope was increased to 20 microg/kg/minute , with crossover to the other inotrope if treatment failed to maintain flow . RESULTS Volume produced a more significant increase in SVC flow than dopamine ( + 43 % ) . At the highest dose , dobutamine result ed in a significantly greater increase in SVC flow than dopamine ( mean , + 9.9 vs -3.2 mL/kg/min , P = .02 ) . Dopamine result ed in a significantly greater increase in blood pressure . Infants receiving dobutamine only at 24 hours had a greater right ventricular output than infants receiving dopamine ( mean , 295 vs 167 mL/kg/min , P < .001 ) . Forty percent failed to increase or maintain SVC flow in response to either inotrope . No significant differences in mortality or morbidity were found . CONCLUSIONS Dobutamine produced a greater increase in blood flow than dopamine In a r and omized blinded study we compared two colloid solutions in 30 neonates undergoing major surgery . Fifteen neonates received 4.5 % Human albumin solution ( HAS ) ( mean volume 25.6 ml.kg-1 , SD 9.5 ) and the others received Haemaccel ( Hoechst ) ( 24.9 ml.kg-1 , SD 10 ) . Pre and postoperative plasma albumin and haemoglobin concentrations and plasma colloid osmotic pressure ( COP ) were compared . In the group given Haemaccel there was an appreciable and statistically significant decrease in the mean plasma albumin concentration from 34.27 to 28.27 g.1(-1 ) ( mean difference 6 , CI 3.38 to 8.62 ) and the mean COP decreased significantly from 22.2 to 19.9 mmHg ( mean difference 2.3 , CI 0.3 to 4.5 ) . In the HAS group there was no significant change in either the plasma albumin concentration or COP . There was a small but significant decrease in the mean haemoglobin concentration from 15.92 to 14.35 g.dl-1 ( mean difference 1.56 , CI 0.57 to 2.55 ) after HAS . We conclude that HAS is the superior colloid for volume replacement in neonates undergoing surgery Exchange transfusion , as a form of therapy , was contrasted with the use of fresh frozen plasma or conventional supportive care alone in the management of 19 infants with birth weights of less than 1,000 gm , without severe respiratory distress , and in the management of 82 infants , birth weights less than 2,000 gm , with severe respiratory distress whose disease manifested itself within the first 24 hours of life . Survival for more than five days was similar , regardless of therapy , in infants weighing less than 1,000 gm without severe RDS . In contrast , the use of exchange transfusion significantly decreased the case fatality rate of infants with severe RDS . In the groups receiving exchange transfusion , the mortality rate was 41 % , whereas the groups receiving either plasma or supportive care alone the mortality was 80 % . Study of coagulation factors and red cell concentrations of fetal hemoglobin and of 2,3-DPG failed to demonstrate any relationship between either improvement in coagulation or oxygen unloading and the improved survival of infants receiving exchange transfusion . Following exchange transfusion there was a significant decrease in the ratio of FIO2 to PaO2 , suggesting that pulmonary perfusion and /or ventilation was improved by the procedure Objective To study the renal effects ( measured by creatininemia ) of plasma volume expansion with a medium molecular weight hydroxyethyl starch in the newborn . Design A prospect i ve , r and omized , double-blinded , pilot study . Patients The study included 26 neonates weighing 690–4030 g ( gestational age , 26–40 wks ) , without cardiac or renal failure or major hemostasis abnormalities and requiring a peripherally inserted central catheter for parenteral nutrition . Setting Pediatric and neonatal intensive care unit of a university-affiliated hospital . Interventions Plasma volume expansion was performed to facilitate insertion of the central catheter . After parental consent , neonates were r and omly allocated to receive intravenous infusions at 10 mL·kg−1 of 5 % albumin or 6 % hydroxyethyl starch 200/0.5 . Sample size was calculated to detect an increase in mean creatininemia of > 20 & mgr;mol·L−1 ( with & agr ; = 0.05 , & bgr ; = 0.80 ) . Measurements and Main Results No clinical ly or statistically significant differences were found between the two groups 6 hrs , 24 hrs , 48 hrs , and 7 days after plasma volume expansion . The study could detect an increase in creatininemia ≥20 & mgr;mol·L−1 with a power of 80 % . Conclusions In 13 healthy neonates , plasma volume expansion with 10 mL·kg−1 of 6 % hydroxyethyl starch 200/0.5 does not increase creatininemia BACKGROUND Fluid restriction has been reported to improve survival of infants without chronic lung disease ( CLD ) , but it remains unknown whether it reduces CLD in a population at high risk of CLD routinely exposed to antenatal steroids and postnatal surfactant without increasing other adverse outcomes . AIM Output:

REVIEW ER 'S CONCLUSIONS There is no evidence from r and omised trials to support the routine use of early volume expansion in very preterm infants without cardiovascular compromise . There is insufficient evidence to determine whether infants with cardiovascular compromise would benefit from volume expansion . There is insufficient evidence to determine what type of volume expansion should be used in preterm infants ( if at all ) or for the use of early red cell transfusions .

MS2_1shot108

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Clinical ly relevant weight loss is achievable through lifestyle modification , but unintentional weight regain is common . We investigated whether recently discovered genetic variants affect weight loss and /or weight regain during behavioral intervention . Participants at high-risk of type 2 diabetes ( Diabetes Prevention Program [ DPP ] ; N = 917/907 intervention/comparison ) or with type 2 diabetes ( Look AHEAD [ Action for Health in Diabetes ] ; N = 2,014/1,892 intervention/comparison ) were from two parallel arm ( lifestyle vs. comparison ) r and omized controlled trials . The associations of 91 established obesity-predisposing loci with weight loss across 4 years and with weight regain across years 2–4 after a minimum of 3 % weight loss were tested . Each copy of the minor G allele of MTIF3 rs1885988 was consistently associated with greater weight loss following lifestyle intervention over 4 years across the DPP and Look AHEAD . No such effect was observed across comparison arms , leading to a nominally significant single nucleotide polymorphism × treatment interaction ( P = 4.3 × 10−3 ) . However , this effect was not significant at a study -wise significance level ( Bonferroni threshold P < 5.8 × 10−4 ) . Most obesity-predisposing gene variants were not associated with weight loss or regain within the DPP and Look AHEAD trials , directly or via interactions with lifestyle The common single-nucleotide polymorphism in the FTO ( fat mass and obesity associated ) gene is consistently associated with an increased risk of obesity . However , the knowledge of a potential modifying effect of the FTO gene on changes in body weight achieved by lifestyle intervention is limited . We examined whether the FTO gene variant ( rs9939609 , T/A ) is associated with body weight and BMI and long-term weight changes in the Finnish Diabetes Prevention Study ( DPS ) . Altogether , 522 ( aged 40 - 65 years ; BMI > or=25 kg/m(2 ) ) subjects with impaired glucose tolerance ( IGT ) were r and omized to control and lifestyle intervention groups . SNP rs9939609 was genotyped from 502 subjects . At baseline , those with the AA genotype had higher BMI than subjects with other genotypes ( P = 0.006 ) . The association was observed in women ( P = 0.016 ) but not in men . During the 4-year follow-up , the subjects with the AA genotype had consistently the highest BMI ( P = 0.009 ) in the entire study population . The magnitude of weight reduction was greater in the intervention group , but the risk allele did not modify weight change in either of the groups . Our results confirm the association between the common FTO variant and BMI in a cross-sectional setting and during the long-term lifestyle intervention . We did not observe association between FTO variant and the magnitude of weight reduction achieved by long-term lifestyle intervention . Based on the results from the DPS , it is unlikely that the common variant of the FTO gene affects the success of lifestyle modification on weight loss BACKGROUND & AIMS Many companies provide genetic tests for obesity-related polymorphisms ( nutrigenetics ) and make dietary recommendations for weight loss that are based on the results . We performed a r and omized controlled trial to determine whether more participants who followed a nutrigenetic-guided diet lost ≥5 % of their body weight than participants on a st and ard balanced diet for 8 and 24 weeks . METHODS We performed a prospect i ve study of 51 obese or overweight U.S. veterans on an established weight management program at the Veterans Administration San Diego Healthcare System ( the MOVE ! program ) . Participants were r and omly assigned to groups placed on a nutrigenetic-guided diet ( balanced , low-carbohydrate , low-fat , or Mediterranean ; n = 30 ) or a st and ard balanced diet ( n = 21 ) . Nutrigenetic diets were selected on the basis of results from the Pathway FIT test . RESULTS There was no significant difference in the percentage of participants on the balanced diet vs the nutrigenetic-guided diet who lost 5 % of their body weight at 8 weeks ( 35.0 % ± 20.9 % vs 26.9 % ± 17.1 % , respectively ; P = .28 ) or at 24 weeks . Both groups had difficulty adhering to the diets . However , adherence to the nutrigenetic-guided diet correlated with weight loss ( r = 0.74 ; P = 4.0 × 10(-5 ) ) , but not adherence to st and ard therapy ( r = 0.34 ; P = .23 ) . Participants who had low-risk polymorphisms for obesity lost more weight than all other participants at 8 weeks ( 5.0 % vs 2.9 % , respectively ; P = .02 ) and had significantly greater reductions in body mass index ( 6.4 % vs 3.6 % , respectively ; P = .03 ) and waist circumference ( 6.5 % vs 2.6 % , respectively ; P = .02 ) at 24 weeks . CONCLUSIONS In a prospect i ve study , a nutrigenetic-based diet did not increase weight loss compared with a st and ard balanced diet . However , genetic features can identify individuals most likely to benefit from a balanced diet weight loss strategy ; these findings require further investigation . Clinical Trials.gov number : NCT01859403 BACKGROUND Common polymorphisms of the fat mass and obesity associated gene ( FTO ) have been linked to obesity in some population s. One of these genetic variants ( rs9939609 ) has been related to an increased risk of obesity . OBJECTIVE Our aim was to evaluate weight loss and adipocytokine levels after two hypocaloric diets with different macronutrient distribution in obese subjects with RS9939609 gene variant . DESIGN 305 obese patients were enrolled in a prospect i ve way . In the basal visit , patients were r and omly allocated during 3 months to low carbohydrates and low fat . RESULTS After treatment with both diets and in both genotypes , weight , fat mass , waist circumference and systolic blood pressures decreased . With the diet type I and in TT genotype , insulin ( -6.6 ± 9.8 IU/L ) and homeostasis model assessment ( -2.9 ± 6.1 units ) decreased . With the diet type II and in both genotypes ( wild and mutant type ) , insulin ( -5.2 ± 6.1 vs. -3.8 ± 6.1 IU/L ; p < 0.05 ) and homeostasis model assessment ( -2.4 ± 4.8 vs. -1.1 ± 3.8 kg ; p < 0.05 ) decreased . In the A allele group , a significant decrease was detected in total cholesterol levels ( -11.5 ± 20.1 mg/dL ) , low density lipoprotein cholesterol levels ( -13.2 ± 20.9 mg/dL ) and c-reactive protein levels ( -1.3 ± 3.8 mg/dL ) secondary to weight loss after treatment with diet II . The decrease of leptin levels was higher in mutant type group than wild type group with low fat diet ( -10.3 ± 36.1 vs. -28.6 ± 53.7 ng/mL ; p < 0.05 ) . CONCLUSION Metabolic improvement secondary to weight loss was better in A carriers with a low fat hypocaloric diet Background : Genome-wide association studies have provided new insights into the genetic factors that contribute to the development of obesity . We hypothesized that these genetic markers would also predict magnitude of weight loss and weight regain after initial weight loss . Methods : Established obesity risk alleles available on the Illumina CARe iSelect ( IBC ) chip were characterized in 3899 overweight or obese participants with type 2 diabetes from the Look AHEAD ( Action for Health in Diabetes ) , a r and omized trial to determine the effects of intensive lifestyle intervention ( ILI ) and diabetes support and education ( DSE ) on cardiovascular morbidity and mortality . Primary analyses examined the interaction between 13 obesity risk polymorphisms in eight genes and r and omized treatment arm in predicting weight change at year 1 , and weight regain at year 4 among individuals who lost 3 % or more of their baseline weight by year 1 . Results : No single-nucleotide polymorphisms ( SNPs ) were significantly associated with magnitude of weight loss or interacted with treatment arm at year 1 . However , fat mass and obesity associated gene ( FTO ) rs3751812 predicted weight regain within DSE ( 1.56 kg per risk allele , P=0.005 ) , but not ILI ( P=0.761 ) , result ing in SNP × treatment arm interaction ( P=0.009 ) . In a partial replication of prior research , the obesity risk ( G ) allele at BDNF rs6265 was associated with greater weight regain across treatment arms ( 0.773 kg per risk allele ) , although results were of borderline statistical significance ( P=0.051 ) . Conclusions : Variations in the FTO and BDNF loci may contribute risk of weight regain after weight loss OBJECTIVE We aim ed to investigate the influence of positive family history ( FH+ ) of diabetes and 19 known genetic risk loci on the effectiveness of lifestyle changes and their predictive value on the incidence of type 2 diabetes in the Finnish Diabetes Prevention Study ( DPS ) . RESEARCH DESIGN AND METHODS A total of 522 subjects with impaired glucose tolerance ( IGT ) were r and omized into the control ( n = 257 ) and intervention ( n = 265 ) groups . The mean follow-up was 6.2 years ( median 7 years ) , and the lifestyle intervention , aim ed at weight reduction , healthy diet , and increased physical activity , lasted for 4 years ( range 1–6 years ) . An oral glucose tolerance test ( OGTT ) and assessment of basic clinical variables were performed annually . RESULTS The effect of intervention on the incidence of diabetes was almost similar in subjects with FH+ compared with subjects with a negative family history ( FH− ) of diabetes during the entire follow-up . In the Cox model , including FH , genetic risk SNPs , and r and omization group , and adjusted for the effects of age , sex , BMI , and study center , only lifestyle intervention had a significant effect ( hazard ratio 0.55 , 95 % CI 0.41–0.75 , P < 0.001 ) on the incidence of diabetes . Further analyses showed that in addition to the baseline glucose and insulin values , 1-year changes in 2-h glucose and 2-h insulin achieved by lifestyle intervention had a significant effect on the incidence of diabetes . CONCLUSIONS These results emphasize the effectiveness of lifestyle intervention in reducing the risk of diabetes in high-risk individuals independently of genetic or familial risk of type 2 diabetes BACKGROUND Differences in the interindividual response to dietary intervention could be modified by genetic variation in nutrient-sensitive genes . OBJECTIVE This study examined single nucleotide polymorphisms ( SNPs ) in presumed nutrient-sensitive c and i date genes for obesity and obesity-related diseases for main and dietary interaction effects on weight , waist circumference , and fat mass regain over 6 mo . DESIGN In total , 742 participants who had lost ≥ 8 % of their initial body weight were r and omly assigned to follow 1 of 5 different ad libitum diets with different glycemic indexes and contents of dietary protein . The SNP main and SNP-diet interaction effects were analyzed by using linear regression models , corrected for multiple testing by using Bonferroni correction and evaluated by using quantile-quantile ( Q-Q ) plots . RESULTS After correction for multiple testing , none of the SNPs were significantly associated with weight , waist circumference , or fat mass regain . Q-Q plots showed that ALOX5AP rs4769873 showed a higher observed than predicted P value for the association with less waist circumference regain over 6 mo ( -3.1 cm/allele ; 95 % CI : -4.6 , -1.6 ; P/Bonferroni-corrected P = 0.000039/0.076 ) , independently of diet . Additional associations were identified by using Q-Q plots for SNPs in ALOX5AP , TNF , and KCNJ11 for main effects ; in LPL and TUB for glycemic index interaction effects on waist circumference regain ; in GHRL , CCK , MLXIPL , and LEPR on weight ; in PPARC1A , PCK2 , ALOX5AP , PYY , and ADRB3 on waist circumference ; and in PPARD , FABP1 , PLAUR , and LPIN1 on fat mass regain for dietary protein interaction . CONCLUSION The observed effects of SNP-diet interactions on weight , waist , and fat mass regain suggest that genetic variation in nutrient-sensitive genes can modify the response to diet . This trial was registered at clinical trials.gov as NCT00390637 OBJECTIVE To examine whether the effect of FTO loci on obesity-related traits could be modified by physical activity ( PA ) levels in European adults . METHODS Of 1,607 Food4Me participants r and omized , 1,2 Output:

Overall , differential changes in body mass index , body weight , and waist circumference in response to weight loss intervention were not significantly different between FTO genotypes . We have observed that carriage of the FTO minor allele was not associated with differential change in adiposity after weight loss interventions . These findings show that individuals carrying the minor allele respond equally well to dietary , physical activity , or drug based weight loss interventions and thus genetic predisposition to obesity associated with the FTO minor allele can be at least partly counteracted through such interventions .

MS2_1shot109

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Dementia care in the Netherl and s is shifting from fragmented , ad hoc care to more coordinated and personalised care . Case management contributes to this shift . The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherl and s. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost . The objective of this article is to describe the design of a study comparing these two case management care models against usual care . Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered . Design Mixed methods include a prospect i ve , observational , controlled , cohort study among persons with dementia and their primary informal caregiver in regions of the Netherl and s with and without case management including a qualitative process evaluation . Inclusion criteria for the cohort study are : community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch . Person with dementia-informal caregiver dyads are followed for two years . The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Question naire for their caregivers . Secondary outcomes include : quality of life and needs assessment in both persons with dementia and caregivers , activity of daily living , competence of care , and number of crises . Costs are measured from a societal perspective using cost diaries . Process indicators measure the quality of care from the participant ’s perspective . The qualitative study uses purposive sampling methods to ensure a wide variation of respondents . Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned . Discussion This study provides relevant insights into care processes , description of two case management models along with clinical and economic data from persons with dementia and caregivers to clarify important differences in two case management care models compared to usual care OBJECTIVE Direct physician order entry ( POE ) offers many potential benefits , but evidence suggests that POE requires substantially more time than traditional paper-based ordering methods . The Medical Gopher is a well-accepted system for direct POE that has been in use for more than 15 years . The authors hypothesized that physicians using the Gopher would not spend any more time writing orders than physicians using paper-based methods . DESIGN A r and omized controlled trial of POE using the Medical Gopher system in 11 primary care internal medicine practice s. MEASUREMENTS The authors collected detailed time use data using time motion studies of the physicians and surveyed their opinions about the POE system . RESULTS The authors found that physicians using the Gopher spent 2.2 min more per patient overall , but when duplicative and administrative tasks were taken into account , physicians were found to have spent only 0.43 min more per patient . With experience , the order entry time fell by 3.73 min per patient . The survey revealed that the physicians believed that the system improved their patient care and wanted the Gopher to continue to be available in their practice s. CONCLUSIONS Little extra time , if any , was required for physicians to use the POE system . With experience in its use , physicians may even save time while enjoying the many benefits of POE AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive cholinesterase inhibitors ( 79.8 % vs 55.1 % ; P = .002 ) and antidepressants ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 BACKGROUND It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers . However , diagnosing dementia often occurs late in the disease . This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care . OBJECTIVES To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers . DESIGN R and omized controlled trial with measurements at baseline and after 6 and 12 months . SETTING Primary care in West-Friesl and , the Netherl and s. PARTICIPANTS 99 pairs of community-dwelling older adults with dementia symptoms ( defined as abnormal screening for symptoms of dementia ) and their primary informal caregivers . INTERVENTION 12 months of case management by district nurses for both older adults and informal caregivers versus usual care . MEASUREMENTS PRIMARY OUTCOME informal caregiver 's sense of competence . SECONDARY OUTCOMES caregiver 's quality of life , depressive symptoms , and burden , and patient 's quality of life . Process measurements : intervention fidelity and caregiver 's satisfaction with the quality of case management . RESULTS Linear mixed model analyses showed no statistically significant and clinical ly relevant differences over time between the two groups . The process evaluation revealed that intervention fidelity could have been better . Meanwhile , informal caregivers were satisfied with the quality of case management . CONCLUSION This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers . One possible explanation is that case management , which has been recommended among diagnosed dementia patients , may not be beneficial if offered too early . However , on the other h and , it is possible that : ( 1 ) case management will be effective in this group if more fully implemented and adapted or aim ed at informal caregivers who experience more severe distress and problems ; ( 2 ) case management is beneficial but that it is not seen in the timeframe studied ; ( 3 ) case management might have undetected small benefits . This has to be established . Trial registration ISCRTN83135728 STUDY QUESTION Did the Medicare Alzheimer 's Disease Demonstration , with its goal of improving caregiver outcomes through case management and subsidized community services , affect the nursing home entry rate of treatments with dementia compared to controls ? DATA SOURCES Interviews conducted at baseline and six months thereafter . Measures include date of nursing home entry , client and caregiver health , and income . STUDY DESIGN The demonstration r and omly assigned voluntary applicants into treatment and control groups . Treatment group cases were eligible for case management and for an 80 percent discount on community care benefits , up to about $ 600 per month . DATA COLLECTION All cases received baseline and semi-annual assessment interviews for up to three years after enrollment . Analyses are among cases that remained in the demonstration for more than 30 days after enrollment ( n = 8,095 ) . PRINCIPAL FINDINGS The intervention of case management and subsidized community service had no effect on nursing home entry rates for treatments overall , compared to those of controls , and few effects on treatment subgroups , with the exception of one site where it may have increased nursing home entry rates . CONCLUSIONS Providing case management and subsidized community services with the goal of improving caregiver outcomes may have little effect on nursing home entry rates for people with dementia Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Output:

The characteristics of CM that negatively influence implementation are low CM intensity ( eg , infrequent follow-up ) , large caseload ( more than 60 patients per full-time case manager ) , and approach , ie , reactive rather than proactive .

MS2_1shot110

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Induction of hypothermia in patients with brain injury was shown to improve outcomes in small clinical studies , but the results were not definitive . To study this issue , we conducted a multicenter trial comparing the effects of hypothermia with those of normothermia in patients with acute brain injury . METHODS The study subjects were 392 patients 16 to 65 years of age with coma after sustaining closed head injuries who were r and omly assigned to be treated with hypothermia ( body temperature , 33 degrees C ) , which was initiated within 6 hours after injury and maintained for 48 hours by means of surface cooling , or normothermia . All patients otherwise received st and ard treatment . The primary outcome measure was functional status six months after the injury . RESULTS The mean age of the patients and the type and severity of injury in the two treatment groups were similar . The mean ( + /-SD ) time from injury to r and omization was 4.3+/-1.1 hours in the hypothermia group and 4.1+/-1.2 hours in the normothermia group , and the mean time from injury to the achievement of the target temperature of 33 degrees C in the hypothermia group was 8.4+/-3.0 hours . The outcome was poor ( defined as severe disability , a vegetative state , or death ) in 57 percent of the patients in both groups . Mortality was 28 percent in the hypothermia group and 27 percent in the normothermia group ( P=0.79 ) . The patients in the hypothermia group had more hospital days with complications than the patients in the normothermia group . Fewer patients in the hypothermia group had high intracranial pressure than in the normothermia group . CONCLUSIONS Treatment with hypothermia , with the body temperature reaching 33 degrees C within eight hours after injury , is not effective in improving outcomes in patients with severe brain injury OBJECT This study was performed to determine whether mild hypothermia therapy is essential for the treatment of severely head injured patients in whom intracranial pressure ( ICP ) can be maintained below 20 mm Hg by using conventional therapies . METHODS Sixteen consecutive severely head injured patients fulfilled the following criteria : the patient 's ICP was maintained below 20 mm Hg by using fluid restriction , hyperventilation , and high-dose barbiturate therapy ; and the patient had a Glasgow Coma Scale score of 8 or less on admission . After conventional therapies had been applied , the patients were divided r and omly into two groups : the mild hypothermia group ( HT group ; eight patients ) and the normothermia group ( NT group ; eight patients ) . The HT group received mild hypothermia ( intracranial temperature 34 degrees C ) therapy for 48 hours followed by rewarming at 1 degree C per day for 3 days , whereas the NT group received normothermia ( intracranial temperature 37 degrees C ) therapy for 5 days . Specimens of cerebrospinal fluid ( CSF ) taken from an intraventricular catheter every 24 hours were analyzed for the presence of excitatory amino acids ( [ EAAs ] glutamate , aspartate , and glycine ) and cytokines ( tumor necrosis factor-alpha , interleukin [IL]-1beta , IL-6 , IL-8 , and IL-10 ) . The two groups did not differ significantly in patient age , neurological status , or level of ICP . There were no significant differences in daily changes in CSF concentrations of EAAs and cytokines between the two groups . The incidence of pneumonia was slightly higher in the HT group compared with the NT group ( p = 0.059 ) . The incidence of diabetes insipidus associated with hypernatremia was significantly higher in the HT group compared with that in the NT group ( p < 0.01 ) . The two groups did not differ with respect to their clinical outcomes . CONCLUSIONS The authors recommend normothermia therapy for the treatment of severely head injured patients in whom ICP can be maintained at lower than 20 mm Hg by using conventional therapies , because mild hypothermia therapy does not convey any advantage over normothermia therapy in such patients OBJECTIVE To observe the changes of evoked potentials after severe brain injury and the effect of mild hypothermia on acute severe brain injury . METHODS A total of 44 patients with severe closed head injury ( GCS 3 - 8 , admitted within 10 hours from injury ) admitted from May 1998 to March 1999 were selected for this study . All patients were admitted into the intensive care unit and divided into 2 groups , Group A ( GCS 3 - 5 ) and Group B ( GCS 6 - 8 ) . Patients were also r and omly assigned to either normothermia or hypothermia subgroups . Patients in the hypothermia group were cooled to 32 - 34 degrees C. Median nerve short-latency somatosensory evoked potentials ( SLSEP ) and brain stem auditory evoked potentials ( BAEP ) were recorded before cooling and 4 , 24 , 48 , 72 , 96 and 120 hours , respectively after cooling and temperature resuming . SLSEP and BAEP were measured at the same time in the normothermia group ( control group ) . The changes of evoked potentials ( EP ) were analyzed by statistical methods . RESULTS In the Group B , N(20 ) amplitudes in SLSEP and I/V amplitudes in BAEP after mild hypothermia treatment in the hypothermia group differed significantly from those in the control group ( P<0.05 ) . However , in the Group A , no significant difference in all parameters was found . CONCLUSIONS These results demonstrate that mild hypothermia treatment ( 32 - 34 degrees C ) in the Group B has a significant neuroelectrophysiological effect on severe brain injury . Nevertheless , the effect of mild hypothermia in the Group A is not apparent and needs further study ing BACKGROUND Traumatic brain injury initiates several metabolic processes that can exacerbate the injury . There is evidence that hypothermia may limit some of these deleterious metabolic responses . METHODS In a r and omized , controlled trial , we compared the effects of moderate hypothermia and normothermia in 82 patients with severe closed head injuries ( a score of 3 to 7 on the Glasgow Coma Scale ) . The patients assigned to hypothermia were cooled to 33 degrees C a mean of 10 hours after injury , kept at 32 degrees to 33 degrees C for 24 hours , and then rewarmed . A specialist in physical medicine and rehabilitation who was unaware of the treatment assignments evaluated the patients 3 , 6 , and 12 months later with the use of the Glasgow Outcome Scale . RESULTS The demographic characteristics and causes and severity of injury were similar in the hypothermia and normothermia groups . At 12 months , 62 percent of the patients in the hypothermia group and 38 percent of those in the normothermia group had good outcomes ( moderate , mild , or no disabilities ) . The adjusted risk ratio for a bad outcome in the hypothermia group was 0.5 ( 95 percent confidence interval , 0.2 to 1.2 ) . Hypothermia did not improve the outcomes in the patients with coma scores of 3 or 4 on admission . Among the patients with scores of 5 to 7 , hypothermia was associated with significantly improved outcomes at 3 and 6 months ( adjusted risk ratio for a bad outcome , 0.2 ; 95 percent confidence interval , 0.1 to 0.9 at both intervals ) , although not at 12 months ( risk ratio , 0.3 ; 95 percent confidence interval , 0.1 to 1.0 ) . CONCLUSIONS Treatment with moderate hypothermia for 24 hours in patients with severe traumatic brain injury and coma scores of 5 to 7 on admission hastened neurologic recovery and may have improved the outcome We prospect ively investigated noninvasive selective brain cooling ( SBC ) in patients with severe traumatic brain injury . Sixty-six in- patients were r and omized into three groups . In one group , brain temperature was maintained at 33 - 35 ° C by cooling the head and neck (SBC);in a second group , mild systemic hypothermia ( MSH ; rectal temperature 33 - 35 ° C ) was produced with a cooling blanket ; and a control group was not exposed to hypothermia . Natural re-warming began after 3 days . Mean intracranial pressure 24 , 48 or 72 h after injury was significantly lower in the SBC group than in the control group . Mean serum superoxide dismutase levels on Days 3 and 7 after injury in the SBC and MSH groups were significantly higher than in the control group . The percentage of patients with a good neurological outcome 2 years after injury was 72.7 % , 57.1 % and 34.8 % in the SBC , MSH and control groups , respectively . Complications were managed without severe sequelae . Non-invasive SBC was safe and effective Forty-six patients with severe nonpenetrating brain injury [ Glasgow Coma Scale ( GCS ) 4 - 7 ] were r and omized to st and ard management at 37 degrees C ( n = 22 ) and to st and ard management with systemic hypothermia to 32 to 33 degrees C ( n = 24 ) . The two groups were balanced in terms of age ( Wilcoxon 's rank sum test , p > 0.95 ) , r and omizing GCS ( chi-square test , p = 0.54 ) , and primary diagnosis . Cooling was begun within 6 h of injury by use of cooling blankets . Metocurine and morphine were given hourly during induction and maintenance of hypothermia . Rewarming was at a rate of 1 degree C per 4 h beginning 48 h after intravascular temperature had reached 33 degrees C. Muscle relaxants and sedation were continued until core temperature reached 35 degrees C. There were no cardiac or coagulopathy-related complications . Seizure incidence was lower in the hypothermia group ( Fisher 's exact text , p = 0.019 ) . Sepsis was seen more commonly in the hypothermia group , but difference was not statistically significant ( chi-square test ) . Mean Glasgow Outcome Scale ( GOS ) score at 3 months after injury showed an absolute increase of 16 % ( i.e. , 36.4 - 52.2 % ) in the number of patients in the Good Recovery/Moderate Disability ( GR/MD ) category as compared with Severe Disability/Vegetative/Dead ( SD/V/D ) ( chi-square test , p > 0.287 ) . Based on evidence of improved neurologic outcome with minimal toxicity , we believe that phase III testing of moderate systemic hypothermia in patients with severe head injury is warranted OBJECT The criteria for the use of mild hypothermia ( 34 degrees C ) in severely head injured patients have not been st and ardized . A prospect i ve r and omized controlled trial was conducted to determine whether mild hypothermia is essential in the treatment of severely head injured patients with low intracranial pressure ( ICP ) . METHODS At 11 medical centers , 91 severely head injured patients with an admission Glasgow Coma Scale score of 8 or less in whom ICP could be maintained below 25 mm Hg by conventional therapies were divided r and omly into two groups : the mild hypothermia group ( HT group , 45 patients ) and the normothermia group ( NT group , 46 patients ) . Patients in the HT group were exposed to mild hypothermia ( 34 degrees C ) for 48 hours , followed by rewarming at 1 degrees C per day for 3 days , whereas patients in the NT group were exposed to normothermia ( 37 degrees C ) for 5 days . The two groups were similar with respect to prognostic factors , and there was no difference in clinical outcome at 3 months postinjury . During treatment , there was a significantly greater use of neuromuscular blocking agents in the HT group ( p = 0.011 ) . During the initial 2 weeks postinjury , the incidences of pneumonia , meningitis , leukocytopenia , thrombocytopenia , hypernatremia , hypokalemia , and hyperamylasemia were significantly higher in the HT than in the NT group ( p < 0.05 ) . CONCLUSIONS Mild hypothermia should not be used for the treatment of severely head injured patients with low ICP because this therapy conveys no advantage over normothermia in such patients Objective To examine the levels of thromboxane B2 ( TXB2 ) and 6-keto prostagl and in F1&agr ; ( 6-keto PGF1&agr ; ) production in arterial and internal jugular bulb sera in patients with traumatic brain injury ( TBI ) . TBI is associated with arachidonate release and may be associated with an imbalance of vasoconstricting and vasodilating cyclooxygenase metabolites . Design A prospect i ve , r and omized study . Setting The intensive care unit of a medical university hospital . Interventions Twenty-six ventilated TBI patents ( Glasgow Coma Scale score on admission , ≤8 points ) were divided r and omly into two groups : a hypothermic group ( n = 15 ) , in which the patients were cooled to 32 to 33 ° C after being giving vecuronium , midazolam , and buprenorphine ; and a normothermic group ( n = 11 ) , in which the patients ’ body temperature was controlled at 36 to 37 ° C by surface cooling using the same treatment as the hypothermic group . Body temperature control including normothermia was started 3 to 4 hrs after injury . The duration of hypothermia usually lasted for 3 to 4 days , after which the patients were rewarmed at a rate of approximately 1 ° C per day . Measurements and Main Results Blood sampling for TXB2 and 6-keto PGF1&agr ; was started shortly after admission in both groups . Arter Output:

In sum , the present study 's up date d meta- analysis supports previous findings that hypothermic therapy constitutes a beneficial treatment of TBI in specific circumstances .

MS2_1shot111

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The effect of treatment with danazol was evaluated with respect to expectant management after laparoscopic conservative surgery . All patients conservatively operated at laparoscopy for stage III-IV endometriosis from July 1994 to October 1996 were requested to enter the study . Patients who underwent surgery for recurrent endometriosis were excluded from the study , as well as patients who had taken hormonal therapies before laparoscopy . Informed consent was obtained from 77 women who were r and omized after surgery to treatment with danazol 600 mg daily for 3 months ( n = 36 ) or to expectant management ( n = 41 ) . All patients were regularly followed up every 6 months for evaluation of fertility , recurrence of pain symptoms and disease . During the follow-up , six ( 55 % ) of the 11 infertile women allocated to danazol and eight ( 50 % ) of the 16 given no treatment became pregnant ( not significant ) . Moderate/severe pelvic pain recurred during follow-up in seven ( 23 % ) of the 31 women with pelvic pain allocated to the danazol group and nine ( 31 % ) of the 29 allocated to no treatment ; the respective cumulative pain recurrence rates at 12 months were 26 and 34 % ( log rank test , not significant ) . Three women ( 8.3 % ) treated with danazol and six ( 15 % ) who received no treatment had disease recurrence as demonstrated by gynaecological examination and /or pelvic ultrasonography ( not significant ) . Our results do not demonstrate a significant advantage of 3 month danazol therapy after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management OBJECTIVE We sought to evaluate the efficacy of postoperative administration of monophasic , combined , low-dose oral contraceptives on endometrioma recurrence and on persistence-recurrence of associated pain symptoms after laparoscopic treatment of moderate-to-severe endometriosis . STUDY DESIGN In a prospect i ve , r and omized trial 70 patients who were not attempting to conceive , aged 20 to 35 years , underwent laparoscopic excision of ovarian endometriomas , followed by either postoperative administration of low-dose cyclic oral contraceptives for 6 months or no treatment on the basis of a computer-generated sequence . At 3 and 6 months after surgery and then at 6-month intervals , both groups underwent ultrasonographic examination for possible evidence of endometrioma recurrence and for evaluation of the absence , persistence , or recurrence of pain symptoms . RESULTS Two patients in the oral contraceptive group did not complete the study . After a mean follow-up of 22 months ( range , 12 - 48 months ) , there were 2 ( 6.1 % ) endometrioma recurrences in the 33 patients who received postoperative oral contraceptives versus 1 ( 2.9 % ) recurrence in the 35 patients in the control group ( not significant ) . The moderate-to-severe pain recurrence rate was 9.1 % in the oral contraceptive group versus 17.1 % in the control group ( not significant ) . The mean time to recurrence of either symptoms or endometriomas was 18.2 months in the oral contraceptive group versus 12.7 months in the control group . The 12-month cumulative recurrence rate at life-table analysis was significantly lower for patients receiving oral contraceptives versus control subjects , whereas no significant difference was evident at 24 and 36 months . CONCLUSION Postoperative administration of low-dose cyclic oral contraceptives does not significantly affect the long-term recurrence rate of endometriosis after surgical treatment . A delay in recurrence is evident at life-table analysis BACKGROUND Little is known about the precise nature of the relationship between dysmenorrhoea ( DM ) and endometriosis . Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis ( DIE ) and indicators of the extent of their disease . METHODS Various indicators of the extent of DIE were recorded during surgery in 209 women . The severity of their DM was assessed with a pain scale . The scale was retrospective for 155 women and prospect i ve for 54 . Correlations were sought with an ordinal logistic regression model with cumulative odds . RESULTS On univariate analysis the following variables were related to the severity of DM : number of previous surgical procedures for endometriosis ; revised American Fertility society classification ; extensiveness of adnexal adhesion ; Douglas obliteration ; size of the posterior DIE implant ; extent of the sub-peritoneal infiltration by the posterior DIE ( rectal , vaginal or both versus sub-peritoneal only ) . Current infertility was associated with less severe DM . After multiple regression analysis , presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity . CONCLUSIONS The concept of ' very deep infiltrating endometriosis ' , defined as implants invading the wall of the pelvic organ , should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain Objective To ascertain whether the frequency of pelvic pain recurrence is reduced and time to symptoms recurrence is prolonged in women with symptomatic endometriosis undergoing conservative surgery and post‐operative hormonal therapy compared with women treated with surgery only . Pregnancy rates and time to conception in women wanting children were also evaluated To evaluate the clinical value of postoperative hormone therapy in endometriosis , 60 patients with advanced disease were r and omized to receive in a double-blind study danazol ( 200 mg , 3 times daily ) , medroxyprogesterone acetate ( MPA ) ( 100 mg daily ) or placebo post-operatively for 6 months . Treatment efficacy was evaluated clinical ly and at laparoscopy 6 months after medication . In relation to placebo , danazol and high-dose MPA treatments , which did not differ from each other in efficacy , significantly alleviated pelvic pain . In addition , the peritoneal endometriosis lesions found at 6-months laparoscopy were significantly smaller in the MPA and danazol groups than in the placebo group . Breakthrough bleeding , weight gain and acne complicated danazol treatment but only breakthrough bleeding complicated MPA treatment . These data suggest that postoperative treatment of advanced endometriosis with high-dose MPA or danazol is clinical ly beneficial OBJECTIVES To determine the relative risk of symptom recurrence and /or reoperation after hysterectomy with ovarian preservation for the treatment of endometriosis . DESIGN Historical prospect i ve study of patients with endometriosis who underwent hysterectomy with or without ovarian preservation . PATIENTS One hundred thirty-eight women who underwent hysterectomy with the diagnosis of endometriosis . METHODS A computer search identified 138 women who underwent hysterectomy with the diagnosis of endometriosis at Johns Hopkins Hospital from 1979 to 1991 . Follow-up information was obtained from medical records , outpatient charts , and telephone surveys . RESULTS Twenty-nine women had hysterectomy with some ovarian tissue preserved ; 109 had all ovarian tissue removed . Of those with ovarian preservation , 18 of 29 ( 62 % ) had recurrent pain and 9 of 29 ( 31 % ) required reoperation . Of those who had no ovarian preservation , 11 of 109 ( 10 % ) had recurrent symptoms and 4 of 109 ( 3.7 % ) required reoperation . Ovarian conservation was associated with a relative risk for pain recurrence of 6.1 ( 95 % confidence interval [ CI ] 2.5 to 14.6 ) compared with patients with oophorectomy in a Cox proportional hazards model . The relative risk for reoperation in patients with ovarian conservation was 8.1 ( 95 % CI 2.1 to 31.3 ) . CONCLUSION Compared with women who had oophorectomy for endometriosis , patients who underwent hysterectomy with ovarian conservation had 6.1 times greater risk of developing recurrent pain and 8.1 times greater risk of reoperation BACKGROUND This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis . METHODS In this prospect i ve observational cohort study , 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis . Of these , 216 women underwent surgical assessment and 176 were confirmed to have endometriosis . Question naires and visual analogue scale ( VAS ) scores for dysmenorrhoea , non-menstrual pelvic pain , dyspareunia and dyschesia as well as quality of life instruments ; the EQ-5Dindex and EQ-5Dvas , Short-Form 12 ( SF-12 ) and sexual activity question naires were completed pre-operatively . Intra-operative details of revised American Fertility Society ( rAFS ) stage , site of disease , associated tests , duration of surgery and complications were noted . Follow-up was performed by postal question naire and chart review . For women who had further surgery , rAFS stage , site of disease , other procedures and histology were all recorded . RESULTS Pain scores were all significantly reduced at 2 - 5 years for dysmenorrhoea ( median VAS baseline versus follow-up 2 - 5 years ) ; 9 versus 3.3 ( P < 0.0001 ) , non-menstrual pelvic pain 8 versus 3 ( P < 0.0001 ) , dyspareunia 7 versus 0 ( P < 0.0001 ) and dyschesia 7 versus 2 ( P < 0.0001 ) . Quality of life was improved for the EQ-5Dindex ( P = 0.008 and the EQ-5Qvas ( P = 0.03 ) and for sexual function with pleasure ( P = 0.001 ) and habit ( P = 0.012 ) being improved and discomfort being decreased ( P = 0.001 ) . The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36 % . A rAFS score of > 70 was predictive of requiring further surgery ( P = 0.03 ) . Of women who had further surgery , endometriosis was found histologically in 68 % . CONCLUSIONS Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years . The probability of requiring further surgery is 36 % . Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence In order to analyse the efficacy of resection/ablation of minimal/mild endometriotic lesions for improving fertility , we conducted a r and omized clinical trial . Eligible patients were women aged < /=36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis ( stage I or II of the revised American Fertility Society classification ) and otherwise unexplained infertility for > /=2 years . Eligible women were r and omly assigned to resection or ablation of visible endometriosis ( 54 patients ) or diagnostic laparoscopy only ( 47 patients ) . After laparoscopy women tried to conceive spontaneously for 1 year ( follow-up period ) . A total of five women withdrew from the study : three for personal reasons , and two were lost to follow-up . Considering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period , 12 ( 24 % ) in the resection/ablation group and 13 ( 29 % ) in the no treatment group conceived ; the difference was not significant . Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one . Thus the 1 year birth rate was 10 out of 51 women ( 19.6 % ) in the resection/ablation group and 10 out of 45 women ( 22.2 % ) in the no-treatment group . In conclusion , the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates OBJECTIVE To examine whether ultralong GnRH analog ( GnRH-a ) therapy after surgical treatment of endometriosis and before ART influences the pregnancy rate . DESIGN Prospect i ve , r and omized , controlled study . SETTING University clinic for reproductive medicine and gynecologic endocrinology . PATIENT(S ) One hundred ten patients with stage II to IV endometriosis according to ASRM criteria . INTERVENTION(S ) Fifty-five patients received GnRH-a for 6 months after surgery and subsequently underwent up to 3 cycles of ART , and 55 patients received 3 cycles of ART alone immediately after surgery . MAIN OUTCOME MEASURE(S ) Clinical pregnancy rates . RESULTS The pregnancy rate per patient was higher among patients who received follow-up treatment with GnRH-a . The same results were found in patients with stage III or IV endometriosis who were undergoing IUI or IVF/ICSI . CONCLUSION ( S ) Ultralong GnRH-a therapy increases the pregnancy rate of ART in patients with severe endometriosis OBJECTIVE To evaluate the efficacy and safety of an intrauterine system releasing 20 microg of levonorgestrel per 24 hours in the long-term treatment of recurrent dysmenorrhea in women already operated on conservatively for endometriosis . DESIGN A prospect i ve noncomparative Output:

In women with laparoscopically confirmed disease , suppression of ovarian function for 6 months reduces endometriosis-associated pain ; all hormonal drugs studied are equally effective although their side-effects and cost profiles differ . Ablation of endometriotic lesions reduces endometriosis-associated pain and the smallest effect is seen in patients with minimal disease ; there is no evidence that also performing laparoscopic uterine nerve ablation ( LUNA ) is necessary . In minimal-mild endometriosis , suppression of ovarian function to improve fertility is not effective , but ablation of endometriotic lesions plus adhesiolysis is effective compared to diagnostic laparoscopy alone . There is insufficient evidence available to determine whether surgical excision of moderate-severe endometriosis enhances pregnancy rates . IVF is appropriate treatment especially if there are coexisting causes of infertility and /or other treatments have failed , but IVF pregnancy rates are lower in women with endometriosis than in those with tubal infertility .

MS2_1shot112

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Previous phase I-II clinical trials have shown that recombinant human erythropoietin ( rHuEpo ) can ameliorate anemia in a portion of patients with multiple myeloma ( MM ) and non-Hodgkin 's lymphoma ( NHL ) . Therefore , we performed a r and omized controlled multicenter study to define the optimal initial dosage and to identify predictors of response to rHuEpo . A total of 146 patients who had hemoglobin ( Hb ) levels < or = 11 g/dL and who had no need for transfusion at the time of enrollment entered this trial . Patients were r and omized to receive 1,000 U ( n = 31 ) , 2,000 U ( n = 29 ) , 5,000 U ( n = 31 ) , or 10,000 U ( n = 26 ) of rHuEpo daily subcutaneously for 8 weeks or to receive no therapy ( n = 29 ) . Of the patients , 84 suffered from MM and 62 from low- to intermediate- grade NHL , including chronic lymphocytic leukemia ; 116 of 146 ( 79 % ) received chemotherapy during the study . The mean baseline Hb level was 9.4 + /- 1.0 g/dL. The median serum Epo level was 32 mU/mL , and endogenous Epo production was found to be defective in 77 % of the patients , as judged by a value for the ratio of observed-to-predicted serum Epo levels ( O/P ratio ) of < or = 0.9 . An intention-to-treat analysis was performed to evaluate treatment efficacy . The median average increase in Hb levels per week was 0.04 g/dL in the control group and -0.04 ( P = .57 ) , 0.22 ( P = .05 ) , 0.43 ( P = .01 ) , and 0.58 ( P = .0001 ) g/dL in the 1,000 U , 2,000 U , 5,000 U , and 10,000 U groups , respectively ( P values versus control ) . The probability of response ( delta Hb > or = 2 g/dL ) increased steadily and , after 8 weeks , reached 31 % ( 2,000 U ) , 61 % ( 5,000 U ) , and 62 % ( 10,000 U ) , respectively . Regression analysis using Cox 's proportional hazard model and classification and regression tree analysis showed that serum Epo levels and the O/P ratio were the most important factors predicting response in patients receiving 5,000 or 10,000 U. Approximately three quarters of patients presenting with Epo levels inappropriately low for the degree of anemia responded to rHuEpo , whereas only one quarter of those with adequate Epo levels did so . Classification and regression tree analysis also showed that doses of 2,000 U daily were effective in patients with an average platelet count greater than 150 x 10(9)/L. About 50 % of these patients are expected to respond to rHuEpo . Thus , rHuEpo was safe and effective in ameliorating the anemia of MM and NHL patients who showed defective endogenous Epo production . From a practical point of view , we conclude that the decision to use rHuEpo in an individual anemic patient with MM or NHL should be based on serum Epo levels , whereas the choice of the initial dosage should be based on residual marrow function PURPOSE To investigate the effect of recombinant human erythropoietin ( epoetin beta ) on anemia , transfusion need , and quality of life ( QOL ) in severely anemic patients with low- grade non-Hodgkin 's lymphoma ( NHL ) , chronic lymphocytic leukemia ( CLL ) , or multiple myeloma ( MM ) . PATIENTS AND METHODS Transfusion-dependent patients with NHL ( n = 106 ) , CLL ( n = 126 ) , or MM ( n = 117 ) and a low serum erythropoietin concentration were r and omized to receive epoetin beta 150 IU/kg or placebo subcutaneously three times a week for 16 weeks . Primary efficacy criteria were transfusion-free and transfusion- and severe anemia-free survival ( hemoglobin [ Hb ] > 8.5 g/dL ) between weeks 5 to 16 . Response was defined as an increase in Hb > or = 2 g/dL with elimination of transfusion need . QOL was assessed by the Functional Assessment of Cancer Therapy scale . RESULTS Transfusion-free ( P = .0012 ) survival and transfusion- and severe anemia-free survival ( P = .0001 ) were significantly greater in the epoetin beta group versus placebo ( Wald chi(2 ) test ) , giving a relative risk reduction of 43 % and 51 % , respectively . The response rate was 67 % and 27 % in the epoetin beta versus the placebo group , respectively ( P < .0001 ) . After 12 and 16 weeks of treatment , QOL significantly improved in the epoetin beta group compared with placebo ( P < .05 ) ; this improvement correlated with an increase in Hb concentration ( > or = 2 g/dL ) . A target Hb that could be generally recommended could not be identified . CONCLUSION Many severely anemic and transfusion-dependent patients with advanced MM , NHL , and CLL and a low performance status benefited from epoetin therapy , with elimination of severe anemia and transfusion need , and improvement in QOL Nine B‐chronic lymphocytic leukaemia ( B‐CLL ) patients suffering from anaemia , due to no obvious cause except their disease , were treated with recombinant human erythropoietin ( r‐HuEPO ) . The treatment protocol provided a closed label phase of 3 months duration , during which the patients received r‐HuEPO or placebo in a ratio of 2:1 , followed by an open label phase , also of 3 months duration , during which r‐HuEPO was administered to all patients three times a week s.c . r‐HuEPO was given at a dose of 150 U/kg of body weight with an escalation of 50 U/kg up to a maximum of 300 U/kg three times a week . Complete response was achieved in 5/9 ( 55 % ) patients and partial response in 3/9 ( 33 % ) . The response obtained was independent of the pretreatment serum EPO levels , the duration of anaemia , the concomitant administration of chemotherapy , the presence of splenomegaly , or the degree of bone marrow infiltration by lymphocytes . It appears that r‐HuEPO is very effective in reversing the disease‐related anaemia of B‐CLL patients PURPOSE The efficacy and safety of darbepoetin alpha ( DA ) for treating patients with active cancer and anemia not receiving or planning to receive cytotoxic chemotherapy or myelosuppressive radiotherapy was evaluated . PATIENTS AND METHODS Patients with active cancer and anemia not receiving or planning to receive chemotherapy or radiotherapy were enrolled onto a phase III , multicenter , r and omized , placebo-controlled study and administered placebo or DA 6.75 microg/kg every 4 weeks ( Q4W ) for up to 16 weeks with a 2-year follow-up for survival . Patients who completed 16 weeks of treatment could receive the same treatment as r and omized Q4W for an additional 16 weeks . The primary end point was all occurrences of transfusions from weeks 5 through 17 ; safety end points included incidence of adverse events and survival . RESULTS The incidence of transfusions between weeks 5 and 17 was lower in the DA group but was not statistically significantly different from that of placebo . DA was associated with an increased incidence of cardiovascular and thromboembolic events and more deaths during the initial 16-week treatment period . Long-term survival data demonstrated statistically significantly poorer survival in patients treated with DA versus placebo ( P = .022 ) . This effect varied by baseline covariates including , sex , tumor type , and geographic region ; statistical significance diminished ( P = .12 ) when the analysis was adjusted for baseline imbalances or known prognostic factors . CONCLUSION DA was not associated with a statistically significant reduction in transfusions . Shorter survival was observed in the DA arm ; thus , this study does not support the use of erythropoiesis-stimulating agents in this subset of patients with anemia of cancer OBJECTIVE To determine a recommended dose of once-weekly epoetin-beta administration for anemic cancer patients receiving myelosuppressive chemotherapy , we conducted a multicenter , r and omized , double-blind trial . METHODS A total of 86 patients with malignant lymphoma or lung cancer who received chemotherapy containing platinum , taxanes or anthracyclines were enrolled in the study . Patients were r and omly assigned into groups that received three dose levels of epoetin-beta ( 9000 , 18,000 or 36,000 IU ) administered subcutaneously once a week for 12 weeks . The primary endpoint was change in hemoglobin , while the secondary endpoints were quality of life ( QOL ) assessed by Functional Assessment of Cancer Therapy-Anemia ( FACT-An ) question naire and transfusion requirements . RESULTS Among the 69 patients ( per protocol set population ) assessable for efficacy , hemoglobin level change in the 36,000 IU group was significantly greater than that in the 9000 IU group ( 1.75 + /- 2.15 versus 0.04 + /- 1.98 g/dl ; P = 0.009 ) , and a significant dose-response relationship was observed for the change in hemoglobin level ( P = 0.003 ) . Although changes in FACT-An Total Fatigue subscale ( Fatigue subscale ) scores were similar for the three dosage groups , there was a statistically significant correlation ( r = 0.435 , P < 0.001 ) between the change in hemoglobin levels and the change in Fatigue subscale scores . The proportion of transfused patients was significantly smaller in the 36 000 IU group compared with that in the 9000 IU group ( P = 0.022 , not adjusted for pre- study transfusions ) . The incidence of adverse events was similar in the three dosage groups . CONCLUSIONS Once-weekly epoetin-beta 36,000 IU for 12 weeks was well tolerated and significantly increased hemoglobin levels in anemic cancer patients receiving chemotherapy BACKGROUND Anemia is common in cancer and has been associated with fatigue and reduced health-related quality of life ( HRQOL ) . We report the association between hemoglobin and fatigue and the impact of reducing fatigue on several domains of HRQOL . PATIENTS AND METHODS These analyses were based on five r and omized trials . Patients completed the Functional Assessment of Cancer Therapy ( FACT ) Anemia scales and numeric rating scales of Energy , Activity and Overall Health at baseline and after the 12-week treatment period . t-tests and linear regression models were used to evaluate associations . Analyses were stratified into three groups : solid tumor chemotherapy patients , lymphoproliferative malignancy chemotherapy patients and non-chemotherapy patients . RESULTS Adjusted mean differences ( 95 % CI ) in FACT Fatigue change scores between hemoglobin responders ( > or = 2 g/dl increase ) and non-responders were 3.0 ( 1.2 , 4.7 ) , 2.8 ( 0.6 , 5.0 ) and 5.8 ( 2.2 , 9.5 ) among the solid tumor , lymphoproliferative malignancy and non-chemotherapy groups , respectively . Significantly greater improvements ( P < 0.01 ) were observed in the FACT well-being scales for patients with meaningful improvement in fatigue ( FACT Fatigue change score > or =3 points ) . After controlling for other factors , patients whose fatigue improved reported substantially greater improvements in energy , ability to perform usual activities and overall health ( P < 0.0001 ) . CONCLUSIONS Across five trials of cancer patients on and off chemotherapy , hemoglobin response was associated with meaningful improvements in fatigue , which , in turn , was associated with improved physical , functional , emotional and overall well-being Anemia is a frequent complication of multiple myeloma , becoming chronic in patients who are resistant to chemotherapy . This r and omized , parallel , controlled multicenter study ( 71 patients receiving concomitant chemotherapy ) evaluated the efficacy and safety of epoetin alfa in improving anemia and eliminating the need for transfusions in multiple myeloma patients refractory to conventional first- or second-line chemotherapy . Forty patients were treated with subcutaneous epoetin alfa ( 150 IU/kg per dose , increasing to 300 IU/kg per dose , every 3 weeks ) for 6 months , and 31 entered a control group . The epoetin alfa group had a significantly ( P≤0.001 ) greater percentage of patients ( 75 % vs. 21 % ) with increases in hemoglobin levels and /or reduced transfusion requirements . In 44 non pre-transfused patients ( 20 controls , 24 in the epoetin alfa group ) , the mean increase in hemoglobin was significantly ( P≤0.0001 ) greater in the epoetin alfa group ( + 2.1 vs. −0.2 g/dl ) . Increases in hematocrit and red blood cells were also significantly ( P≤0.0001 ) greater in epoetin alfa-tre Output:

We conclude that available data evaluating ESAs in patients with hematologic malignancies demonstrate that these agents reduce transfusion requirements . Limitations of these data preclude conclusions that these agents improve QOL .

MS2_1shot113

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE The aim of the present study is to compare piezoelectric surgery to the conventional rotatory surgery in m and ibular cyst enucleation , and to determine the 2 method 's suitability and the postoperative outcomes . MATERIAL AND METHODS Eighty patients were included in the study . 35 male and 45 female , which showed cystic m and ibular lesions , compared with the inferior alveolar nerve or the mental nerve . The patients were r and omly divided into two groups . In the test group , cystectomy was performed using conventional rotatory instrumentation ( rotatory-group ) , and in the other one piezoelectric surgery ( piezo-group ) . The swelling was documented 24/48/72 h and 1 week post-surgery and the patients recorded their subjective postoperative pain daily for 7 days using a Visual Analog Scale ( VAS ) . RESULTS Patients treated with piezoelectric technique have presented a lower VAS , minor swelling and less recovery time compared to the rotatory-group . No lesions of the m and ible nerve were detected with piezosurgery whereas surgery with rotary instruments result ed in 8 % hypesthesia at least up to one week . CONCLUSION The results of this study suggest that piezosurgery may be considered effective in cyst enucleation compared to traditional procedures with burs , since it grants the patients significantly less post-surgical pain and swelling Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose This clinical trial aim ed to test the hypothesis that piezosurgery causes reduced nerval irritations and , thus , reduced somatosensory impairment when used in orthognathic surgery of the m and ible . Methods To this end , 37 consecutive patients with Angle Class II and III malocclusion were treated using bilateral sagittal split osteotomies ( BSSO ) of the m and ible . In a split mouth design , r and omized one side of the m and ible was operated using a conventional saw , while a piezosurgery device was used on the contralateral side . In order to test the individual qualities of somatosensory function , quantitative sensory testings ( QSTs ) were performed 1 month , 6 months and 1 year after surgery . Results A comparison of the data using a two-way analysis of variance ( ANOVA ) revealed a significant reduction in postoperative impairment in warm detection threshold ( WDT ) ( P = 0.046 ) , a decreased dynamic mechanical allodynia ( ALL ) ( P = 0.002 ) and a decreased vibration detection threshold ( VDT ) ( P = 0.030 ) on the piezosurgery side of the m and ible as opposed to the conventionally operated control side . In the remaining QSTs , minor deviations from the preoperative baseline conditions and a more rapid regression could be observed . Conclusions Piezosurgery caused reduced somatosensory impairment and a faster recovery of somatosensory functions in the present investigation The aim of this report is to present preliminary results and experiences using an ultrasonic bone-cutting device in bilateral sagittal split osteotomies of the m and ible ( BSSRO ) with particular attention to possible damages to the inferior alveolar nerve ( IAN ) . Seven patients with class II or class III malocclusion were treated by BSSRO with a conventional combined orthognathic and surgical approach . The osteotomy was carried out using an ultrasonic bone-cutting device . Subjective neurosensory deficits of the inferior alveolar nerve were assessed on 14 sides . Compared to the conventional techniques using saws , chisels and burs , the use of the ultrasonic device was more time-consuming , but the osteotomies were carried out at a high level of precision . In addition , this procedure offered the advantage of a blood-free surgical field and thus provided good control of the surgical procedure . Subjective neurosensory disturbances of the IAN showed a continuous decrease from 57.1 % ( eight sides ) 2 months after the surgical procedure to 14.3 % ( 2 sides ) after 5 months and to 7.1 % 7 months after BSSRO . Within the seven patients of this pilot study associated neurosensory disturbances were low . A possible advantage in terms of nerve protection is subject to a prospect i ve study Background Ultrasonic bone-cutting surgery has been introduced as a feasible alternative to the conventional sharp instruments used in craniomaxillofacial surgery because of its precision and safety . The piezosurgery medical device allows the efficient cutting of mineralized tissues with minimal trauma to soft tissues . Piezoelectric osteotome has found its role in surgically assisted rapid maxillary expansion ( SARME ) , a procedure well established to correct transverse maxillary discrepancies . The advantages include minimal risk to critical anatomic structures . The purpose of this clinical comparative study ( CIS 2007 - 237-M ) was to present the advantages of the piezoelectric cut as a minimally invasive device in surgically assisted , rapid maxillary expansion by protecting the maxillary sinus mucosal lining . Methods Thirty patients ( 18 females and 12 males ) at the age of 18 to 54 underwent a surgically assisted palatal expansion of the maxilla with a combined orthodontic and surgical approach . The patients were r and omly divided into two separate treatment groups . While Group 1 received conventional surgery using an oscillating saw , Group 2 was treated with piezosurgery . The following parameters were examined : blood pressure , blood values , required medication , bleeding level in the maxillary sinus , duration of inpatient stay , duration of surgery and height of body temperature . Results The results displayed no statistically significant differences between the two groups regarding laboratory blood values and inpatient stay . The duration of surgery revealed a significant discrepancy . Deploying piezosurgery took the surgeon an average of 10 minutes longer than working with a conventional-saw technique . However , the observation of the bleeding level in the paranasal sinus presented a major and statistically significant advantage of piezosurgery : on average the bleeding level was one category above the one of the remaining patients . Conclusion This method of piezoelectric surgery with all its advantages is going to replace many conventional operating procedures in oral and maxillofacial surgery . Trial registration CIS 2007 - We investigated the average operating time and extent of intra-operative blood loss in orthognathic surgeries performed using induced hypotensive general anaesthesia , with the intention of devising a practical guideline for blood unit preparation for these procedures . We prospect ively studied 32 Chinese patients undergoing surgery to correct dentofacial deformities at a public hospital in Hong Kong from 1 December 1997 to 1 December 1998 . Most patients ( 72 . 4 % ) needed double-jaw surgery . The mean estimated blood loss was approximately 617.6 mL. The blood loss during simple Le Fort I osteotomies was about half that of multiple segmentalised osteotomies . For m and ibular ramus osteotomies , the mean blood loss and operating time for were approximately 280 mL and 2 hours , respectively ; for anterior m and ibular osteotomies , the corresponding values were 171.3 mL and 1 hour 13 minutes . The average drop in the haematocrit value was 15.4 % , and the crossmatch to transfusion ratio was 29 . A bivariate correlation test between the blood loss and operating time gave a strong correlation ( P<0.01 ) , as did blood loss with a drop in haematocrit value ( P<0.01 ) . Orthognathic surgeries are thus safe and predictable in terms of intra-operative blood loss and operating time , and a ' type , screen , and save ' policy for blood unit preparation is more appropriate than a ' crossmatch ' policy Introduction Piezoosteotomy was assessed as alternative osteotomy method in orthognathic surgery regarding h and ling , time requirement , nerve and vessel impairment . Material s and methods In this comparative clinical experience , 90 patient ’s orthognathic surgery procedures were performed in typical distribution prospect ively by piezoosteotomy : 34 ( 38 % ) monosegment , 47 ( 52 % ) segmented LeFortI osteotomies , 94 ( 52 % ) sagittal split osteotomies , 11 ( 12 % ) symphyseal , and 4 ( 2 % ) m and ibular body osteotomies . As controls served 90 retrospective patients with conventional saw and chisel osteotomy : 58 ( 64 % ) monosegment , 27 ( 30 % ) segmented LeFortI osteotomies , 130 ( 72 % ) sagittal split , and 4 ( 4 % ) symphyseal osteotomies . Results and discussion Piezoosteotomies were individually design ed to interdigitate the jaw segments after repositioning . The pterygomaxillary suture weakened angulated tools ; auxiliary chisels were required in 100 % of cases for the nasal septum and lateral nasal walls , in 33 % for pterygoid processes . The dorsal maxilla as the pterygoid process were easily reduced ; 15 % m and ibular osteotomies required sawing , while the lingual dorsal osteotomy was performed by manual feedback due to limited visibility . Bloodloss decreased from average 537 ± 208 ml vs. 772 ± 338 ml ( p = 0.0001 ) . Operation time remained unchanged : 223 ± 70 min vs. 238 ± 60 min ( p = 0.2 ) for a conventional bimaxillary procedure . Clinical courses and reossification were unobtrusive . Alveolar inferior nerve sensitivity was retained in 98 % of the piezoosteotomy collective versus 84 % of controls ( p = 0.0001 ) at 3 months postoperative testing . Conclusion Piezoelectric osteotomy did not prolong the operation and reduced blood loss as alveolar nerve impairment . A few patients required additional sawing or chisel . Piezoelectric screw insertion as complex osteotomies may be initiated to simplify the procedure and increase segment interdigitation after repositioning as to minimize the osteofixation time and dimensions PURPOSE Autologous blood donation is not routinely recommended for all cases of orthognathic surgery . The aim of this study was to evaluate the factors for blood loss during bimaxillary osteotomies that might indicate preoperative blood donation . PATIENTS AND METHODS In a prospect i ve study , 127 consecutive patients undergoing bimaxillary surgery within a 14-month period were examined for hemoglobin and hematocrit reduction . Possible factors for intraoperative blood loss such as operating time , application of hydroxyethyl starch in segmental osteotomies , experience of the surgeon , and additional procedures ( genioplasty , malar osteotomy , iliac crest graft ) were statistically analyzed . RESULTS The experience of the surgeon had no influence on the blood loss . Operating time and Quick value correlated significantly with hemoglobin and hematocrit drop after surgery . There was no difference between 1-piece maxilla cases with or without additional procedures and segmental maxilla cases without additional procedures . Only for the group of patients with segmental osteotomies and additional procedures was a significant higher blood loss found . Two patients ( 1.6 % ) received 1 unit of blood . CONCLUSION For patients undergoing bimaxillary osteotomies with segmentation of the maxilla and additional procedures , a preoperative donation of autologous blood should be considered Abstract The aim of the study was to compare in a r and omized controlled clinical trial the use of the piezoelectric osteotomy as an alternative to the conventional approach in terms of surgery time , intraoperative blood loss , cut quality , nerve injury , and costs . One hundred ten patients who had orthognathic surgery procedures with bimaxillary osteotomy were divided into 2 groups : group A was treated with a piezosurgery device , and group B , with a reciprocating saw and bur . The piezosurgical bone osteotomy permitted individualized cut design s. The surgical time in group A was reduced , with a mean for the m and ibular osteotomy ( 1 side ) between 3 minutes 31 seconds and 5 minutes 2 seconds , whereas in group B , the surgical time was between 7 minutes 23 seconds and 10 minutes 22 seconds . The surgical time in group A for the Le Fort I osteotomy was between 5 minutes 17 seconds and 7 minutes 55 seconds in group A and between 8 minutes 38 seconds and 15 minutes 11 seconds in group B. All patients in group A had a low blood loss ( < 300 mL ) versus patients of group B who had a medium to high blood loss ( medium loss : 400 mL , high loss : > 500 mL ) . Inferior alveolar nerve sensation was retained in 98.2 % of group A versus 92.7 % in group B at 6 months postoperative testing . Piezoelectric osteotomy reduced surgical time , blood loss , and inferior alveolar nerve injury in bimaxillary osteotomy . Absence of macrovibrations makes the instrument more manageable and easy to use and allows greater intraoperative control with higher safety in cutting in difficult anatomical regions PURPOSE Piezo-osteotomy feasibility as a substitute for the conventional saw in orthognathic surgery was evaluated regarding operative technique , blood loss , time requirement , and nerve and vessel integrity . PATIENTS AND METHODS Fifty patients had orthognathic surgery procedures in typical distribution using piezosurgical osteotomy : 22 ( 44 % ) monosegment , 26 ( 52 % ) segmented Le Fort I osteotomies ; 48 ( 48 Output:

Currently available evidence suggests that piezo-surgery has favorable effects on complications associated with orthognathic surgery , including reductions in intraoperative blood loss and severe nerve disturbance

MS2_1shot114

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background The aim was to compare effectiveness of group versus individual sessions of physiotherapy in terms of symptoms , quality of life , and costs , and to investigate the effect of patient preference on uptake and outcome of treatment . Methods A pragmatic , multi-centre r and omised controlled trial in five British National Health Service physiotherapy departments . 174 women with stress and /or urge incontinence were r and omised to receive treatment from a physiotherapist delivered in a group or individual setting over three weekly sessions . Outcome were measured as Symptom Severity Index ; Incontinence-related Quality of Life question naire ; National Health Service costs , and out of pocket expenses . Results The majority of women expressed no preference ( 55 % ) or preference for individual treatment ( 36 % ) . Treatment attendance was good , with similar attendance with both service delivery models . Overall , there were no statistically significant differences in symptom severity or quality of life outcomes between the models . Over 85 % of women reported a subjective benefit of treatment , with a slightly higher rating in the individual compared with the group setting . When all health care costs were considered , average cost per patient was lower for group sessions ( Mean cost difference £ 52.91 95 % , confidence interval ( £ 25.82 - £ 80.00 ) ) . Conclusion Indications are that whilst some women may have an initial preference for individual treatment , there are no substantial differences in the symptom , quality of life outcomes or non-attendance . Because of the significant difference in mean cost , group treatment is recommended . Trial Registration Trial Registration number : IS RCT N Background Mobile apps can increase access to care , facilitate self-management , and improve adherence to treatment . Stress urinary incontinence ( SUI ) affects 10 - 35 % of women and , currently , an app with instructions for pelvic floor muscle training ( PFMT ) is available as first-line treatment . A previous r and omized controlled study demonstrated that the app benefitted symptom severity and quality of life ( QoL ) ; in this study we investigate the cost-effectiveness of the app . Objective The objective of this study was to evaluate the health economy of the app for treating SUI . Methods This deterministic cost-utility analysis , with a 1-year societal perspective , compared the app treatment with no treatment . Health economic data were collected alongside a r and omized controlled trial performed in Sweden from March 2013 to October 2014 . This study included 123 community-dwelling women participants of 18 years and above , with stress urinary incontinence ≥1 time per week . Participants were self-assessed with vali date d question naires and 2-day leakage diaries , and then r and omized to 3 months of treatment ( app group , n=62 ) or no treatment ( controls , n=61 ) . The app focused on pelvic floor muscle training , prescribed 3 times daily . We continuously registered treatment delivery costs . Data were collected on each participant ’s training time , incontinence aids , and laundry at baseline and at a 3-month follow-up . We measured quality of life with the International Consultation on Incontinence Modular Question naire on Lower Urinary Tract Symptoms and Quality of Life , and calculated the quality -adjusted life years ( QALYs ) gained . Data from the 3-month follow-up were extrapolated to 1 year for the calculations . Our main outcome was the incremental cost-effectiveness ratios compared between app and control groups . One-way and multiway sensitivity analyses were performed . Results The mean age of participants was 44.7 years ( SD 9.4 ) . Annual costs were € 547.0 for the app group and € 482.4 for the control group . Annual gains in quality -adjusted life years for app and control groups were 0.0101 and 0.0016 , respectively . Compared with controls , the extra cost per quality -adjusted life year for the app group ranged from −€2425.7 to € 14,870.6 , which indicated greater gains in quality -adjusted life years at similar or slightly higher cost . Conclusions The app for treating stress urinary incontinence is a new , cost-effective , first-line treatment with potential for increasing access to care in a sustainable way for this patient group AIMS To compare the cost-effectiveness ( CE ) of retropubic midurethral sling ( RMS ) versus transobturator midurethral sling ( TMS ) for the treatment of female stress urinary incontinence ( SUI ) . METHODS A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS . Costing data were obtained from the Medicare RBRVS . Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 r and omized RCTs with a minimum of 12 months follow-up , as were corresponding utilities for different continence states . Deterministic and probabilistic estimates of cost-effectiveness ( CE ) for each procedure were calculated and compared , and sensitivity analyses were performed . RESULTS In the base-case deterministic analysis , the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS . QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention . The average cost for treatment with RMS however was higher at $ 9,579 versus $ 9,017 with TMS . TMS was therefore overall more cost-effective than RMS ( CE = $ 1,438/QALY vs. $ 1,527/QALY ) . Sensitivity analysis demonstrated that physician and sling characteristics such as device cost , surgeon fee , efficacy of treatment , operative time , and duration of hospitalization could all affect the relative CE of the therapies . CONCLUSIONS Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI . The efficacy of the two treatments could be affected by physician and sling characteristic factors Background . The aim of this study was to compare laparoscopic colposuspension with tension‐free vaginal tape ( TVT ) in terms of costs to the county AIMS To determine the 12-month , societal cost-effectiveness of involving urinary incontinence ( UI ) nurse specialists in primary care compared to care-as-usual by general practitioners ( GPs ) . METHODS From 2005 until 2008 an economic evaluation was performed alongside a pragmatic multicenter r and omized controlled trial comparing UI patients receiving care by nurse specialists with patients receiving care-as-usual by GPs in the Netherl and s. One hundred eighty-six adult patients with stress , urgency , or mixed UI were r and omly allocated to the intervention and 198 to care-as-usual ; they were followed for 1 year . Main outcome measures were Quality Adjusted Life Year ( QALY(societal ) ) based on societal preferences for health outcomes ( EuroQol-5D ) , QALY(patient ) based on patient preferences for health outcomes ( EuroQol VAS ) , and Incontinence Severity weighted Life Year ( ISLY ) based on patient-reported severity and impact of UI ( ICIQ-UI SF ) . Health care re source use , patient and family costs , and productivity costs were assessed . Data were collected by three monthly question naires . Incremental cost-effectiveness ratios were calculated . Uncertainty was assessed using bootstrap simulation , and the expected value of perfect information was calculated ( EVPI ) . RESULTS Compared to care-as-usual , nurse specialist involvement costs € 16,742/QALY(societal ) gained . Both QALY(patient ) and ISLY yield slightly more favorable cost-effectiveness results . At a threshold of € 40,000/QALY(societal , ) the probability that the intervention is cost-effective is 58 % . The EVPI amounts to € 78 million . CONCLUSIONS Based on these results , we recommend adopting the nurse specialist intervention in primary care , while conducting more research through careful monitoring of the effectiveness and costs of the intervention in routine practice OBJECTIVE To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence ( SUI ) . METHODS Cost and outcome data were taken from the Stress Urinary Incontinence Treatment ( SUIT ) study , a 12-month , prospect i ve , observational , naturalistic , multicenter , multicountry study . Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol ( EQ-5D ) ; numbers of urine leaks were also estimated . Potential selection bias was countered using multivariate regression and propensity score analysis . RESULTS Duloxetine alone , duloxetine in combination with conservative treatment , and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment . Duloxetine alone and with conservative treatment for SUI were associated with incremental quality -adjusted life-years ( QALYs ) of about 0.03 over a year compared with no treatment or with conservative treatment alone . Conservative treatment alone did not show an effect on QALYs . None of the interventions appeared to have marked impacts on costs over a year . Depending on the form of matching , duloxetine either dominated or had an incremental cost-effectiveness ratio ( ICER ) below pound900 per QALY gained compared with no treatment and with conservative treatment alone . Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone . Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention . CONCLUSIONS Although the limitations of the use of SUIT 's observational data for this purpose need to be acknowledged , the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative OBJECTIVE The objective of the study was to estimate the effect of Burch and fascial sling surgery on out-of-pocket urinary incontinence ( UI ) management costs at 24 months postoperatively and identify predictors of change in cost among women enrolled in a r and omized trial comparing these procedures . STUDY DESIGN Re sources used for UI management ( supplies , laundry , dry cleaning ) were self-reported by 491 women at baseline and 24 months after surgery , and total out-of-pocket costs for UI management ( in 2012 US dollars ) were estimated . Data from the 2 surgical groups were combined to examine the change in cost for UI management over 24 months . Univariate and bivariate changes in cost were analyzed using the Wilcoxon signed rank test . Predictors of change in cost were examined using multivariate mixed models . RESULTS At baseline mean ( ±SD ) age of participants was 53 ± 10 years , and the frequency of weekly UI episodes was 23 ± 21 . Weekly UI episodes decreased by 86 % at 24 months ( P < .001 ) . The mean weekly cost was $ 16.60 ± $ 27.00 ( median $ 9.39 ) at baseline and $ 4.57 ± $ 15.00 ( median $ 0.10 ) at 24 months ( P < .001 ) , a decrease of 72 % . In multivariate analyses , cost decreased by $ 3.38 ± $ 0.77 per week for each decrease of 1 UI episode per day ( P < .001 ) and was strongly associated with greater improvement in Urogenital Distress Inventory and Incontinence Impact Question naire scores ( P < .001 ) and decreased 24-hour pad weight ( P < .02 ) . CONCLUSION Following Burch or fascial sling surgery , the UI management cost at 24 months decreased by 72 % ( $ 625 per woman per year ) and was strongly associated with decreasing UI frequency . Reduced out-of-pocket expenses may be a benefit of these established urinary incontinence procedures AIM The efficacy , safety and hospital costs of the tension-free vaginal tape procedure were compared with the pubovaginal sling operation . METHODS A total of 60 women urodynamically diagnosed as having stress or mixed urinary incontinence were operated on using either the tension-free vaginal tape or pubovaginal sling operation in a prospect i ve manner . Preoperative characteristics of the women were not significantly different for the groups . The women were followed for up to 24 months . RESULTS In the tension-free vaginal tape group , the operation time was shorter , numbers of analgesics postoperatively required were less and hospital charges were less expensive compared to those in the pubovaginal sling operation ( P < 0.01 ) . Kaplan-Meier survival analysis showed a marginal significant difference ( P = 0.059 ) in the objective cumulative cure rates at 24 months between the groups receiving the former ( 70.3 % ) and latter ( 48.3 % ) procedures . Subjective cure rates were not significantly different ( P = 0.101 ) . In both groups , an improvement in quality of life was significant and surgical complications were identical . De novo urge incontinence developed in 6 % and 10 % in the former and latter , respectively . CONCLUSIONS The tension-free tape was significantly superior to the pubovaginal sling in terms of operation time , postoperative pain , and hospital charges , but not in cure rates . A longer follow up with a larger sample size is necessary to draw definite conclusions AIMS Urodynamic studies ( UDS ) are generally recommended prior to surgical treatment for stress urinary incontinence ( SUI ) , despite insufficient evidence that it impacts treatment plans or outcomes in patients with uncomplicated SUI . This analysis aim ed to calculate the cost incurred when UDS was performed as a supplement to a basic office evaluation and to extrapolate the potential savings of not doing UDS in this patient population on a national basis . METHODS This is a secondary analysis from the Value of Urodynamic Evaluation ( ValUE ) trial , a multicenter Output:

Conclusions Heterogeneity was observed in cost estimates for all units at all levels of health care .

MS2_1shot115

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Recent studies of pancreatic cancer suggest a role for hyperinsulinemia in carcinogenesis . Because insulin is secreted in response to elevated blood glucose concentrations , dietary factors that increase these concentrations may be important in pancreatic carcinogenesis . OBJECTIVE The objective was to examine prospect ively the relation between pancreatic cancer risk and dietary glycemic load ( GL ) , overall glycemic index ( GI ) , and intake of total carbohydrates and mono- and disaccharides . DESIGN The Netherl and s Cohort Study consisted of 120,852 men and women who completed a baseline question naire in 1986 . After 13.3 y of follow-up , 408 pancreatic cancer cases were detected , 66 % of which were microscopically confirmed . A vali date d 150-item food-frequency question naire , completed at baseline , was used to calculate carbohydrate and mono- and disaccharide intakes and the GL and GI of the diet . RESULTS Dietary GL , GI , or intake of carbohydrates and mono- and disaccharides were not associated with pancreatic cancer risk in this cohort . Also , the associations were not modified by sex . Our results did not change after the analysis was restricted to microscopically confirmed pancreatic cancer cases or after individuals who reported a history of diabetes at baseline were excluded from the analyses . CONCLUSIONS Overall , our findings do not support the hypothesis that GL , GI , or intake of carbohydrates and mono- and disaccharides are positively associated with pancreatic cancer risk . This is in agreement with previous prospect i ve studies that investigated the relation between GL and GI and pancreatic cancer risk Hyperinsulinemia may explain excess colorectal cancer among individuals who are overweight or inactive . Recent studies have observed elevated colorectal cancer risk among individuals with elevated insulin levels 2 hours after oral glucose challenge or with elevated plasma C-peptide levels . The effect of consuming a high glycemic diet on colorectal risk , however , remains uncertain . Two prospect i ve cohort studies , the Nurses ' Health Study and the Health Professionals Follow-up Study , contributed up to 20 years of follow-up . After exclusions , 1,809 incident colorectal cancers were available for analyses . Dietary glycemic load ( GL ) was calculated as a function of glycemic index ( postpr and ial blood glucose response as compared with a reference food ) , carbohydrate content , and frequency of intake of individual foods reported on food frequency question naires . Multivariable Cox proportional hazards models were used to adjust for potential confounders . Intakes of dietary carbohydrate , GL , overall glycemic index , sucrose , and fructose were not associated with colorectal cancer risk in women . A small increase in risk was observed in men with high dietary GL ( multivariate relative risk , 1.32 ; 95 % confidence interval , 0.98 - 1.79 ; highest versus lowest quintile ) , sucrose or fructose ( multivariate relative risk , 1.37 ; 95 % confidence interval , 1.05 - 1.78 ; highest versus lowest quintile of fructose , P = 0.008 ) . Associations were slightly stronger among men with elevated body mass index ( > or = 25 kg/m(2 ) ) . Results among women were similar after stratifying by body mass index or physical activity . High intakes of GL , fructose , and sucrose were related to an elevated colorectal cancer risk among men . For women , however , these factors did not seem to increase the risk of colorectal cancer CONTEXT Diabetes is a serious and costly disease that is becoming increasingly common in many countries . The role of diabetes as a cancer risk factor remains unclear . OBJECTIVE To examine the relationship between fasting serum glucose and diabetes and risk of all cancers and specific cancers in men and women in Korea . DESIGN , SETTING , AND PARTICIPANTS Ten-year prospect i ve cohort study of 1,298,385 Koreans ( 829,770 men and 468,615 women ) aged 30 to 95 years who received health insurance from the National Health Insurance Corp and had a biennial medical evaluation in 1992 - 1995 ( with follow-up for up to 10 years ) . MAIN OUTCOME MEASURES Death from cancer and registry-documented incident cancer or hospital admission for cancer . RESULTS During the 10 years of follow-up , there were 20,566 cancer deaths in men and 5907 cancer deaths in women . Using Cox proportional hazards models and controlling for smoking and alcohol use , the stratum with the highest fasting serum glucose ( > or = 140 mg/dL [ > or = 7.8 mmol/L ] ) had higher death rates from all cancers combined ( hazard ratio [ HR ] , 1.29 ; 95 % confidence interval [ CI ] , 1.22 - 1.37 in men and HR , 1.23 ; 95 % CI , 1.09 - 1.39 in women ) compared with the stratum with the lowest level ( < 90 mg/dL [ < 5.0 mmol/L ] ) . By cancer site , the association was strongest for pancreatic cancer , comparing the highest and lowest strata in men ( HR , 1.91 ; 95 % CI , 1.52 - 2.41 ) and in women ( HR , 2.05 ; 95 % CI , 1.43 - 2.93 ) . Significant associations were also found for cancers of the esophagus , liver , and colon/rectum in men and of the liver and cervix in women , and there were significant trends with glucose level for cancers of the esophagus , colon/rectum , liver , pancreas , and bile duct in men and of the liver and pancreas in women . Of the 26,473 total cancer deaths in men and women , 848 were estimated as attributable to having a fasting serum glucose level of less than 90 mg/dL. For cancer incidence , the general patterns reflected those found for mortality . For persons with a diagnosis of diabetes or a fasting serum glucose level greater than 125 mg/dL ( 6.9 mmol/L ) , risks for cancer incidence and mortality were generally elevated compared with those without diabetes . CONCLUSION In Korea , elevated fasting serum glucose levels and a diagnosis of diabetes are independent risk factors for several major cancers , and the risk tends to increase with an increased level of fasting serum glucose Factors linked to glucose metabolism are involved in the etiology of several cancers . High glycemic index ( GI ) or high glycemic load ( GL ) diets , which chronically raise postpr and ial blood glucose , may increase cancer risk by affecting insulin-like growth factor . We prospect ively investigated cancer risk and dietary GI/GL in the EPIC-Italy cohort . After a median 14.9 years , 5112 incident cancers and 2460 deaths were identified among 45,148 recruited adults . High GI was associated with increased risk of colon and bladder cancer . High GL was associated with : increased risk of colon cancer ; increased risk of diabetes-related cancers ; and decreased risk of rectal cancer . High intake of carbohydrate from high GI foods was significantly associated with increased risk of colon and diabetes-related cancers , but decreased risk of stomach cancer ; whereas high intake of carbohydrates from low GI foods was associated with reduced colon cancer risk . In a Mediterranean population with high and varied carbohydrate intake , carbohydrates that strongly raise postpr and ial blood glucose may increase colon and bladder cancer risk , while the quantity of carbohydrate consumed may be involved in diabetes-related cancers . Further studies are needed to confirm the opposing effects of high dietary GL on risks of colon and rectal cancers The objective of this study was to evaluate the prospect i ve associations between dietary glycemic index ( GI ) and glycemic load ( GL ) and the risk for invasive breast cancer incidence in postmenopausal women at high cardiovascular disease ( CVD ) risk . This study was conducted within the framework of the PREvención con DIeta MEDiterránea ( PREDIMED ) study , a nutritional intervention trial for primary cardiovascular prevention . We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease . Dietary information was collected using a vali date d 137-item food frequency question naire . We assigned GI values using the International Tables of GI and GL values . Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index . Only cases confirmed by results from cytology tests or histological evaluation were included . We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models . We repeated our analyses using yearly repeated measures of GI/GL intakes . No associations were found between baseline dietary GI/GL and invasive breast cancer incidence . The multivariable hazard ratio and 95 % confidence interval ( CI ) for the top tertile of dietary GI was 1.02 ( 95 % CI : 0.42–2.46 ) and for dietary GL was 1.00 ( 95 % CI : 0.44–2.30 ) when compared with the bottom tertile . Repeated- measures analyses yielded similar results . In sensitivity analyses , no significant associations were observed for women with obesity or diabetes . Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers . Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content Epidemiological evidence regarding the association between carbohydrate intake , glycaemic load ( GL ) and glycaemic index ( GI ) and risk of ovarian cancer has been mixed . Little is known about their impact on ovarian cancer risk in African-American women . Associations between carbohydrate quantity and quality and ovarian cancer risk were investigated among 406 cases and 609 controls using data from the African American Cancer Epidemiology Study ( AACES ) . AACES is an ongoing population -based case-control study of ovarian cancer in African-Americans in the USA . Cases were identified through rapid case ascertainment and age- and site-matched controls were identified by r and om-digit dialling . Dietary information over the year preceding diagnosis or the reference date was obtained using a FFQ . Multivariable logistic regression models were used to estimate odds ratios and 95 % CI adjusted for covariates . The OR comparing the highest quartile of total carbohydrate intake and total sugar intake v. the lowest quartile were 1·57 ( 95 % CI 1·08 , 2·28 ; P trend=0·03 ) and 1·61 ( 95 % CI 1·12 , 2·30 ; P trend<0·01 ) , respectively . A suggestion of an inverse association was found for fibre intake . Higher GL was positively associated with the risk of ovarian cancer ( OR 1·18 for each 10 units/4184 kJ ( 1000 kcal ) ; 95 % CI 1·04 , 1·33 ) . No associations were observed for starch or GI . Our findings suggest that high intake of total sugars and GL are associated with greater risk of ovarian cancer in African-American women BACKGROUND The glycemic potential of a diet is associated with chronically elevated insulin concentrations , which may augment breast cancer ( BC ) risk by stimulating insulin receptor or by affecting insulin-like growth factor I (IGF-I)-mediated mitogenesis . It is unclear whether this effect differs by BC phenotype . OBJECTIVE The objective was to investigate the relation between glycemic index ( GI ) , glycemic load ( GL ) , and total carbohydrate intake with BC by using data from the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . DESIGN We identified 11,576 women with invasive BC among 334,849 EPIC women aged 34 - 66 y ( 5th to 95th percentiles ) at baseline over a median follow-up of 11.5 y. Dietary GI and GL were calculated from country-specific dietary question naires . We used multivariable Cox proportional hazards models to quantify the association between GI , GL , and carbohydrate intake and BC risk . BC tumors were classified by receptor status Output:

GL was not significantly related to those cancer sites . Stomach , prostate and lung cancers were not associated with GI and GL . The present analysis , based on an up date d comprehensive evaluation of the epidemiological literature , indicates moderate unfavorable effects of high versus low GI on colorectal , and possibly bladder and kidney cancers , and a possible moderate positive association between GL and endometrial cancer

MS2_1shot116

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The inhibition of poly(adenosine diphosphate [ADP]-ribose ) polymerase ( PARP ) is a potential synthetic lethal therapeutic strategy for the treatment of cancers with specific DNA-repair defects , including those arising in carriers of a BRCA1 or BRCA2 mutation . We conducted a clinical evaluation in humans of olaparib ( AZD2281 ) , a novel , potent , orally active PARP inhibitor . METHODS This was a phase 1 trial that included the analysis of pharmacokinetic and pharmacodynamic characteristics of olaparib . Selection was aim ed at having a study population enriched in carriers of a BRCA1 or BRCA2 mutation . RESULTS We enrolled and treated 60 patients ; 22 were carriers of a BRCA1 or BRCA2 mutation and 1 had a strong family history of BRCA-associated cancer but declined to undergo mutational testing . The olaparib dose and schedule were increased from 10 mg daily for 2 of every 3 weeks to 600 mg twice daily continuously . Reversible dose-limiting toxicity was seen in one of eight patients receiving 400 mg twice daily ( grade 3 mood alteration and fatigue ) and two of five patients receiving 600 mg twice daily ( grade 4 thrombocytopenia and grade 3 somnolence ) . This led us to enroll another cohort , consisting only of carriers of a BRCA1 or BRCA2 mutation , to receive olaparib at a dose of 200 mg twice daily . Other adverse effects included mild gastrointestinal symptoms . There was no obvious increase in adverse effects seen in the mutation carriers . Pharmacokinetic data indicated rapid absorption and elimination ; pharmacodynamic studies confirmed PARP inhibition in surrogate sample s ( of peripheral-blood mononuclear cells and plucked eyebrow-hair follicles ) and tumor tissue . Objective antitumor activity was reported only in mutation carriers , all of whom had ovarian , breast , or prostate cancer and had received multiple treatment regimens . CONCLUSIONS Olaparib has few of the adverse effects of conventional chemotherapy , inhibits PARP , and has antitumor activity in cancer associated with the BRCA1 or BRCA2 mutation . ( Clinical Trials.gov number , NCT00516373 . Although ovarian cancer treatment has advanced in the last 20 years , long-term survival remains stable . The purpose of this study was to determine whether survival has improved in line with treatment advances in a population -based prospect i ve cohort of ovarian cancer patients ( 1978 - 1997 , with a follow-up through to 2000 ) . The 10-year overall survival rate for cancer patients was similar before and after 1988 : 32.2 % ( n=1661 ) and 34.4 % ( n=2089 ) . For patients after 1988 , a 12-month prolongation of median survival was observed . In terms of stage according to the International Federation of Gynecology and Obstetrics ( FIGO ) , only FIGO I and FIGO II patients showed , in addition to a prolongation in survival , an absolute improvement of 12.9 and 12.6 % after 5 years and of 13.2 and 8.6 % after 10 years . This hardly affected the survival of the total sample . For the most frequent stage FIGO III patients and for FIGO IV patients , a prolongation in survival time , but no improvement in survival rate , was seen after five or 10 years . The progress in FIGO I and II patients may be due to more accurate staging . More effective chemotherapy may also explain some of the improvement . The prolongation in FIGO-stages III-IV may be due to more radical surgery . Patient selection criteria , not only the treatment modalities , may be responsible for the superior results reported in clinical trials . Cancer registries are important for evaluating the quality of healthcare delivery Output:

There are to date no published RCT data on the effectiveness and side effects of DNA-repair pathways inhibitors used alone or in association with conventional chemotherapy in the treatment of ovarian cancer .

MS2_1shot117

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIM To compare the immediate restoration of single implants in the esthetic zones performed on implants placed immediately after tooth extraction or 8 weeks later ( immediate replacement vs. immediate restoration ) . METHODS Sixteen patients ( 10 women and 6 men ) with a mean age of 35 years ( ranging from 21 to 49 years old ) were treated from 2004 to 2005 for single-tooth replacement in the upper arch . The patients were r and omly divided into two groups : in the test group patients received implants placed and restored ( non-occlusal loading ) at the time of tooth extraction ; in the control group implants were placed 8 weeks after tooth extraction and immediately restored . All the patients received tapered effect ( TE ) implants from the Straumann Dental Implant System . The following parameters were evaluated at the moment of provisional restoration ( within 48 h after implant placement ) and at the 2 years follow-up visit : marginal bone resorption , papilla index , position of the mucosal margin . The implant stability quotient was measured at the moment of implant placement and at the moment of the delivery of the definitive restoration . RESULTS No statistically significant differences were found in any of the studied parameters between the test and the control groups ( P>0.05 ) . The implant stability quotient values between the test and control groups were significant ( P<0.05 ) at the moment of implant placement but were no more significant at the loading of the definitive restoration ( P>0.05 ) . CONCLUSION The results of the present study suggest that immediate replacement without functional loading may be considered a valuable therapeutic option for selected cases of single-tooth replacement in the esthetic area when TE implants are used . Implant stability at the moment of implant placement is slightly inferior in the immediate replacement group , but it does not affect the treatment result Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more PURPOSE The aim of this study was to report a clinical comparative assessment of crestal bone level change around single implants in fresh extraction sockets in the esthetic zone of the maxilla either immediately loaded or loaded after a delay . MATERIAL S AND METHODS Forty patients were included in a prospect i ve , r and omized study . All patients required 1 tooth extraction ( ie , 1 tooth with a hopeless prognosis ) and were r and omized into either the test group or the control group . Implants were positioned immediately after tooth extraction and were loaded immediately in the test group ( 20 implants ) and after 3 months in the control group ( 20 implants ) . The implant site was prepared , with at least 4 mm of sound apical bone below the implant apex , and the coronal margin of the implant was placed at the buccal level of the bone crest . All implants were 13 mm long ; 30 implants had a diameter of 5 mm , and 10 had a diameter of 3.75 mm . Radiographic examinations were made at baseline , at 6 months , and at 24 months . To compare the mean values between test and control group , a paired t test was performed ( considered statistically significant at P < .05 ) . RESULTS After a 24-month follow-up period , a cumulative survival rate of 100 % was reported for all implants . The control group result ed in a mean mesial bone loss of 1.16 + /- 0.32 mm and a mean distal bone loss of 1.17 + /- 0.41 ( mean bone loss , 1.16 + /- 0.51 mm ) . The test group result ed in a mesial bone loss of 0.93 + /- 0.51 mm and a distal bone loss of 1.1 + /- 0.27 mm ( mean bone loss , 1.02 + /- 0.53 mm ) . No statistically significant difference between control and test groups ( P > .05 ) was found . CONCLUSION The success rate and radiographic results of immediate restorations of dental implants placed in fresh extraction sockets were comparable to those obtained in delayed loading group BACKGROUND Single-rooted teeth deemed not restorable via conventional means may be c and i date s for implant placement at the time of tooth extraction . Immediate implant placements are believed to preserve soft and hard tissue form and contours , reduce the need for augmentation procedures , minimize surgical exposure of the patient , reduce treatment time and improve esthetic outcomes . METHOD This retrospective review analyzed the esthetic outcomes of 42 non-adjacent single-unit implant restorations completed using an immediate implant surgical placement protocol . RESULTS The mean time in function was 18.9 months ( range 6 - 50 months ) and the majority of implants placed had a restorative platform diameter of 4.1 and 4.8 mm . A highly significant change in crown height due to marginal tissue recession of 0.9 + /- 0.78 mm ( P=0.000 ) was recorded for all sites , with no difference seen between implant systems ( P=0.837 ) . Thin tissue biotype showed slightly greater recession than thick tissue biotype ( 1 + /- 0.9 vs. 0.7 + /- 0.57 mm , respectively ) ; however , this difference was not statistically significant ( P=0.187 ) . Implants with a buccal shoulder position showed three times more recession than implants with a lingual shoulder position ( 1.8 + /- 0.83 vs. 0.6 + /- 0.55 mm , respectively ) with the difference being highly statistically significant ( P=0.000 ) . CONCLUSIONS Immediate implant placement requires very careful case selection and high surgical skill levels if esthetic outcomes are to be achieved . Long-term prospect i ve studies on tissue stability and esthetic outcomes are needed PURPOSE The aim of this study was to evaluate the feasibility of using a 2-stage implant system in a single-stage procedure and to study the impact of the microgap between the implant and the abutment . MATERIAL S AND METHODS Sixty edentulous patients ( Cawood class V or VI ) participated in this study . After r and omization , 20 patients received 2 IMZ implants placed in a single-stage procedure , 20 patients received 2 IMZ implants placed in the traditional 2-stage procedure , and 20 patients were treated with 2 ITI implants ( single-stage procedure ) . The implants were placed in the canine area of the m and ible . After 3 months , m and ibular overdentures were fabricated , supported by a bar- and -clip attachment . A st and ardized clinical and radiographic evaluation was performed immediately after prosthesis placement and after 12 and 24 months . RESULTS One IMZ implant of the 1-stage group and 1 IMZ implant of the 2-stage group were lost after 6 and 12 months , respectively . Apart from several significant but clinical ly irrelevant differences , the 3 groups did not appear to differ markedly with regard to clinical parameters during the evaluation period . The mean bone loss within the first 2 years of functioning ( 1.1 mm IMZ 1-stage , 0.8 mm IMZ 2-stage , 1.2 mm ITI ) was comparable for the 3 groups . DISCUSSION AND CONCLUSIONS The results of this study suggest that dental implants design ed for a submerged implantation procedure can also be used in a single-stage procedure and may be as predictable as when the same implants used in a 2-stage procedure or as 1-stage implants . Placement of the microgap at the crestal level in 2-stage implants did not appear to have an adverse effect on the amount of peri-implant bone loss at 2 years in this study population AIM The aim of this study was to compare the clinical outcome of submerged vs. non-submerged tapered implants placed into fresh extraction sockets . MATERIAL S AND METHODS A prospect i ve , controlled , multicenter , r and omized , clinical trial has been performed in two centers in Rome and Torino ( Italy ) . Thirty healthy patients were recruited according to the following inclusion criteria : need for an immediate post extraction implant , ages between 18 and 70 , horizontal defect depth < 2 mm , smokers < 10 cigarettes/day and absence of any circumstance or condition that could represent contraindications to implant surgery . The patients were r and omly allocated to submerged or non-submerged treatment groups immediately after flap elevation and tooth extraction . Submerged implants were exposed 8 weeks after the first surgery ; all implants were loaded with provisional restorations 12 weeks after the first surgery and with definitive restoration 12 weeks thereafter . Clinical and radiographic parameters were evaluated at baseline , at implant loading and at the 1-year follow-up visit . RESULTS The results showed statistically significant differences between the two groups in the mean value of keratinized tissue ( KT ) height after surgery that was significantly reduced for submerged implants when compared with transmucosal implants ( mean reduction of KT at year follow-up : T group 0.2 mm , S group 1.3 mm ; P=0.007 ) . CONCLUSION Similar outcomes were found for submerged and non-submerged implants placed in fresh extraction sockets with a horizontal peri-implant defect smaller than 2 mm , except for a reduction of KT in the submerged group . Either with a submerged or a non-submerged procedure , 1 mm of mean soft tissue recession is seen after 1 year when compared with the pre- extraction situation BACKGROUND Early implantation may preserve the alveolar anatomy , and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest . Although a number of clinical studies exist , no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone . METHODS Forty-eight healthy patients , receiving at least 4 fixtures in each of 2 symmetrical quadrants , underwent placement of 1 experimental fixture placed in a fresh extraction socket ( TI ) and 1 contralateral fixture in mature bone ( CI ) . TI were placed after atraumatical tooth extraction , with a surgical site at the apex of the socket and a tight contact between the fixture and the socket 's walls , but without the use of filling material s or membranes . The flap was coronally repositioned to obtain primary wound closure . Immediately after surgical intervention , a st and ardized periapical radiograph was taken . Second-stage surgery was done after 6 months . Six months after the second surgery , a second st and ardized periapical radiograph was taken and clinical parameters ( bleeding and plaque index ) recorded . Marginal bone loss ( MBL ) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs . TI and CI were then removed by a hollow drill to obtain histological specimens . Non-demineralized sections were stained by acid fuchsin and toluidine blue , and by von Kossa to evaluate the degree of bone mineralization . The percentage of direct implant-bone contact ( DBC ) was calculated by a computerized microscopic digitizer . RESULTS No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories . There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the m and ible . No connective or fibrous tissues were present around TI or CI . Bone resorption was not present in any of the histological sections . CONCLUSIONS The present study shows that when a screw-type dental implant is placed without the use of barrier membranes or other regenerative material s into a fresh extraction socket with a bone-to-implant gap of 2 mm or less , the clinical outcome and degree of osteointegration does not differ from implants placed in healed , mature bone OBJECTIVE To determine clinical success when implants are placed in chronic periapical infected sites . STUDY DESIGN Fifty patients ( 25 females , 25 males , mean age 39.7 + /- 14.5 years ) were included in this prospect i ve controlled study . After r and omization , 25 Frialit-2 Synchro implants were immediately placed ( IP ) after extraction , and 25 Frialit-2 Synchro implants were placed after a 3-month healing period ( DP ) . Thirty-two implants were placed in the anterior maxilla and 18 implants were placed in the premolar region . Implant survival , mean Implant Stability Quotient ( ISQ ) values , gingival aesthetics , radiographic bone loss , and microbiologic characteristics of periapical lesions were evaluated for both groups . RESULTS Overall , 2 implants belonging to the IP group were lost , result ing in a survival rate of 92 % for IP implants versus 100 % for DP implants . Mean ISQ , gingival aesthetics and radiographic bone resorption , and periapical cultures were not significantly different with the IP and DP implants . CONCLUSIONS Immediate implant placement in chronic periapical lesions may be indicated BACKGROUND Dental implants have been used to replace missing teeth to provide function and esthetics . One goal of such restorations is to maintain host tissue around the implants . The purpose of this prospect i ve multicenter human clinical trial was to evaluate radiographic marginal bone levels around non-submerged hollow cylindrical and solid-screw implants for 5 years after loading . METHODS Patients older than 18 years of age with sufficient native bone to surround a dental implant without imposing on a vital structure were recruited at five sites . Solid-screw or hollow-cylinder implants with a Output:

Meta-analyses showed less CBL loss around IIP compared with implant placement in healed bone . Platform-switched implants showed greater crestal bone preservation than non-platform-switched implants . There was no significant difference in CBL with one- versus two-stage placement or use of immediate versus delayed IIP loading . Although there were statistically significant differences favoring IIP , the small differences may not be clinical ly relevant .

MS2_1shot118

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIMS The aim of this study was to assess patient outcome after discontinuation of alfuzosin treatment in patients with benign prostatic hyperplasia ( BPH ) . METHODS This study included 200 BPH patients . Alpha-blockers were discontinued after 12 weeks of treatment when the International Prostatic Symptom Score ( IPSS ) was reduced to < 8 points , peak urine flow rate ( Q(max ) ) was increased to ≥ 15 ml/s , the postvoiding residual ( PVR ) urine volume was ≤ 100 ml and the patient agreed to discontinue treatment . Urinary symptoms of the patients were assessed at 4 , 8 , 12 and 24 weeks after discontinuation of medication , and surveys were performed asking whether patients wanted to restart administration of medication . RESULTS Of 200 enrolled patients , 142 ( 71.00 % ) received 12 weeks of treatment with 10 mg of alfuzosin . The medication was discontinued in 58 of 142 patients ( 40.85 % ) because urinary symptoms had improved . Among these patients , follow-up observations were performed for 49 patients up to 24 weeks after treatment discontinued . Of these 49 patients , 28 ( 57.14 % ) showed correct urination without a need to restart treatment up to 24 weeks after the medication was discontinued . The discontinuation group demonstrated improved voiding symptoms , including Q(max ) and PVR , relative to the re-administration group at baseline . Furthermore , the discontinuation group showed a smaller prostate volume than the re-administration group ( p = 0.045 ) . CONCLUSION When patients with BPH displayed symptomatic improvement upon treatment with alpha-blockers , the improvements were maintained in a select sub population of patients without the need to re-administer the alpha-blockers OBJECTIVE This study was conducted to examine the effect of discontinuing tamsulosin in patients with benign prostatic hyperplasia who had been receiving combination therapy with tamsulosin and dutasteride . METHODS The study sample consisted of 108 men with benign prostatic hyperplasia and lower urinary tract symptoms who visited our urology clinics between April 2008 and December 2010 . All were assessed using the International Prostate Symptom Score ( IPSS ) . The patients had IPSS of 8 - 19 and prostate volumes ≥25 mL by transrectal ultrasonography . They were put on tamsulosin and dutasteride , and the efficacy of this regimen was assessed every 12 weeks . After 48 weeks , patients were divided at r and om into a group continuing to take the same drug combination ( group 1 ) and a group taking only dutasteride 0.5 mg ( group 2 ) . RESULTS Sixty-nine of the original 108 patients completed the study , 36 ( 52 % ) in group 1 and 33 ( 48 % ) in group 2 . The mean age of all patients was 67.96 ± 7.88 years and mean prostatic volume was 40.45 ± 12.81 mL. Mean prostate-specific antigen was 3.31 ( 0.4 - 9.9 ) ng/mL at the outset . The IPSS scores of the two groups at first visit , 48 and 72 weeks were , respectively , 14.69 versus 15.85 ( P = 0.322 ) , 12.08 versus 12.85 ( P = 0.582 ) and 10.89 versus 11.06 ( P = 0.897 . ) There was a statistically significant difference between the baseline and 72-week IPSS scores in both groups ( group 1 : P < 0.001 , group 2 : P < 0.001 ) . CONCLUSION In patients with moderate IPSS , discontinuing tamsulosin after 48 weeks of combined tamsulosin and dutasteride therapy has no significant effect on outcome OBJECTIVE To evaluate the long-term efficacy and safety of terazosin in the treatment of benign prostatic hyperplasia ( BPH ) . METHODS Thirty-three sites in 13 countries enrolled men with BPH who had an International Prostate Symptom Score ( IPSS ) > or = 12 [ corrected ] . After a 2-week , no-treatment lead-in period and a 26-week , single-blind treatment period , patients responding to terazosin were r and omly assigned to receive either terazosin or placebo for a 24-week , double-blind withdrawal period . RESULTS Of the initial 427 patients enrolled , 378 were evaluable , 273 of whom completed the single-blind period , of which 186 patients were r and omized . During the single-blind treatment period , IPSS , quality -of-life score ( QOL ) , peak flow rate ( PFR ) , and nocturia score ( NOC ) improved significantly ( p < or = 0.05 ) . During the double-blind withdrawal period , IPSS , QOL , PFR , and NOC deteriorated significantly in the placebo group compared with the terazosin group . The most common adverse event result ing in premature termination from the study was dizziness . There were no clinical ly important mean reductions in diastolic blood pressure ( DBP ) for patients normotensive at baseline . Terazosin significantly reduced mean DBP in hypertensive patients during the single-blind period and maintained the reduction during the double-blind period . CONCLUSION Treatment with terazosin has a beneficial effect on BPH , continuing for at least 12 months , and can be safely considered for medium- to long-term use in those who benefit Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To determine the safety and efficacy of intermittent alpha-blocker therapy in men with lower urinary tract symptoms ( LUTS ) in a prospect i ve study . Alpha-blockers have been demonstrated to be safe and effective in the treatment of men with LUTS . To date , the role of varying dosing regimens in responding patients has not been well studied . METHODS Men with LUTS were entered into this prospect i ve open label , parallel , r and omized trial . In phase 1 , patients were treated with alfuzosin , 2.5 mg three times daily for 3 months . In phase 2 , those patients who had a significant therapeutic response were r and omized into one of the following three groups : ( 1 ) maintenance of alfuzosin ; ( 2 ) alfuzosin every other day ; and ( 3 ) discontinuation of alfuzosin ( ie , no treatment ) . Patients were followed up for a total of 6 months . Parameters of evaluation included the International Prostate Symptom Score ( IPSS ) , global satisfaction , peak urinary flow rate ( Qmax ) , and adverse events . RESULTS At 3 months , there were 79 patients who were categorized as having obtained a therapeutic response : IPSS decreased to 7.6 + /- 3.2 and Qmax increased to 11.3 + /- 2.9 mL/s . After r and omization , IPSS was 7.1 + /- 2.9 and 6.5 + /- 2.5 for group 1 ; 6.5 + /- 3.2 and 6.7 + /- 2.1 for group 2 ; and 11.4 + /- 4.8 and 12.3 + /- 4.9 for group 3 at 3 and 6 months , respectively . Qmax was 12.7 + /- 4.8 and 11.7 + /- 5.2 mL/s for group 1 ; 12.2 + /- 3.9 and 11.9 + /- 3.7 mL/s for group 2 ; and 9.7 + /- 2.5 and 9.3 + /- 2.1 mL/s for group 3 at 3 and 6 months , respectively . Global satisfaction at 6 months was the same for groups 1 and 2 . There were no differences in adverse events among the three groups . CONCLUSIONS In men with LUTS who responded to alfuzosin , changing the dosing regimen from daily to once every other day result ed in similar efficacy and safety at 3 and 6 months . By contrast , complete cessation of alfuzosin result ed in recurrence of both symptoms and impaired urinary flow . These data provide evidence that in responding patients , intermittent alpha-blocker therapy may be a reasonable therapeutic regimen . The role of intermittent alpha-blocker therapy using other agents , as well as in a large cohort of men with LUTS , remains to be determined OBJECTIVES To assess the results of doxazosin treatment in men with lower urinary tract symptoms ( LUTS ) treated for 15 months and to correlate symptomatic changes with alterations in urodynamic measures . METHODS After an initial 3-month treatment period with doxazosin 4 mg/day , 50 men with LUTS were given the choice of continued treatment with this agent or other therapeutic options . All patients were evaluated by International Prostate Symptom Score ( IPSS ) question naires and urodynamic evaluation initially and after 3 months of treatment . Patients were followed for an additional 12 months and those who continued doxazosin treatment underwent repeat urodynamic testing . RESULTS Among the original 50 patients , 24 men ( 48 % ) continued doxazosin treatment for 15 months , 18 men ( 36 % ) discontinued therapy , and 8 men ( 16 % ) were either dead or lost to follow-up or had been diagnosed and treated for prostate cancer . Comparison of values at 3 and 15 months of follow-up ( 9.4 versus 13.4 , P = 0.03 ) showed significant worsening of voiding symptoms , as assessed by the IPSS , in the 24 men still receiving doxazosin . This deterioration of subjective results with doxazosin occurred despite continued improvements in peak urinary flow rate ( Qmax ) , detrusor pressure at peak flow ( PdetQmax ) , and objective measures of obstruction ( Abrams-Griffiths number ) from 3 to 15 months of follow-up . CONCLUSIONS Relief of voiding symptoms in men with LUTS treated with doxazosin over prolonged intervals of 15 months does not correlate well with changes in urodynamic measures OBJECTIVES To evaluate the efficacy and tolerability of the selective alpha(1)-adrenergic antagonist doxazosin and the 5-alpha-reductase inhibitor finasteride , alone and in combination , for the symptomatic treatment of benign prostatic hyperplasia . METHODS In a prospect i ve , double-blind , placebo-controlled trial , 1095 men aged 50 to 80 years were r and omized to treatment for 52 weeks with doxazosin , finasteride , the combination of doxazosin and finasteride , or placebo . The dose of finasteride ( or its matched placebo ) was 5 mg/day . Doxazosin ( or its matched placebo ) was initiated at 1 mg/day , and titrated up to a maximum of 8 mg/day over approximately 10 weeks according to the response of the maximal urinary flow rate ( Qmax ) and International Prostate Symptom Score ( IPSS ) . The IPSS and Qmax were assessed at baseline and at weeks 10 , 14 , 26 , 39 , and 52 or at the endpoint . RESULTS An intent-to-treat analysis of 1007 men showed doxazosin and doxazosin plus finasteride combination therapy produced statistically significant improvements in total IPSS and Qmax compared with placebo and finasteride alone ( P < 0.05 ) . Finasteride alone was not significantly different statistically from placebo with respect to total IPSS and Qmax . All treatments were generally well tolerated . CONCLUSIONS Doxazosin was effective in improving urinary symptoms and urinary flow rate in men with benign prostatic hyperplasia , and was more effective than finasteride alone or placebo . The addition of finasteride did not provide further benefit to that achieved with doxazosin alone PURPOSE To revise the 2003 version of the American Urological Association 's ( AUA ) Guideline on the management of benign prostatic hyperplasia ( BPH ) . MATERIAL S AND METHODS From MEDLINE ® search es of English language publications ( January 1999 through February 2008 ) using relevant MeSH terms , articles concerning the management of the index patient , a male ≥45 years of age who is consulting a healthcare provider for lower urinary tract symptoms ( LUTS ) were identified . Qualitative analysis of the evidence was performed . Selected studies were stratified by design , comparator , follow-up interval , and intensity of intervention , and meta-analyses ( quantitative synthesis ) of outcomes of r and omized controlled trials were planned . Guideline statements were drafted by an appointed expert Panel based on the evidence . RESULTS The studies varied as to patient selection ; r and omization ; blinding mechanism ; run-in periods ; patient demographics , comorbidities , prostate characteristics and symptoms ; drug doses ; other intervention characteristics ; comparators ; rigor and intervals of follow-up ; trial duration and timing ; suspected lack of applicability to current US practice ; and techniques of outcomes measurement . These variations affected the quality of the evidence review ed making formal meta- analysis impractical or futile . Instead , the Panel and extractors review ed the data in a systematic fashion and without statistical rigor . Diagnosis and treatment algorithms were adopted from the 2005 International Consultation of Urologic Diseases . Guideline statements concerning pharmacotherap Output:

After discontinuing monotherapy , symptom scores increased and peak flow rates decreased at 3 and 6 months , but not at 12 months ; however , neither parameter changed when alpha-blockers were stopped during combination therapy . Discontinuing alpha-blocker monotherapy leads to a worsening compared with continuing therapy . Discontinuing the alpha-blocker after combination therapy had no significant effects on outcomes in either the short or long term .

MS2_1shot119

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Body image disturbances play a significant role in the development of eating disorders . Since body image can vary in diverse context s , the aim of the present experiment was to investigate whether it is affected by recent food intake . Fifty-seven females without clinical ly relevant eating disorders were r and omly assigned to an experimental group ( EG , n=28 ) that consumed a milkshake while watching a neutral film and a control group ( CG , n=29 ) that only viewed the movie . Before and after the tasks , participants filled in the " Body Image States Scale " and the " Mood Question naire " and indicated their own " actual " , " felt " and " ideal " body dimensions with a digital distortion technique based on a photograph of themselves . It was shown that after milkshake consumption , state body dissatisfaction as well as the discrepancy between " actual-ideal " and " felt-ideal " body size estimations was higher in the EG than in the CG . Judgements of the " actual " , " felt " and " ideal " body dimensions and of mood were not affected . Further analyses revealed that the effect of milkshake consumption on body image and mood was higher the more the participants displayed restrained eating or eating , weight and shape concerns in general . Clinical implication s are discussed Laughter or smile is one of the emotional expressions of pleasantness with characteristic contraction of the facial muscles , of which the neural substrate remains to be explored . This currently described study is the first to investigate the generation of human facial expression of pleasant emotion using positron emission tomography and H(2)(15)O. Regional cerebral blood flow ( rCBF ) during laughter/smile induced by visual comics and the magnitude of laughter/smile indicated significant correlation in the bilateral supplementary motor area ( SMA ) and left putamen ( P < 0.05 , corrected ) , but no correlation in the primary motor area ( M1 ) . In the voluntary facial movement , significant correlation between rCBF and the magnitude of EMG was found in the face area of bilateral M1 and the SMA ( P < 0.001 , uncorrected ) . Laughter/smile , as opposed to voluntary movement , activated the visual association areas , left anterior temporal cortex , left uncus , and orbitofrontal and medial prefrontal cortices ( P < 0.05 , corrected ) , whereas voluntary facial movement generated by mimicking a laughing/smiling face activated the face area of the left M1 and bilateral SMA , compared with laughter/smile ( P < 0.05 , corrected ) . We demonstrated distinct neural substrates of emotional and volitional facial expression and defined cognitive and experiential processes of a pleasant emotion , laughter/smile OBJECTIVE To investigate attentional biases for body shape and weight-related stimulus words among subjects with anorexia nervosa , bulimia nervosa , and control subjects classified using a measure of dietary restraint . METHODS A visual probe detection task was used to assess attention toward stimulus words reflecting either a thin or a large physique and positively or negatively valenced emotion words . RESULTS In comparison to controls , subjects with eating disorders detected target probes more slowly when they appeared in the same location as had stimulus words connoting a thin physique . In addition , there was a trend toward faster detection or target probes that appeared in the same location as had stimulus words connoting a large physique . Neither of these effects were observed among restrained eaters . DISCUSSION Our results extend prior work suggesting information-processing biases for body shape and weight-related stimuli among persons with eating disorders The studies discussed in this report investigate the neural mechanisms involved in processing a light tactile stimulus as measured by positron emission tomography ( PET ) . This light tactile stimulus ( a 2-Hz tap with a von Frey hair ) produced a significant increase in regional cerebral blood flow ( rCBF ) in contralateral primary somatosensory cortex ( SI ) and bilateral secondary somatosensory cortex ( SII ) , with a larger response in the side contralateral to the stimulus . Light tactile stimulation also produced activity in multiple discrete areas in the human inferior parietal lobule ( IPL ) , which we believe to comprise a region homologous to the monkey area 7b or feline tertiary somatosensory cortex ( SIII ) . Directing attention to the tactile stimulus increased blood flow to SIII and activated a right-lateralized cortical network , regardless of the side of body stimulated . Directed attention to the stimulus decreased blood flow to visual cortex , but minimally modulated SI rCBF The contribution of anterior cingulate cortex ( ACC ) to human cognition remains unclear . The rostral ( rACC ) and dorsal ( dACC ) ACC cortex are implicated in tasks that require increased response control due to emotional and cognitive interference , respectively . However , both rACC and dACC are activated by conditions that induce changes in visceral arousal , suggesting that ACC supports a generation of integrated bodily responses . To clarify the relationship between purely cognitive and psychophysiological accounts of ACC function , we scanned 15 subjects using functional magnetic resonance imaging while they performed numerical versions of the Stroop task . To index autonomic arousal , we simultaneously measured pupil diameter . Performance errors accounted for most of the variance in a pupil-derived measure of evoked autonomic arousal . In analysis of the functional imaging data , activity within a region spanning rACC and dACC predicted trial-by-trial variation in autonomic response magnitude and was enhanced during error trials , shown using conjunction analyses . Activity within other loci within rACC predicted evoked autonomic arousal and showed sensitivity to errors but did not meet criteria for both . These data highlight the role of ACC in psychophysiological aspects of error processing and suggest that an interface exists within ACC between cognitive and biobehavioral systems in the service of response adaptation BACKGROUND Abnormalities in perception and evaluation of body shape are a hallmark of eating disorders . METHODS Brain responses to line drawings of underweight , normal weight , and overweight female bodies were measured with functional magnetic resonance imaging in 9 women with bulimia nervosa , 13 with anorexia nervosa , and 18 healthy women . Participants rated the stimuli for fear and disgust . RESULTS In the three groups , the lateral fusiform gyrus , inferior parietal cortex , and lateral prefrontal cortex were activated in response to body shapes compared with the control condition ( drawings of houses ) . The responses in the lateral fusiform gyrus and in the parietal cortex were less strong in patients with eating disorders compared with healthy control subjects . Patients with eating disorders rated the body shapes in all weight categories as more aversive than did healthy women . In the group with eating disorders , the aversion ratings correlated positively with activity in the right medial apical prefrontal cortex . CONCLUSIONS Processing of female body shapes engages a distributed neural network , parts of which are underactive in women with eating disorders . The considerable variability in subjective emotional reaction to body shapes in patients with eating disorders is associated with differential activity in the prefrontal cortex BACKGROUND Previous neuroimaging studies have demonstrated abnormalities in visual body image processing in anorexia and bulimia nervosa , possibly underlying body image disturbance in these disorders . Although cognitive behavioural interventions have been shown to be successful in improving body image disturbance in eating disorders , no r and omized controlled study has yet analysed treatment-induced changes in neuronal correlates of visual body image processing . METHOD Altogether , 32 females with eating disorders were r and omly assigned either to a manualized cognitive behavioural body image therapy consisting of 10 group sessions , or to a waiting list control condition . Using functional magnetic resonance imaging , brain responses to viewing photographs of one 's own and another female 's body taken from 16 st and ardized perspectives while participants were wearing a uniform bikini were acquired before and after the intervention and the waiting time , respectively . RESULTS Data indicate a general blood oxygen level dependent signal enhancement in response to looking at photographs of one 's own body from pre- to post-treatment , whereas exclusively in the control group activation decreases from pre- to post-waiting time were observed . Focused activation increases from pre- to post-treatment were found in the left middle temporal gyrus covering the coordinates of the extrastriate body area and in bilateral frontal structures including the middle frontal gyrus . CONCLUSIONS Results point to a more intense neuronal processing of one 's own body after the cognitive behavioural body image therapy in cortical regions that are responsible for the visual processing of the human body and for self-awareness To test effects of body image therapy in anorexia nervosa , functional magnetic resonance imaging was used to assess neuronal responses to viewing photographs of one 's own body before and after treatment . Activation decreases emerged in a distributed network and increases were observed in the extrastriate body area , possibly reflecting more intense body image processing We measured brain activation in six anorexia nervosa patients and six healthy controls performing a novel emotional Stroop task using Fat , Thin , and Neutral words , and words made of XXXXs . Reaction times increased in the patient group in Thin and Fat conditions . In the Thin – XXXX contrast , patients showed greater activation than controls at the junction of left insula , frontal and temporal lobes and in left middle and medial frontal gyri . In the Fat – XXXX contrast , controls showed greater activation in left dorsolateral prefrontal cortex and right parietal areas . Mechanisms underlying attentional bias in anorexia nervosa likely differ under conditions of positive and negative valence . This paradigm is a promising tool to examine neural mediation of emotional response in anorexia nervosa Several studies have been carried out using the Stroop test in eating disorders . Some of these studies have brought to light the existence of cognitive and attention deficits linked principally to weight and to food in anorexic and bulimic patients . The aim of the current study is to replicate and to clarify the existence of cognitive and attention deficits in anorexic patients using the Stroop test and a word recognition test . The recognition test is made up of 160 words ; 80 words from the previous Stroop experiment mixed at r and om and matched from a semantic point of view to 80 distractions . The recognition word test is carried out 2 or 3 days after the Stroop test . Thirty-two subjects took part in the study : 16 female patients hospitalised for anorexia nervosa and 16 normal females as controls . Our results do not enable us to confirm the existence of specific cognitive deficits in anorexic patients Output:

For both food stimuli and body stimuli , AN patients showed increased hemodynamic response in the emotion-related regions ( frontal , cau date , uncus , insula and temporal ) and decreased activation in the parietal region . Although no robust brain activation has been found in response to emotional stimuli , emotion-related neural networks are involved in the processing of food and body stimuli among AN . It suggests that negative emotional arousal is related to cognitive processing bias of food and body stimuli in AN

MS2_1shot120

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Summary The comparative effects of alcoholism treatment programmes were examined by r and omly assigning 113 male and female detoxified alcoholics to either : a 6-week inpatient programme , a 6-week outpatient programme or a single confrontational interview . On a variety of outcome measures , that included both levels of drinking and general functioning taken 6 and 18 months after intake , no treatment appeared to be consistently more effective than another . Furthermore , those who stayed in treatment did not show significantly more long-term improvement than those who refused or dropped out of treatment . Abstinent subjects felt more often than drinkers that they had achieved the goals they had set themselves and by the final follow-up there were many positive differences in apparent lifestyle . Although individual drinking patterns were unstable , on average , almost half the subjects located had either abstained or were drinking moderately . Patient and treatment variables combined explained up to 57 % of the variance in amount drunk after treatment , with patient variables providing the strongest associations AIMS The present study aim ed to evaluate whether individual counselling for alcohol-dependent patients in three sessions is as effective as a 2-week group treatment programme as part of an in-patient stay in a psychiatric hospital which was to foster motivation to seek further help and to strengthen the motivation to stay sober . Of particular importance was the external validity of the results , i.e. a ' normal ' intake load of in- patients in detoxification and a wide variety of motivation to stop drinking were to be investigated . METHODS Subjects eligible for the study were all patients with alcohol problems admitted to a psychiatric hospital , but without psychosis , as the main diagnosis , and with a maximum of 10 detoxification treatments in the past . A r and omized-controlled trial was conducted with 161 alcohol-dependent in- patients who received three individual counselling sessions on their ward in addition to detoxification treatment and 161 in- patients who received 2 weeks of in-patient treatment and four out-patient group sessions in addition to detoxification . Both interventions followed the principles and strategies of motivational interviewing . RESULTS Six months after intervention , group-treatment patients showed a higher rate of participation in self-help groups ; however , this difference had disappeared 12 months after treatment . The abstinence rate among the former patients did not differ between the two intervention groups . CONCLUSION Group treatment may lead to a higher rate of participation in self-help groups , but does not increase the abstinence rate 6 months after treatment BACKGROUND Individuals with comorbid substance use and posttraumatic stress disorder may differentially benefit from integrated trauma-focused interventions based on specific presenting characteristics such as substance use type and PTSD severity . The current study is a secondary analysis of a NIDA Clinical Trials Network study exploring the effectiveness of two interventions for women with comorbid PTSD and substance use disorders . METHOD Generalized estimating equations were used to examine the association of baseline alcohol misuse with PTSD outcome measures over time for all r and omized participants . RESULTS Women entering treatment with baseline alcohol misuse had higher Post Traumatic Stress Disorder Symptom Scale ( PSS-SR ) total scores ( t=2.43 , p<.05 ) , cluster C ( avoidance/numbing ) scores ( t=2.63 , p<.01 ) , and cluster D ( hyper-arousal ) scores ( t=2.31 , p<.05 ) . For women with alcohol misuse , after treatment week 1 , PSS-SR scores were significantly lower in the Seeking Safety intervention during treatment ( chi(2)(1)=4.00 , p<.05 ) and follow-up ( chi(2)(1)=4.87 , p<.05 ) compared to those in the health education intervention . Alcohol misusers in the Seeking Safety group who had higher baseline hyper-arousal severity improved more quickly than those with lower baseline hyper-arousal severity during treatment ( chi(2)(1)=4.06 , p<.05 ) . CONCLUSIONS These findings suggest that the type of substance abuse at treatment entry may inform treatment selection , predict treatment response among those with co-occurring PTSD and substance use disorders , and indicate a more severe clinical picture Background : People who are homeless and chronically alcoholic have increased health problems , use of emergency services and police contact , with a low likelihood of rehabilitation . Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence . The shelter-based Managed Alcohol Project ( MAP ) was created to deliver health care to homeless adults with alcoholism and to minimize harm ; its effect upon consumption of alcohol and use of crisis services is described as proof of principle . Methods : Subjects enrolled in MAP were dispensed alcohol on an hourly basis . Hospital charts were review ed for all emergency department ( ED ) visits and admissions during the 3 years before and up to 2 years after program enrolment , and the police data base was accessed for all encounters during the same periods . The results of blood tests were analyzed for trends . A question naire was administered to MAP participants and staff about alcohol use , health and activities of daily living before and during the program . Direct program costs were also recorded . Results : Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months . Their monthly mean group total of ED visits decreased from 13.5 to 8 ( p = 0.004 ) ; police encounters , from 18.1 to 8.8 ( p = 0.018 ) . Changes in blood test findings were nonsignificant . All program participants reported less alcohol consumption during MAP , and subjects and staff alike reported improved hygiene , compliance with medical care and health . Interpretation : A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters The aim of this research was to evaluate the effectiveness of long-term brief intervention in routine general practice . In five primary care out-patient clinics in a Finnish town , 296 male early-phase heavy drinkers consulting a general practitioner ( GP ) for various reasons were identified . Control group C ( n = 88 ) was informed of the risks of drinking after the screening and were advised at the subsequent feedback about 2 weeks later to reduce their drinking . Groups A ( n = 109 ) and B ( n = 99 ) were offered in addition seven and three brief intervention sessions , respectively . All GPs took part , whether or not they indicated a special interest . The main outcome measures were differences between beginning and end-point at 3 years in self-reported alcohol consumption , mean corpuscular volume ( MCV ) , and serum carbohydrate-deficient transferrin , aspartate aminotransferase , alanine aminotransferase and gamma-glutamyltransferase . There were no statistically significant differences between study groups A , B and C in mean changes in outcome measures . Within all the groups , MCV decreased . Depending on the outcome measure used and the study group analysed , clinical ly significant reduction of drinking was found in 25 - 53 % of the subjects . In routine general practice , giving additional sessions of brief intervention may not be as effective as in special research conditions . Factors reducing the effectiveness of brief intervention programmes should be investigated , so that primary health care staff can be better supported in their efforts OBJECTIVES To characterize the homeless adult population of an urban emergency department ( ED ) and study the medical , psychiatric , and social factors that contribute to homelessness . METHODS A prospect i ve , case-control survey of all homeless adult patients presenting to an urban , tertiary care ED and a r and om set of non-homeless controls over an eight-week period during summer 1999 . Research assistants administered a 50-item question naire and were trained in assessing dentition and triceps skin-fold thickness . INCLUSION CRITERIA all homeless adults who consented to participate . Homelessness was defined as being present for any person not residing at a private address , group home , or drug treatment program . R and omly selected controls were concurrently enrolled with a 3:1 homeless : control rate . EXCLUSION CRITERIA critically ill , injured , or incapacitated patients , or patients < 21 years of age . Univariate analysis with appropriate statistical tests was used . The Mantel-Haenszel test was used to adjust for population differences . RESULTS Two hundred fifty-two homeless subjects and 88 controls were enrolled . Data are presented for homeless vs control patients , and all p-values were < 0.01 . Odds ratios ( ORs ) with 95 % confidence intervals ( 95 % CIs ) are given where appropriate : mean age ( + /-SD ) = 42 + /- 10 vs 48 + /- 13 ; male gender 95 % vs 54 % ( OR = 17 ; 95 % CI = 8 to 37 ) ; history of ( hx ) tuberculosis 49 % vs 15 % ( OR = 2.5 ; 95 % CI = 1.2 to 3 ) ; hx HIV infection 35 % vs 13 % ( OR = 3.8 ; 95 % CI = 1.8 to 8) ; hx penetrating trauma 62 % vs 16 % ( OR = 8.62 ; 95 % CI = 4.4 to 17.1 ) ; hx depression 70 % vs 15 % ( OR = 13.4 ; 95 % CI = 6.7 to 27 ) ; hx schizophrenia 27 % vs 7 % ( OR = 5.1 ; 95 % CI = 2.0 to 14 ) ; hx alcoholism 81 % vs 15 % ( OR = 24 ; 95 % CI = 12 to 49 ) ; significant tooth loss ( > 3 ) 43 % vs 18 % ( OR = 3.3 ; 95 % CI = 1.8 to 6.4 ) ; percentage of body fat 16.5 % vs 19.7 % ; hx social isolation ( no weekly social contacts ) 81 % vs 11 % ( OR = 33.3 ; 95 % CI = 14 to 100 ) ; mean number of ED visits/year 6.0 vs 1.6 . CONCLUSIONS In the study population homelessness was associated with a history of significantly higher rates of infectious disease , ethanol and substance use , psychiatric illness , social isolation , and rates of ED utilization Homeless shelters provide a unique opportunity to intervene with occupants who have substance abuse problems , as not addressing these issues may lead to continuation of problems playing a contributing role in homelessness . Attempts to implement Contingency Management ( CM ) with this population have often been complex , costly , and not straightforward to replicate in community setting s. We conducted a r and omized trial evaluating a simple , low-cost 4-week CM program for 30 individuals seeking shelter in a community-based homeless shelter who had both current substance and psychiatric disorders . Behavioral assessment s were performed at baseline , weekly , and termination of the study . Overall retention in the trial was high ; participants assigned to CM reduced their cocaine and alcohol use more than those in assessment -only . This pilot trial suggests that application of low-cost CM procedures is feasible within this novel setting and may decrease substance use AIMS Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone . The present study ( Depression and Alcohol Integrated and Single-focused Interventions ; DAISI ) aim ed to compare the effectiveness of brief intervention , single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems . METHODS Participants ( n = 284 ) with current depressive symptoms and hazardous alcohol use were assessed and r and omly allocated to one of four individually delivered interventions : ( i ) a brief intervention only ( single 90-minute session ) with an integrated focus on depression and alcohol , or followed by a further nine 1-hour sessions with ( ii ) an alcohol focus ; ( iii ) a depression focus ; or ( iv ) an integrated focus . Follow-up assessment s occurred 18 weeks after baseline . RESULTS Compared with the brief intervention , 10 sessions were associated with greater reductions in average drinks per week , average drinking days per week and maximum consumption on 1 day . No difference in duration of treatment was found for depression outcomes . Compared with single-focused interventions , integrated treatment was associated with a greater reduction in drinking days and level of depression . For men , the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning . Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment . CONCLUSIONS Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems , at least in the short term . Gender differences between single-focused depression and alcohol treatments warrant further study OBJECTIVE This study compared two different implementation strategies for Cutting Back , a primary care alcohol screening and brief intervention ( SBI ) program for hazardous and harmful drinkers . It also identified organizational factors contributing to the success or failure of SBI implementation . METHOD Cutting Back was implemented in 10 primary care practice s associated with managed care organizations ( MCOs ) in five states , through a system of planning , training , technical assistance and clinic feedback . Clinics were r and omly assigned to one of two brief intervention systems : In the P Model , medical providers were responsible for delivering interventions , whereas in the S Model mid-level professionals ( usually nurses ) acted as the clinic specialists to provide that service . Data were collected to measure the performance of screening and delivery of interventions in each clinic . RESULTS The S Model screened a higher percentage of patients than did the P Output:

These results accurately reflect the use of MAPs in current practice as existing programmes are ongoing only in a small number of sample pilot projects that target individuals with severe alcohol dependence or who consume non-beverage alcohol . AUTHORS ' CONCLUSIONS The lack of evidence does not allow for a conclusion regarding the efficacy of MAP on their own , or as compared to brief intervention , moderate drinking , no intervention or 12-step variants . It is the review authors ' opinion that it is likely to be the objective of MAPs that reduce their reportability and use in current practice , rather than a failure to provide an intervention that reduces the effects of alcohol dependence . Aim ing to reduce harmful or antisocial behaviour in vulnerable individuals through the regulation of daily alcohol intake , rather than reducing harmful alcohol intake over time , provides considerable difficulty in developing measures of success from self-reported data ( low treatment thresholds ) , monitoring long-term efficacy or establishing causal links between programme admission and a reduction in targeted behaviours , owing to the fact that prolonged participation in the programme is likely to indicate a willingness in the individual to change their behaviour patterns .

MS2_1shot121

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Female adolescent runners have an elevated prevalence of low bone mass for agemdashan outcome that may be partially due to inadequate energy intake . OBJECTIVE The objective was to evaluate diet , menstrual history , serum hormone concentrations , and bone mass in female adolescent runners with normal or abnormal bone turnover . DESIGN Thirty-nine cross-country runners ( age : 15.7 plusmn 0.2 y ) participated in the study , which included a 7-d dietary assessment with the use of a food record and daily 24-h dietary recalls ; serum measures of insulin-like growth factor I , estradiol , leptin , parathyroid hormone , progesterone , triiodothyronine , 25-hydroxycholecalciferol , bone-specific alkaline phosphatase ( BAP ) , and cross-linked C-telopeptides of type I collagen ( CTX ) ; an evaluation of height , weight , bone mass , and body composition with the use of dual-energy X-ray absorptiometry ; and a question naire to assess menses and sports participation . Age- and sex-specific BAP and CTX concentrations of at least the 97th percentile and no greater than the third percentile , respectively , were considered abnormal . RESULTS All abnormal BAP and CTX concentrations fell within the elevated ( ge 97 % ) range . Runners with an elevated bone turnover ( EBT ) ( n = 13 ) had a lower body mass , fewer menstrual cycles in the past year , lower estradiol and 25-hydroxycholecalciferol concentrations , and a higher prevalence of body mass index lt 10 % for age , vitamin D insufficiency , amenorrhea , and low bone mass . Girls with EBT consumed less than the recommended amounts of energy and had a higher prevalence of consuming lt 1300 mg Ca than did those with normal bone turnover . CONCLUSIONS Runners with EBT had a profile consistent with energy deficiency . Nutritional support to increase energy , calcium intake , and 25-hydroxycholecalciferol concentrations may improve bone mineral accrual in young runners with EBT . This trial was registered at clinical trials.gov as NCT01059968 PURPOSE This investigation examined the effect of variations in protein intake on whole-body protein turnover ( WBPTO ) after exercise in endurance-trained males . METHODS Five male runners ( 21.3 + /- 0.3 yr , 179 + /- 2 cm , 70.6 + /- 0.1 kg , 8.7 + /- 0.4 % body fat , 70.6 + /- 0.1 VO2peak ) participated in a r and omized , crossover- design diet intervention , where they consumed either a low- ( 0.8 g.kg(-1 ) ; LP ) , moderate- ( 1.8 g.kg(-1 ) ; MP ) , or high-protein ( 3.6 g.kg(-1 ) ; HP ) diet for 4 wk . WBPTO ( Ra , leucine rate of appearance ; NOLD , nonoxidative leucine disposal ; and Ox , leucine oxidation ) were assessed after a 75-min run at 70 % VO2peak after each diet-intervention period . RESULTS Leucine Ra ( indicator of protein breakdown ) and leucine Ox were greater on the HP diet than on the LP diet ( Ra , 123.4 + /- 6.9 vs 97.9 + /- 6.0 micromol.kg(-1).h(-1 ) ; Ox , 23.9 + /- 0.5 vs 17.0 + /- 0.8 micromol.kg(-1).h(-1 ) , P < 0.05 ) . No differences were noted in NOLD ( an indicator of protein synthesis ) across diets . Plasma branched chain amino acids ( BCAA ) at rest were greater for MP and HP than for LP , and nonessential amino acids ( NEAA ) were greater for LP than MP at rest and greater than MP and HP after exercise . CONCLUSION Findings from this study show that variations in protein intake can alter plasma amino acid levels and modulate rates of WBPTO after exercise . Additionally , a lower protein intake was associated with decreased rates of WBPTO after exercise Background : Current literature shows conflicting results regarding the possible direct role of exercise on leptin concentrations , mainly because of a non-homogeneous level of energy expenditure ( EE ) and the lack of st and ardization of energy balance . Aim : The aim of the study was to evaluate the effect of exercise duration and its corresponding EE on leptin levels , during prolonged treadmill exercise , in a well-controlled laboratory setting . Material s and methods : Seven young trained males underwent a 4-h treadmill exercise . The starting intensity was set at 65 % of maximal oxygen consumption . At the start of the test and throughout the exercise , venous blood sample s were drawn for the assays of leptin , glucose , free fatty acids ( FFA ) , cortisol , epinephrine ( E ) and norepinephrine ( NE ) . Hourly and total EE was monitored with gas analysis . Results : Plasma leptin levels decreased from 1.10±0.15 to 0.85±0.26 µg/l ( p<0.01 ) at the end of the exercise , reaching a significant reduction already after the second hour . FFA and cortisol showed a progressive significant increase , while glucose did not significantly change throughout the test . Plasma E and NE significantly increased at all sampling times compared to basal values ( 48.1±30.3 to 352.3±187.7 pg/ml , p<0.001 and 238.1±118.9 to 1798.7±413.5 pg/ml , p<0.001 ) . The r and om-effects model for panel data analysis showed negative correlation between leptin , NE and the values of progressive EE ( r2=0.745 , p<0.05 ) . Conclusions : Our data demonstrate that , during a prolonged moderate intensity exercise , leptin decrease is significantly related to the total EE . Further , NE concentrations seem to play an important role in the inhibition of leptin secretion In order to compare the influence of a single bout of exercise on HDL-C metabolism with normal variability , 12 male runners ( mean age : 24.9 + /- 4 yr ) who ran 15 - 30 miles per week underwent exercise ( E ) and control ( C ) experimental conditions . During the E trial subjects ran on a motor driven treadmill at 75 % ( 42.5 + /- 4.7 ml.kg-1.min-1 ) VO2max until 800 Kcals were expended . The C trial consisted of no exercise . Subjects were instructed to follow the same diet and keep a four d food diary during each experimental condition . Fasted blood sample s were obtained at the same time of day in each condition at time points corresponding to 24 h pre-exercise ( 24 PRE ) , 6 h post- ( 6 h ) and 24 h post-exercise ( 24 h ) . Plasma was analyzed for HDL-C , HDL2-C and HDL3-C ( mg.dl-1 ) . In addition post-heparin plasma sample s were analyzed for lipoprotein lipase ( LPL ) and hepatic lipase ( HL ) activity ( mumol . FFA-1.ml-1 ) . All values were adjusted for changes in plasma volume and compared to Baseline . HDL-C levels were unaltered following the C trial . However , following the E trial , HDL-C increased ( p < 0.01 ) above baseline values at 24 h. The increase in HDL-C was reflected in the HDL3-C subfraction ( p < 0.05 ) . Analysis of lipolytic activity revealed an overall greater LPL activity ( p < 0.05 ) in the E trial vs the C trial . In addition , a decrease in HL was observed at 24 h ( p < 0.05 ) but was not different between experimental conditions . These data suggest that exercise and not normal variability are responsible for alterations in lipolytic activity and corresponding increases in HDL-C levels Objective : To explore potential factors that could be associated with low bone mineral density ( BMD ) in female endurance runners . Methods : Fifty two female endurance runners ( 1500 m to marathon ) , aged 18–44 years , took part . Body fat percentage , lumbar spine BMD , and femoral neck BMD were measured using the Hologic QDR 4500w bone densitometer . Data on training , menstrual cycle status , osteoporosis , and health related factors were obtained by question naire . Dietary variables were assessed from a prospect i ve seven day dietary record of macronutrients and micronutrients . Results : The mean ( SD ) lumbar spine and femoral neck BMD were 1.11 ( 0.11 ) and 0.89 ( 0.12 ) g/cm2 respectively . A backward elimination regression analysis showed that age , body mass , body fat , distance run , magnesium , and zinc intake were the variables significantly associated with BMD . Lumbar spine BMD ( g/cm2 ) = −1.90 + ( 0.0486 × age ( years ) ) + ( 0.342 × log mass ( kg ) ) − ( 0.000861 × age2 ( years ) ) − ( 0.00128 × distance ( km/week ) ) , with an R2 = 30.1 % ( SEE = 0.089 ( 95 % confidence interval ( CI ) 0.05 to 0.23 ) ; p<0.001 ) . Femoral neck BMD ( g/cm2 ) = −2.51 − ( 0.00989 × age ( years ) ) + ( 0.720 × log mass ( kg ) ) + ( 0.000951 × magnesium ( mg/day ) ) −(0.0289 × zinc ( mg/day ) ) − ( 0.00821 × body fat ( % ) ) − ( 0.00226 × distance ( km/week ) ) , with an R2 = 50.2 % ( SEE = 0.100 ( 95 % CI 0.06 to 0.22 ) ; p<0.001 ) . The negative association between skeletal BMD and distance run suggested that participants who ran longer distances had a lower BMD of the lumbar spine and femoral neck . Further , the results indicated a positive association between body mass and BMD , and a negative association between body fat and BMD . Conclusions : The results suggest a negative association between endurance running distance and lumbar spine and femoral neck BMD , with a positive association between body mass and femoral neck and lumbar spine BMD . However , longitudinal studies are required to assess directly the effect of endurance running and body mass on BMD , and to see if the addition of alternative exercise that would increase lean body mass would have a positive effect on BMD and therefore help to prevent osteoporosis The purpose of this investigation was to examine the effects of 7 - 10 days of inactivity ( IA ) on glucose tolerance ( GT ) , resting metabolic rate ( RMR ) , thermic effect of a meal ( TEM ) , and limb blood flow in endurance-trained men . Eight highly trained ( peak O2 consumption 64 + /- 2 ml . kg-1 . min-1 ) endurance athletes participated in this study involving two identical test days , one approximately 24 h after a normal training bout ( Tr ) and the second after 7 - 10 days of IA . The following tests were conducted at each visit : 75-g oral glucose tolerance test ( OGTT ) , RMR , and TEM and measurements of calf and forearm blood flow ( BF ) by using venous occlusive plethysmography . Body weight remained unchanged during this short period of IA ( Tr , 78.5 + /- 1 kg ; IA , 78.7 + /- 1 kg ) . The area under the glucose and insulin curves increased 65 % ( Tr , 3,375 + /- 877 vs. IA , 5,559.4 + /- 621 mg . dl-1 . 180 min-1 ) and 73 % ( Tr , 2,182.5 + /- 270 vs. IA , 3,793.1 + /- 739 microU . ml-1 . 180 min-1 ) after IA , respectively ( P < 0.01 ) . RMR decreased significantly ( 4 % ; 1.5 + /- 0 . 02 vs. 1.44 + /- 0.02 kcal/min ; P < 0.05 ) and respiratory exchange ratio during the OGTT increased ( 4 % , 0.812 + /- 0.011 vs. 0.842 + /- 0 . 009 ; P < 0.05 ) after IA , whereas TEM increased similarly in the Tr and IA states . In the Tr state , mean calf BF increased by 22 % ( 3.17 + /- 0.22 vs. 3.87 + /- 0.38 ml . 100 ml-1 . min-1 ; P < 0.05 ) during the OGTT but remained unchanged after IA , whereas no differences at rest or during OGTTs existed between the two conditions for forearm BF . Incremental insulin area above fasting during the OGTT was correlated with mean calf BF in the Tr ( r = 0.76 , P < 0.05 ) and I Output:

During the competition phase , both body mass and fat-free mass were significantly higher compared to other seasonal training phases ( p < 0.05 ) . Male and female endurance athletes show important training seasonal fluctuations in TEE , energy intake , and body composition .

MS2_1shot122

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: In this experiment , we tested for opioid and nonopioid mechanisms of pain control through cognitive means and the relation of opioid involvement to perceived coping efficacy . Subjects were taught cognitive methods of pain control , were administered a placebo , or received no intervention . Their pain tolerance was then measured at periodic intervals after they were administered either a saline solution or naloxone , an opiate antagonist that blocks the effects of endogenous opiates . Training in cognitive control strengthened perceived self-efficacy both to withst and and to reduce pain ; placebo medication enhanced perceived efficacy to withst and pain but not reductive efficacy ; and neither form of perceived self-efficacy changed without any intervention . Regardless of condition , the stronger the perceived self-efficacy to withst and pain , the longer subjects endured mounting pain stimulation . The findings provide evidence that attenuation of the impact of pain stimulation through cognitive control is mediated by both opioid and nonopioid mechanisms . Cognitive copers administered naloxone were less able to tolerate pain stimulation than were their saline counterparts . The stronger the perceived self-efficacy to reduce pain , the greater was the opioid activation . Cognitive copers were also able to achieve some increase in pain tolerance even when opioid mechanisms were blocked by naloxone , which is in keeping with a nonopioid component in cognitive pain control . We found suggestive evidence that placebo medication may also activate some opioid involvement . Because placebos do not impart pain reduction skills , it was perceived self-efficacy to endure pain that predicted degree of opioid activation A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine . Forty-three children aged between 8 and 16 years ( mean age : 11.3 years ) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback , both with stress management training , or metoprolol , a beta-blocker . Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks . Relaxation and stress management training reduced the headache index ( frequency x intensity of headache episodes ) , more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between . An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake . When comparing pre- to post-treatment data , children treated with relaxation training improved significantly in headache frequency and intensity , whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood . The clinical improvement was stable at an 8-months follow-up & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief CONTEXT A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient OBJECTIVE To examine relationships among changes in self-efficacy and changes in other clinical ly relevant outcome measures . METHOD Subjects ( n = 44 ) were participants in a prospect i ve , r and omized stress-management study followed over 15 months . Outcome measures included self-efficacy , depression , pain , health status , and disease activity . RESULTS Correlational analyses revealed significant associations between changes in self-efficacy ( particularly total self-efficacy ) and changes in selected measures of depression , pain , health status , and disease activity . The observed associations were not due to changes in medication regimen or to nonadherence to the stress-management program . CONCLUSIONS Evidence is provided that induced changes in self-efficacy following a stress-management program were significantly related to other clinical ly important outcome measures OBJECTIVE To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women . DESIGN A semi- prospect i ve case control study in which women attending antenatal clinics were invited to undergo hypnotherapy . SUBJECTS One hundred twenty-six primigravid women with 300 age matched controls , and 136 parous women having their second baby with 300 age matched controls . Only women who had spontaneous deliveries were included . SETTING Aberdare District Maternity Unit , Mid Glamorgan , Wales . INTERVENTION Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy . OUTCOME MEASURES Analgesic requirements , duration of first and second stages of labour . RESULTS The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group ( P < 0.0001 ) ; the mean lengths of the second stage were 37 min and 50 min , respectively ( P < 0.001 ) . In the parous women the corresponding values were 5.3 h and 6.2 h ( P < 0.01 ) ; and 24 and 22 min ( ns ) . The use of analgesic agents was significantly reduced ( P < 0.001 ) in both hypnotised groups compared with their controls . CONCLUSION In addition to demonstrating the benefits of hypnotherapy , the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women The aim of this study was to investigate the role of dispositional optimism ( DO ) as a predictor of health-related quality of life ( HRQL ) in a sample of upper aerodigestive tract cancer ( UADT ) patients . A prospect i ve observational study design was used with a cohort of patients from one centre . DO was evaluated using a French version of the Life Orientation Test ( the FLOT ) translated and vali date d for this study . HRQL was evaluated using the EORTC QLQ-C30 prior to and 3 months following treatment . The association between FLOT ratings and HRQL was evaluated using linear multiple regression analysis and a two-way ANOVA with repeated measures . Baseline data were gathered on 101 subjects and follow-up data on 88 of these . The sample was dichotomized around the median FLOT score creating ‘ optimist ’ and ‘ pessimist ’ groups . Before treatment , optimists reported better role , cognitive and emotional function , less pain and fatigue and a better global rating of HRQL than did pessimists . Following treatment , optimists reported better role and cognitive functioning , less pain and better global HRQL than did pessimists . Pessimists reported a greater deterioration in the role domain following treatment than did optimists . At no point did pessimists rate HRQL better than optimists . The results suggest that optimism is associated with better HRQL in French UADT cancer patients & NA ; Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post‐chemotherapy nausea and emesis . In this study , 67 bone marrow transplant patients with hematological malignancies were r and omly assigned to one of four groups prior to beginning transplantation conditioning : hypnosis training (HYP);cognitive behavioral coping skills training (CB);therapist contact control ( TC ) ; ortreatment as usual ( TAU ; no treatment control ) . Patients completed measures of physical functioning ( Sickness Impact Profile ; SIP ) and psychological functioning ( Brief Symptom Inventory ; BSI ) , which were used as covariates in the analyses . Biodemographic variables included gender , age and a risk variable based on diagnosis and number of remissions or relapses . Patients in the HYP , CB and TC groups met with a clinical psychologist for two pre‐transplant training sessions and ten in‐hospital “ booster ” sessions during the course of transplantation . Forty‐five patients completed the study and provided all covariate data , and 80 % of the time series outcome data . Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation . Risk , SIP , and BSI pre‐transplant were found to be effective predictors of inpatient physical symptoms . Nausea , emesis and opioid use did not differ significantly between the treatment groups . The cognitive behavioral intervention , as applied in this study , was not effective in reducing the symptoms measured 24 patients with chronic low back pain were r and omly assigned to three treatment conditions : ( a ) EMG biofeedback , ( b ) relaxation training , and ( c ) a placebo condition . Patients were seen for eight sessions and were evaluated before Session 1 and after Session 8 . Eight analyses of covariance which were adjusted for age and pretest scores were computed on the final scores to find which variables could detect significant difference between treatments . Age was included as a covariate because the differences in age between conditions were significant . Four variables with significant and nearly significant differences were chosen for analysis . The second set of analyses identified the nature of the differences among the three conditions . These included a priori planned comparisons among conditions , and paired t tests . Relaxation-trained subjects were significantly superior to subjects in the placebo condition , in decreasing pain during the function test , increasing relaxation , and decreasing Upper Trapezius EMG . They were superior to EMG Biofeedback training in increasing reported activity . Both Relaxation and EMG trained subjects were able to reduce Upper Trapezius EMG by Session 8 Relaxation-trained subjects showed significant change on eight of the 14 possible comparisons for each treatment condition . EMG biofeedback training showed significant favorable results in only one condition ; the placebo condition showed no significant results . Relaxation training gave better results in reducing EMG and pain , and in increasing relaxation and activity than either EMG biofeedback alone or a placebo condition Chronic low back pain ( CLBP ) presents a problem of massive dimensions . While inpatient approaches have been evaluated , outpatient treatment programs have received relatively little examination . Hypnosis and relaxation are two powerful techniques amenable to outpatient use . Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis ( n = 9 ) or Relaxation Output:

Based on evidence from r and omized controlled trials and in many cases , systematic review s of the literature , the following recommendations can be made : 1 ) multi-component mind-body approaches that include some combination of stress management , coping skills training , cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain ; 2 ) multimodal mind-body approaches such as cognitive-behavioral therapy , particularly when combined with an educational/informational component , can be an effective adjunct in the management of rheumatoid and osteoarthritis ; 3 ) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or st and alone therapy for recurrent tension headache ; 4 ) an array of mind-body therapies ( eg , imagery , hypnosis , relaxation ) when employed pre-surgically , can improve recovery time and reduce pain following surgical procedures ; 5 ) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures

MS2_1shot123

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Transcranial direct current stimulation ( tDCS ) of the human motor cortex results in polarity-specific shifts of cortical excitability during and after stimulation . Anodal tDCS enhances and cathodal stimulation reduces excitability . Animal experiments have demonstrated that the effect of anodal tDCS is caused by neuronal depolarisation , while cathodal tDCS hyperpolarises cortical neurones . However , not much is known about the ion channels and receptors involved in these effects . Thus , the impact of the sodium channel blocker carbamazepine , the calcium channel blocker flunarizine and the NMDA receptor antagonist dextromethorphane on tDCS-elicited motor cortical excitability changes of healthy human subjects were tested . tDCS- protocol s inducing excitability alterations ( 1 ) only during tDCS and ( 2 ) eliciting long-lasting after-effects were applied after drug administration . Carbamazepine selectively eliminated the excitability enhancement induced by anodal stimulation during and after tDCS . Flunarizine result ed in similar changes . Antagonising NMDA receptors did not alter current-generated excitability changes during a short stimulation , which elicits no after-effects , but prevented the induction of long-lasting after-effects independent of their direction . These results suggest that , like in other animals , cortical excitability shifts induced during tDCS in humans also depend on membrane polarisation , thus modulating the conductance of sodium and calcium channels . Moreover , they suggest that the after-effects may be NMDA receptor dependent . Since NMDA receptors are involved in neuroplastic changes , the results suggest a possible application of tDCS in the modulation or induction of these processes in a clinical setting . The selective elimination of tDCS-driven excitability enhancements by carbamazepine proposes a role for this drug in focussing the effects of cathodal tDCS , which may have important future clinical applications Summary Noninvasive brain stimulation has shown considerable promise for enhancing cognitive functions by the long-term manipulation of neuroplasticity [ 1–3 ] . However , the observation of such improvements has been focused at the behavioral level , and enhancements largely restricted to the performance of basic tasks . Here , we investigate whether transcranial r and om noise stimulation ( TRNS ) can improve learning and subsequent performance on complex arithmetic tasks . TRNS of the bilateral dorsolateral prefrontal cortex ( DLPFC ) , a key area in arithmetic [ 4 , 5 ] , was uniquely coupled with near-infrared spectroscopy ( NIRS ) to measure online hemodynamic responses within the prefrontal cortex . Five consecutive days of TRNS-accompanied cognitive training enhanced the speed of both calculation- and memory-recall-based arithmetic learning . These behavioral improvements were associated with defined hemodynamic responses consistent with more efficient neurovascular coupling within the left DLPFC . Testing 6 months after training revealed long-lasting behavioral and physiological modifications in the stimulated group relative to sham controls for trained and nontrained calculation material . These results demonstrate that , depending on the learning regime , TRNS can induce long-term enhancement of cognitive and brain functions . Such findings have significant implication s for basic and translational neuroscience , highlighting TRNS as a viable approach to enhancing learning and high-level cognition by the long-term modulation of neuroplasticity Computer-administered cognitive training ( CT ) tasks are a common component of cognitive remediation treatments . There is growing evidence that transcranial direct current stimulation ( tDCS ) , when given during cognitive tasks , improves performance . This r and omized , controlled trial explored the potential synergistic effects of CT combined with tDCS in healthy participants . Altogether , 60 healthy participants were r and omized to receive either active or sham tDCS administered during training on an adaptive CT task ( dual n-back task ) , or tDCS alone , over 10 daily sessions . Cognitive testing ( working memory , processing speed , executive function , reaction time ) was conducted at baseline , end of the 10 sessions , and at 4-wk follow-up to examine potential transfer effects to non-trained tasks . Altogether , 54 participants completed the study . Over the 10 ' online ' sessions , participants in the active tDCS+CT condition performed more accurately on the CT task than participants who received sham tDCS+CT . The performance enhancing effect , however , was present only during tDCS and did not result in greater learning ( i.e. improvement over sessions ) on the CT task . These results confirm prior reports of enhancement of cognitive function during tDCS stimulation . At follow-up , the active tDCS+CT group , but not the sham tDCS+CT group , showed greater gains on a non-trained test of attention and working memory than the tDCS-only group ( p < 0.01 ) . Although this gain can mainly be attributable to training , this result suggests that active tDCS may have a role in further enhancing outcomes The capacity for transcranial direct current stimulation ( tDCS ) to increase learning and cognition shows promise for the development of enhanced therapeutic interventions . One potential application is the combination of tDCS with cognitive training ( CT ) , a psychological intervention which aims to improve targeted cognitive abilities . We have previously shown that tDCS enhanced performance accuracy , but not skill acquisition , on a dual n-back working memory ( WM ) CT task over repeated sessions . In the current study , we investigated the optimal timing for combining tDCS with the same CT task to enhance within and between session performance outcomes across two daily CT sessions . Twenty healthy participants received in a r and omised order 30 min of anodal tDCS to the left dorsolateral prefrontal cortex immediately before ( ‘ offline ’ tDCS ) and during performance ( ‘ online ’ tDCS ) on a dual n-back WM CT task , in an intra-individual crossover design . Analyses examined within and between session consolidation effects of tDCS on CT performance outcomes . Results showed that ‘ online ’ tDCS was associated with better within session skill acquisition on the CT task , with a significant difference found between conditions the following day . These results suggest that ‘ online ’ tDCS is superior to ‘ offline ’ tDCS for enhancing skill acquisition when combining anodal tDCS with CT . This finding may assist with the development of enhanced protocol s involving the combination of tDCS with CT and other rehabilitation protocol The time-dependent effect of transcranial direct current stimulation ( tDCS ) on working memory was investigated by applying anodal stimulation over the left prefrontal cortex . This single-blind , sham-controlled crossover study recruited 15 healthy participants . A three-back verbal working-memory task was performed before , during , and 30 min after 1 mA anodal or sham tDCS . Anodal tDCS , compared with sham stimulation , significantly improved working-memory performance . Accuracy of response was significantly increased after 20 min of tDCS application , and was further enhanced after 30 min of stimulation . This effect was maintained for 30 min after the completion of stimulation . These results suggest that tDCS at 1 mA enhances working memory in a time-dependent manner for at least 30 min in healthy participants Weak transcranial direct current stimulation ( tDCS ) induces persisting excitability changes in the human motor cortex . These plastic excitability changes are selectively controlled by the polarity , duration and current strength of stimulation . To reveal the underlying mechanisms of direct current (DC)-induced neuroplasticity , we combined tDCS of the motor cortex with the application of Na(+)-channel-blocking carbamazepine ( CBZ ) and the N-methyl-D-aspartate (NMDA)-receptor antagonist dextromethorphan ( DMO ) . Monitored by transcranial magnetic stimulation ( TMS ) , motor cortical excitability changes of up to 40 % were achieved in the drug-free condition . Increase of cortical excitability could be selected by anodal stimulation , and decrease by cathodal stimulation . Both types of excitability change lasted several minutes after cessation of current stimulation . DMO suppressed the post-stimulation effects of both anodal and cathodal DC stimulation , strongly suggesting the involvement of NMDA receptors in both types of DC-induced neuroplasticity . In contrast , CBZ selectively eliminated anodal effects . Since CBZ stabilizes the membrane potential voltage-dependently , the results reveal that after-effects of anodal tDCS require a depolarization of membrane potentials . Similar to the induction of established types of short- or long-term neuroplasticity , a combination of glutamatergic and membrane mechanisms is necessary to induce the after-effects of tDCS . On the basis of these results , we suggest that polarity-driven alterations of resting membrane potentials represent the crucial mechanisms of the DC-induced after-effects , leading to both an alteration of spontaneous discharge rates and to a change in NMDA-receptor activation BACKGROUND Major depressive disorder ( MDD ) is frequently associated with underactivity of the dorsolateral prefrontal cortex ( DLPFC ) which has led to this brain region being identified as an important target for the development of neurobiological treatments . Transcranial direct current stimulation ( tDCS ) administered to the DLPFC has antidepressant efficacy , however the magnitude of antidepressant outcomes are limited . Concurrent cognitive activity has been shown to enhance tDCS induced stimulation effects . Cognitive control training ( CCT ) is a new cognitive therapy for MDD that aims to enhance DLPFC activity via behavioral methods . HYPOTHESIS We tested the hypothesis that co-administration of DLPFC tDCS and CCT would result in a greater reduction in depressive symptomology than administration of tDCS or CCT alone . METHODS 27 adult participants with MDD were r and omized into a three-arm sham-controlled between-groups pilot study comparing the efficacy of 2 mA tDCS + CCT , sham tDCS + CCT and sham CCT + 2 mA tDCS ( 5 sessions administered on consecutive working days ) . Blinded assessment s of depression severity and cognitive control were conducted at baseline , end of treatment and a three week follow up review . RESULTS All three treatment conditions were associated with a reduction in depression severity at the end of five treatment sessions . However , only administration of tDCS + CCT result ed in sustained antidepressant response at follow up , the magnitude of which was greater than that observed immediately following conclusion of the treatment course . CONCLUSIONS The results provide preliminary evidence that concurrent CCT enhances antidepressant outcomes from tDCS . In the current sample , participants receiving concurrent tDCS and CCT continued to improve following cessation of treatment . The clinical superiority of a combined therapeutic approach was apparent even in a small sample and following a relatively short treatment course Improvement in performance following cognitive training is known to be further enhanced when coupled with brain stimulation . Here we ask whether training-induced changes can be maintained long term and , crucially , whether they can extend to other related but untrained skills . We trained overall 40 human participants on a simple and well established paradigm assessing the ability to discriminate numerosity – or the number of items in a set – which is thought to rely on an “ approximate number sense ” ( ANS ) associated with parietal lobes . We coupled training with parietal stimulation in the form of transcranial r and om noise stimulation ( tRNS ) , a noninvasive technique that modulates neural activity . This yielded significantly better and longer lasting improvement ( up to 16 weeks post-training ) of the precision of the ANS compared with cognitive training in absence of stimulation , stimulation in absence of cognitive training , and cognitive training coupled to stimulation to a control site ( motor areas ) . Critically , only ANS improvement induced by parietal tRNS + Training transferred to proficiency in other parietal lobe-based quantity judgment , i.e. , time and space discrimination , but not to quantity-unrelated tasks measuring attention , executive functions , and visual pattern recognition . These results indicate that coupling intensive cognitive training with tRNS to critical brain regions result ed not only in the greatest and longer lasting improvement of numerosity discrimination , but importantly in this enhancement being transferable when trained and untrained abilities are carefully chosen to share common cognitive and neuronal components Non-invasive electrical stimulation of the human cortex by means of transcranial direct current stimulation ( tDCS ) has been instrumental in a number of important discoveries in the field of human cortical function and has become a well-established method for evaluating brain function in healthy human participants . Recently , transcranial alternating current stimulation ( tACS ) has been introduced to directly modulate the ongoing rhythmic brain activity by the application of oscillatory currents on the human scalp . Until now the efficiency of tACS in modulating rhythmic brain activity has been indicated only by inference from perceptual and behavioural consequences of electrical stimulation . No direct electrophysiological evidence of tACS has been reported . We delivered tACS over the occipital cortex of 10 healthy participants to entrain the neuronal oscillatory activity in their individual alpha frequency range and compared results with those from a separate group of participants receiving sham stimulation . The tACS but not the sham stimulation elevated the endogenous alpha power in parieto- central electrodes of the electroencephalogram . Additionally , in a network of spiking neurons , we simulated how tACS can be affected even after the end of stimulation . The results show that spike-timing-dependent plasticity ( STDP ) selectively modulates synapses depending on the resonance frequencies of the neural circuits that they belong to . Thus , tACS influences STDP which in turn results in aftereffects upon neural activity . The present findings are the first direct electrophysiological evidence of an interaction of tACS and ongoing oscillatory activity in the human cortex . The data demonstrate the ability of tACS to specifically modulate oscillatory brain activity and show its potential both at fostering knowledge on the functional significance of brain oscillations and for therapeutic application Perceptual learning is considered a manifestation of neural plasticity Output:

Findings indicated that tES + CT enhanced performance on the majority of CT tasks . The effects on non-trained tasks were mixed , with some evidence for improvements in working memory , cognitive control , approximate number sense and arithmetic processing . tES + CT enhances performance on CT tasks across a range of cognitive functions . Preliminary evidence suggests that tES may also increase transfer effects to non-trained tasks in some domains .

MS2_1shot124

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To compare the effectiveness of annual topical application of silver diamine fluoride ( SDF ) solution , semi-annual topical application of SDF solution , and annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth . METHODS A total of 212 children , aged 3 - 4 years , were r and omly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth : Gp1-annual application of SDF , Gp2-semi-annual application of SDF , and Gp3-annual application of glass ionomer . Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested . RESULTS After 24 months , 181 ( 85 % ) children remained in the study . The caries arrest rates were 79 % , 91 % and 82 % for Gp1 , Gp2 and Gp3 , respectively ( p=0.007 ) . In the logistic regression model using GEE to adjust for clustering effect , higher caries arrest rates were found in lesions treated in Gp2 ( OR=2.98 , p=0.007 ) , those in anterior teeth ( OR=5.55 , p<0.001 ) , and those in buccal/lingual smooth surfaces ( OR=15.6 , p=0.004 ) . CONCLUSION Annual application of either SDF solution or high fluoride-releasing glass ionomer can arrest active dentine caries . Increasing the frequency of application to every 6 months can increase the caries arrest rate of SDF application . CLINICAL SIGNIFICANCE Arrest of active dentine caries in primary teeth by topical application of SDF solution can be enhanced by increasing the frequency of application from annually to every 6 months , whereas annual paint-on of a flowable glass ionomer can also arrest active dentine caries and may provide a more aesthetic outcome Root caries is common in institutionalized elders , and effective prevention methods are needed . This clinical trial compared the effectiveness of four methods in preventing new root caries . From 21 residential homes , 306 generally healthy elders having at least 5 teeth with exposed sound root surfaces were r and omly allocated into one of four groups : ( 1 ) individualized oral hygiene instruction ( OHI ) ; ( 2 ) OHI and applications of 1 % chlorhexidine varnish every 3 months ; ( 3 ) OHI and applications of 5 % sodium fluoride varnish every 3 months ; and ( 4 ) OHI and annual applications of 38 % silver diamine fluoride ( SDF ) solution . Two-thirds ( 203/306 ) of the elders were followed for 3 years . Mean numbers of new root caries surfaces in the four groups were 2.5 , 1.1 , 0.9 , and 0.7 , respectively ( ANOVA , p < 0.001 ) . SDF solution , sodium fluoride varnish , and chlorhexidine varnish were more effective in preventing new root caries than giving OHI alone Background Occlusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to caries . The objective of the study was to assess and compare the effect of a single application of 38 % SDF with ART sealants and no treatment in preventing dentinal ( D3 ) caries lesions on occlusal surfaces of permanent first molars of school children who participated in a daily school-based toothbrushing program with fluoride toothpaste . Methods The prospect i ve community clinical trial in the Philippines was conducted over a period of 18 months and included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based fluoride toothpaste brushing program . Children were r and omly assigned for SDF application or ART sealant treatment . Children from two of the eight schools did not receive SDF or ART sealant treatment and served as controls . SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars . Surfaces that were originally defined as sound at baseline but which changed to dentinal ( D3 ) caries lesions were defined as surfaces with new caries ( caries increment ) . Non-compliance to the daily toothbrushing program in three schools offered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste brushing and in non-toothbrushing children . Results In the brushing group , caries increment in the SDF treatment group was comparable with the non-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a statistically significant lower hazard ratio of 0.12 ( 0.02 - 0.61 ) . In the non-brushing group , caries increment in the SDF treatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only statistically significant for the sealant group ( HR 0.33 ; 0.20 - 0.54 ) . Caries increment was lower in toothbrushing children than in non-toothbrushing children . Hazard ratios reached statistical significance for the non-treated children ( HR 0.43 ; 0.21 - 0.87 ) and the sealant-treated children ( HR 0.15 ; 0.03 - 0.072 ) . Conclusions A one-time application of 38 % SDF on the occlusal surfaces of permanent first molars of six- to eight-year-old children is not an effective method to prevent dentinal ( D3 ) caries lesions . ART sealants significantly reduced the onset of caries over a period of 18 months . Trial registration numberGerman Clinical Trial Register Background / Aims : Root caries among elderly communities is of growing public health concern globally . This controlled clinical trial investigated the effectiveness of silver diamine fluoride and oral health education in preventing and arresting root caries . Methods : Two hundred sixty-six elderly subjects who had at least 5 teeth with exposed root surfaces and did not have serious life-threatening medical diseases were allocated to 3 groups according to a computer-generated r and om list : group 1 ( the control group ) received oral hygiene instructions ( OHI ) annually ; group 2 received OHI and silver diamine fluoride ( SDF ) application annually , and group 3 was given OHI and SDF application annually , plus an oral health education ( OHE ) programme every 6 months . Results : Two hundred twenty-seven elderly subjects were followed for 24 months . The mean numbers of new root caries surfaces in groups 1 , 2 and 3 were 1.33 , 1.00 and 0.70 , respectively ( ANOVA , p < 0.05 ) . Group 3 had fewer root surfaces with new caries than group 1 ( Scheffé multiple-comparison test , p < 0.05 ) . The mean numbers of arrested root caries surfaces in groups 1 , 2 and 3 were 0.04 , 0.28 and 0.33 , respectively ( ANOVA , p < 0.01 ) . Group 3 and group 2 had a greater number of active root caries surfaces which became arrested than group 1 ( Scheffé multiple-comparison test , p < 0.05 ) . Conclusion : Annual application of SDF together with biannual OHE was effective in preventing new root caries and arresting root caries among community-dwelling elderly subjects Aim : To evaluate in vivo the remineralizing efficacy of silver diamine fluoride ( SDF ) , glass ionomer Type VII ( GC VII ) and calcium hydroxide ( Dycal ) . Material s and Methods : 60 subjects in the age group of 18 - 35 years , matching the inclusion criteria and having deep carious lesions in the permanent first and second molars were selected . The teeth were aseptically opened under rubber dam and after gross caries removal , approximately 0.4 mg of soft discolored dentin was removed with a sharp spoon excavator from the mesial or distal aspect of the cavity . The test material was r and omly selected and applied in a thickness of 1.5 - 2 mm and the cavity sealed with cavit . The patients were followed up at regular intervals with radiographic evaluation at 12 weeks . At 3 months the temporary restoration was removed and dentin sample s were collected from the other half of the cavity which was left in the first appointment . Atomic absorption spectrophotometry , Colorimetric test using UV-vis spectrometer and potentiometric titration were used for determining calcium , phosphorous and fluoride respectively . Results : Almost equivalent rise in the percentage of calcium level was seen in GC VII and Ca(OH)2 groups , followed by SDF group . Highest percentage rise in phosphate ions was seen in GC VII group followed by SDF group and Ca(OH)2 group . Highest percentage of fluoride rise was seen in GC VII group followed by SDF group and Ca(OH)2 group . Conclusions : The results indicated that both GC VII and SDF can be potential indirect pulp capping material Arresting Caries Treatment ( ACT ) has been proposed to manage untreated dental caries in children . This prospect i ve r and omized clinical trial investigated the caries-arresting effectiveness of a single spot application of : ( 1 ) 38 % silver diamine fluoride ( SDF ) with tannic acid as a reducing agent ; ( 2 ) 38 % SDF alone ; ( 3 ) 12 % SDF alone ; and ( 4 ) no SDF application in primary teeth of 976 Nepalese schoolchildren . The a priori null hypothesis was that the different treatments have no effect in arresting active cavitated caries . Only the single application of 38 % SDF with or without tannic acid was effective in arresting caries after 6 months ( 4.5 and 4.2 mean number of arrested surfaces ; p < 0.001 ) , after 1 year ( 4.1 and 3.4 ; p < 0.001 ) , and after 2 years ( 2.2 and 2.1 ; p < 0.01 ) . Tannic acid conferred no additional benefit . ACT with 38 % SDF provides an alternative when restorative treatment for primary teeth is not an option To investigate the effectiveness of topical fluorides in preventing fissure caries , we conducted a r and omized controlled trial with parallel groups . In total , 501 children ( 1,539 molars , 3,078 sites ) , mean age 9.1 years , who had at least one sound permanent first molar with deep fissures or fissures with signs of early caries were recruited . They were r and omly allocated among four groups : ( 1 ) resin sealant , single placement ; ( 2 ) 5 % NaF varnish , semi-annual application ; ( 3 ) 38 % silver diamine fluoride ( SDF ) solution , annual application ; and ( 4 ) placebo control . Follow-up examinations were conducted every 6 months by a masked examiner . After 24 months , 485 children ( 97 % ) were examined . Proportions of pit/fissure sites with dentin caries in the sealant , NaF , SDF , and control groups were 1.6 % , 2.4 % , 2.2 % , and 4.6 % , respectively . A multi-level logistic regression analysis accounting for the effects of data clustering and confounding factors showed that fissures in any of the three treatment groups had significantly lower risks of carious cavity development into dentin than did controls ( p < 0.05 ) . We concluded that placement of resin sealant , semi-annual application of NaF varnish , and annual application of SDF solution are all effective in preventing pit and fissure caries in permanent molars ( Clinical Trials.gov number CT01446107 ) Background There is growing interest in the use of diammine silver fluoride ( DSF ) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world . While DSF has been available in various formulations for many years , most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized . Methods This preliminary study determined the applied doses ( 3 teeth treated ) , maximum serum concentrations , and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode , and silver was determined using inductively coupled plasma-mass spectrometry . The mean amount of DSF solution applied to the 3 teeth was 7.57 mg ( 6.04 μL ) . Results Over the 4 hour observation period , the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver . These maximums were reached 3.0 h and 2.5 h for fluoride and silver , respectively . Conclusions Fluoride exposure was below the U.S. Environmental Protection Agency ( EPA ) oral reference dose . Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime , but for occasional use was well below concentrations associated with toxicity . This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults . Clinical trials registration NCT01664871 Systematic review s have become very popular . A recent estimate suggests that 22 new systematic review s are published daily [ 1 ] . One reason for this interest is that they serve many purpose s. For example , the influential Institute of Medicine has indicated that a systematic review is an essential component when developing clinical practice guidelines within the USA [ 2 ] . Some granting agencies are now advocating for the use of systematic review s as an evidence -based rationale for the conduct of a proposed r and omized trial [ 3 ] . And journals are now dem and ing the use of systematic review s to provide readers with context of the results of a clinical trial [ 4 ] . For systematic review s to be useful , they need to be reported in Output:

This systematic review evaluates the use of SDF for both root caries prevention and arrest in older adults . Existing reports of SDF trials support effectiveness in root caries prevention and arrest , remineralization of deep occlusal lesions and treatment of hypersensitive dentin

MS2_1shot125

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The aim of the present study was to evaluate the efficacy of alpha-human atrial natriuretic peptide ( hANP ) in cardiac surgery under cardiopulmonary bypass ( CPB ) . METHODS AND RESULTS A prospect i ve r and omized study was conducted with 150 patients who underwent scheduled coronary artery bypass grafting to compare a group of patients receiving 0.02 microg x kg(-1 ) x min(-1 ) of hANP from the initiation of CPB with a group not receiving hANP . Hemodynamics , levels of atrial and brain natriuretic peptides ( BNP ) , angiotensin-II and aldosterone , renin activity , and left ventricular ( LV ) function were examined . The hANP group showed significantly lower renin activity and lower levels of angiotensin-II and aldosterone during the early postoperative period , compared with the non-hANP group . The incidence of postoperative ventricular arrhythmia and the postoperative peak level of creatine kinase-MB were significantly lower in the hANP group . BNP at 1 month after surgery and measures of LV function were also significantly lower in the hANP group . CONCLUSIONS Low-dose continuous infusion of hANP during cardiac surgery not only had a compensatory effect for the imperfections of CPB during the early postoperative period but also an inhibitory effect on postoperative LV remodeling and a reduction in ischemia/reperfusion injury . hANP should be part of the postoperative care for cardiac surgery BACKGROUND We evaluated the effects of human atrial natriuretic peptide ( hANP ) during cardiopulmonary bypass ( CPB ) . METHODS Forty patients undergoing coronary artery bypass grafting were investigated . A group of patients given hANP for 24 hours from the start of CPB ( hANP group ) was compared with a non-hANP group . Parameters examined were hemodynamics , urine volume , dosage of furosemide , respiratory index , pleural effusion , ANP , cyclic guanosine monophosphate , renin activity ( renin ) , angiotensin-II , aldosterone , and glomerular filtration rate . RESULTS Central venous pressure , systemic vascular resistance index , and pulmonary vascular resistance index were significantly lower in the hANP group than in the non-hANP group . The hANP group showed significantly higher levels of ANP , cyclic guanosine monophosphate , glomerular filtration rate , and respiratory index , and significantly lower levels of renin , angiotensin-II , aldosterone , and pleural effusion , as compared with the non-hANP group . The dosage of furosemide was significantly lower and the urine volume was significantly larger in the hANP group . CONCLUSIONS hANP can satisfactorily compensate for the shortcomings of CPB by decreasing the peripheral vascular resistance , suppressing the renin-angiotensin-aldosterone system , and exerting a strong diuretic effect Atrial natriuretic factor ( ANF ) ameliorates renal damage in animal models of acute ischemic renal failure . Consequently , ANF could blunt acute tubular necrosis related to ischemia that occurs frequently in cadaveric renal transplants . Ten pairs of cadaveric kidneys were transplanted into 20 recipients . Paired recipients received either alpha-human ANF ( hANF ) or vehicle alone in a prospect i ve , double-blind protocol . Upon revascularization of the allograft , either hANF or vehicle was administered intravenously as a 50-micrograms bolus , followed by a 4-h infusion ( 0.1 microgram/kg/min ) . Glomerular filtration rate ( [125I]iothalamate clearance ) was measured between 4 and 7 days posttransplant and again between 14 and 21 days posttransplant . Serum creatinine was measured daily when patients were in the hospital , then twice weekly as patients were examined in the outpatient clinic . Between the groups , there was no significant difference in age of the recipients or donors , cold ischemia time , or histocompatibility leukocyte antigen match . Infusion of hANF had no adverse effects . When subjects receiving hANF were compared with those treated with vehicle alone , there were no significant differences in serum creatinine or glomerular filtration rate . Three hANF and four vehicle recipients required dialysis postoperatively . At 1 month posttransplant , 19 of 20 patients had functioning allografts ; an allograft from one hANF recipient never functioned . It was concluded that hANF , when given by the protocol of this study , had no beneficial effect on the outcome of cadaveric renal transplantation in humans This study was performed to investigate the effects of atrial natriuretic peptide ( ANP ) and mannitol on renal blood flow ( RBF ) and radiocontrast-induced nephropathy ( RCIN ) in human subjects with chronic renal failure . ANP preserves glomerular filtration rate or RBF ( or both ) in severe animal models of acute renal failure . Radiocontrast is known to substantially decrease RBF and can induce acute renal failure . Twenty consecutive patients with chronic renal failure ( 60 % with diabetes ) were r and omized in a prospect i ve , double-blind fashion to receive either ANP ( 50 micrograms bolus , then 1 microgram/min infusion ) or mannitol ( 15 % at 100 ml/hr ) for 2 hours before and during cardiac catheterization with diatrizoate . Baseline serum creatinine level ( ANP 2.4 + /- 0.7 mg/dl , mannitol 2.5 + /- 0.8 mg/dl ) , medications , and quantity of radiocontrast were similar in both groups . Direct measurements of RBF were made with thermodilution catheters placed in the left renal vein . RBF rose significantly ( p less than 0.05 ) , to 198 % of baseline at 15 minutes and 166 % of baseline at 65 minutes in the group receiving ANP and remained stable in the group receiving mannitol . ANP levels rose significantly from baseline at 5 , 15 , 65 and 120 minutes in both groups ( p less than 0.05 ) . Acute renal failure defined as a 0.5 mg/dl rise of creatinine within 24 hours of cardiac catheterization , developed only in patients with diabetes mellitus and was similar in both experimental groups ( ANP , 50 % ; mannitol , 30 % ) . Only patients with diabetes mellitus responded with an increase in RBF after a 5-minute infusion of either ANP or mannitol ( diabetes , 165 % + /- 28 % baseline ; no diabetes , 96 % + /- 8 % baseline ) ( p less than 0.05 ) . In conclusion , RBF was maintained or increased despite administration of radiocontrast , a documented renal vasoconstrictor . Patients with diabetes mellitus had a renal vasodilatory response to drug infusion . Acute renal failure occurred to a similar extent in both groups . Plasma ANP levels rose significantly in both groups . Mannitol may induce ANP release , thus contributing to mannitol 's renal effects Acute renal failure is a serious problem following heart transplantation . In first uncontrolled clinical trials , Urodilatin revealed beneficial effects in the prophylaxis and therapy of acute renal failure following heart and liver transplantation . Here , we present the first r and omized , placebo-controlled , double-blind study on 24 patients following heart transplantation to investigate whether prophylactic i.v . Urodilatin infusion can prevent acute renal failure requiring renal replacement therapy . Postoperative drug management was characterized by intravenous application of high furosemide , cyclosporine , and vancomycin doses . Urodilatin infusion was started postoperatively with a dose of 40 ng / kg bw / min for 6 days . 6 of the 12 patients in the Urodilatin group and 6 of the 12 patients in the placebo group had a stable diuresis ( 3 - 4 l / day ) during the study period of 6 days . In contrast , the remaining 6 patients of each group developed oliguria / anuria and required subsequent hemofiltration / hemodialysis . Cumulative duration of hemofiltration ( 88 + /- 7.39 hours in the placebo treated patients versus 44 + /- 5.35 hours in the Urodilatin treated patients , p < 0 . 05 ) as well as frequency of hemodialysis ( 3.0 + /- 0.49 times in the placebo group vs 1.2 + /- 0.29 times in the Urodilatin group , p < 0 . 05 ) were significantly reduced using Urodilatin . Mean arterial blood pressure was stable during the Urodilatin infusion period and was not different to that observed in placebo patients . We conclude that Urodilatin does not reduce the incidence of acute renal failure and the subsequent requirement for hemofiltration / hemodialysis in our patient population , but seems to reduce the duration of hemofiltration and frequency of hemodialysis compared to the placebo group Summary Renal failure after heart transplantation ( HTx ) still remains a serious problem , especially when cyclosporin A is used for immunosuppression in the early postoperative therapy . To preserve good renal function without reducing immunosuppressive cyclosporin A treatment , we administered urodilatin ( CDD/ANP-95 - 126 ) in a long-term , low-dose infusion in addition to the usual medication after heart transplantation . From November 1990 to June 1991 , 51 patients ( 46 male and 5 female ; mean age 48 years ) were treated with a 620 ng/kg bw·min infusion for 96 h after HTx . The renal function and hemodynamic parameters of these urodilatin-treated patients were compared in this sequential study with 40 patients ( 33 male and 7 female ; mean age 49 years ) who had undergone HTx previously from May to November , 1990 , as controls . In this phase IIa study , both groups did not differ significantly with respect to age , sex , indication for HTx , and preoperative renal function . In comparison with controls patients treated with urodilatin had a significantly better renal function : a reduction in the peak plasma creatinine ( PC values day 4 : 1.5 ± 0.11 vs. 2.19 ± 0.19 mg/dl ; P = 0.002 ) , a lower peak serum urea ( SU values day 4 : 109 ± 8 vs. 154.7 ± 8.94 mg/dl ; P = 0.0036 ) , and a lower incidence of hemodialysis ( 6 % vs. 10 % ) were observed . Adequate diuresis was maintained in spite of the reduction of furosemide by more than 60 % ( P = 0.005 ) on each day of urodilatin infusion in comparison with controls . The mean central venous pressure was significantly lower by about 50 % ( P = 0.02 ) during the administration of urodilatin in spite of reduced vasodilator medication with nitroglycerin . From this phase IIa study , we may conclude that urodilatin could be an important drug in intensive care treatment . For patients undergoing HTx , this peptide seems to be indicated for the improvement of renal function and cardiovascular status , especially in postoperative therapy using high-dose cyclosporin A treatment Many therapeutic measures have been employed to prevent or at least ameliorate postoperative renal impairment following liver transplantation . Recent clinical phase II studies have demonstrated that the new natriuretic peptide urodilatin has beneficial effects on renal function following heart and liver transplantation . The present study reports the first prospect i ve r and omized placebo-controlled trial of prophylactic urodilatin administration following liver transplantation . Seventy consecutive recipients of primary liver transplants were included in the study following r and omization , and 33 patients continuously received urodilatin at a dose of 20 ng/kg/min for 7 d. The remaining 37 patients received a placebo infusion for the same time period . The course of serum creatinine and urea did not differ between the two groups nor did the daily urine production . However , the urodilatin group showed a higher preoperative median serum creatinine and a significant reduction on days 1 and 2 , whereas this observation was not made in the placebo group . Furthermore , less furosemide was administered to the patients in the urodilatin group during the first 2 d. The incidence of postoperative hemodialysis and the number of treatments did not differ between the groups either ( urodilatin group 4 , vs. placebo group 6 and 22 for both groups , respectively ) . Side effects of the urodilatin therapy were not detected . The prophylactic low-dose urodilatin administration result ed in a trend towards amelioration of the renal function , but did not result in significant differences between the two experimental groups . Further studies , using higher doses , will be required to define the value of urodilatin for prevention of renal impairment after liver transplantation Objective Imbalance in the renal medullary oxygen supply/dem and relationship can cause hypoxic medullary damage and ischemic acute renal failure . Human atrial natriuretic peptide ( h-ANP ) increases glomerular filtration rate in clinical acute renal failure . This would increase renal oxygen consumption due to increased tubular load of sodium . Loop diuretics are commonly used in acute renal failure . Data on the effects of loop diuretics on glomerular Output:

For the treatment of established AKI , ANP , particularly in high doses , was associated with a trend toward increased mortality and more adverse events . Analysis of the existing literature suggests ANP might be associated with beneficial clinical effects when administered in patients undergoing major surgery such as cardiovascular surgery .

MS2_1shot126

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : The effect of regular and expected printed educational material s on physician prescribing behaviour has not been studied . We sought to measure the impact of a series of evidence -based drug therapy letters mailed to physicians in British Columbia on prescribing to newly treated patients . Methods : A paired , cluster r and omized community design was used . The study population included 499 physicians from 24 local health areas in British Columbia . Local health areas were paired by number of physicians , and 1 of each pair was r and omly selected and its physicians assigned to an intervention group or a control group . The intervention was 12 issues of an evidence -based series called Therapeutics Letter . Physicians in the control group ( n = 241 ) received the letters 3–8 months after physicians in the intervention group ( n = 258 ) . The impact on prescribing to newly treated patients ( defined as patients who had not previously made a cl aim for any medication from the class of drugs profiled in the letter ) was analyzed using the drug cl aims data base of BC Pharmacare , a publicly funded drug benefits program that covered all seniors and people receiving social assistance . Results : The probability of prescribing a drug recommended in the Therapeutics Letter rather than another drug in the same class increased by 30 % in the 3 months after the mailing of the letter relative to the preceding 3 months , adjusted for any before – after changes in the control group ( relative risk 1.30 ; 95 % confidence interval 1.13–1.52 ) . No letter achieved statistical significance on its own . However , 11 of the 12 letters produced prescribing changes in the predicted direction such that the overall result was significant when their effect was combined . Interpretation : The combined effect of an ongoing series of printed letters distributed from a credible and trusted source can have a clinical ly significant effect on prescribing to newly treated patients This study tests whether a managed behavioral health care organization can influence adherence to practice guidelines for the treatment of major depression in a r and omized trial of guideline dissemination . Guidelines were disseminated to mental health clinicians ( N=443 ) under one of three conditions : ( 1 ) a general mailing of guidelines to clinicians , ( 2 ) a mailing in which guidelines were targeted to a patient starting treatment with the clinician , and ( 3 ) no mailing of guidelines . The results showed no effects of guideline dissemination as measured by self-report of patients and clinicians and through episode characteristics derived from cl aims data , despite sentinel effects . Results also showed high rates of clinician-reported guideline adherence that were not detected in the cl aims data , indicating significant undertreatment of depression . Results suggest that mental health systems must look to other dissemination strategies to improve adherence to st and ards of care and raise the performance of independent practicing Little is known about incorporation of new knowledge from r and omised clinical trials into clinical practice . Thrombolytic therapy was shown to reduce the mortality of acute myocardial infa rct ion in several large trials published during 1986 - 88 . To examine the effect of these data on clinical practice , we analysed the supply of thrombolytic drugs in a representative English region ( population 4.7 million ) in 1987 - 92 . During the study period there were over 10,000 hospital admissions per year in the region for acute myocardial infa rct ion . From a very low initial level , thrombolytic drug use rose slowly for several years after publication of the trial results and reached a plateau in 1991 - 92 . Rates of use per 1000 patients admitted with myocardial infa rct ion varied almost six-fold between districts in 1989 - 90 and over two-fold in 1991 - 92 . Level of use attained by districts in the latter period was strongly associated with the extent of their previous participation in multicentre trials of thrombolysis ( p = 0.003 ) ; we estimate that 35 - 50 % of patients admitted with acute myocardial infa rct ion were receiving thrombolytics . The full potential of thrombolytic treatment has still not been achieved in routine care and the limiting factors need to be defined Study Design . Back‐injured workers with high disability risk scores on a predictive question naire participated in a r and omized , controlled trial of physician notification , with outcomes follow‐up 3 months after injury . Objectives . To test whether physician intervention improves return to work and self‐ assessment outcomes for people at relatively high risk for disability . Summary of Background Data . Only a small number of back‐injured workers suffer significant disability . Ouick identification of these people would facilitate more efficient targeting and trials of interventions . Controlling variations in practice through practice guidelines has been recommended as a promising strategy for improving care and reducing disability . Methods . Workers filing back injury reports responded to a disability prediction question naire . Those with high risk scores were r and omly assigned to control or intervention groups . Patient‐ design ated physicians in the intervention group received two letters identifying the patient 's risk and making recommendations for care , including the Agency for Health Care Policy and Research 's algorithms for acute low back pain . Predictive accuracy of the question naire and efficacy of physician intervention were evaluated on the basis of work status and self‐ assessment s 3 months after injury . Results . Of the 268 workers completing the question naire portion of the study , 32 ( 12 % ) were out of work because of back pain 3 months after injury . The question naire 's predictive accuracy included maximum κ of 0.277 and a receiver operating curve area of 0.78 . Fifty‐three people completed the physician intervention trial . The intervention had no significant impact on return to work , self‐assessed pain , or satisfaction with health care . Conclusions . Stratification of back‐injured people according to disability risk can can increase intervention efficiency by identifying those who require treatment and sparing those who do not . The apparent failure of risk notification and practice guidelines to reduce disability in this study may be improved by different application methods in the future BACKGROUND Public agencies responsible for implementing health care policies often adapt and disseminate clinical practice guidelines , but the effectiveness of mass dissemination of guidelines is unknown . AIM To study the effects of guideline dissemination on physicians ' prescribing practice s for the treatment of stable angina pectoris . DESIGN R and omized controlled trial . METHODS A sample of 3293 Quebec physicians were r and omly assigned to receive a one-page summary of clinical practice guidelines on the treatment of stable angina ( in February 1999 ) , to receive the summary and a reminder ( in February and March 1999 , respectively ) , or to receive no intervention ( controls ) . The prescribing profiles of participants , as well as sociodemographic characteristics of the physicians and their patients , were examined for June-December 1999 . RESULTS The intervention had no effect on prescription rates of beta-blockers , antiplatelet agents , or hypolipaemic drugs . Compared to 1997 data for the same physicians , there was an overall 10 % increase in appropriate prescription rates , irrespective of the intervention . DISCUSSION In-house production and dissemination of clinical practice guidelines may not improve physicians ' practice patterns if there is pre-existing substantial scientific consensus on the issue Health risk appraisal ( HRA ) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness . Theories of behavior change predict conventional HRA 's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors . In this study , a r and omized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practice s. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated , individually-tailored behavior change information in addition to typical HRA risk feedback . Changes in seven behaviors were assessed at a 6 month follow-up . Overall , patients receiving enhanced HRA feedback were 18 % more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback ( OR = 1.18 , 95 % CI = 1.00 , 1.39 ) . The enhanced HRA feedback appeared to promote changes in cholesterol screening , dietary fat consumption and physical activity , but not in smoking , seat belt use , mammography and Pap smears . We conclude that the addition of theory-based , individually-tailored behavior change information may improve the effectiveness of HRA The cost-effectiveness of quality assurance programs is often poorly documented , especially for innovative approaches . The authors analyzed the economic effects of an experimental educational outreach program design ed to reduce inappropriate drug prescribing , based on a four-state r and omized controlled trial ( N = 435 physicians ) . Primary care physicians r and omized into the face-to-face group were offered two individualized educational sessions with clinical pharmacists , lasting an average of 18 minutes each , concerning optimal use of three drug groups that are often used inappropriately . After the program , expenditures for target drugs prescribed by these physicians to Medicaid patients decreased by 13 % , compared with controls ( P = 0.002 ) ; this effect was stable over three quarters . Implementation of this program for 10,000 physicians would lead to projected drug savings ( to Medicaid only ) of $ 2,050,000 , compared with re source costs of $ 940,000 . Net savings remain high , even after adjustment for use of substitution medications . Although there was a ninefold difference in average preintervention prescribing levels between the highest and lowest thirds of the sample , all groups reduced target drug expenditures at the same rate . Targeting of higher-volume prescribers would thus further raise the observed benefit-to-cost ratio from approximately 1.8 to at least 3.0 . Net benefits would also increase further if non-Medicaid savings were added , or if the analysis included quality -of-care considerations . Although print material s alone may be marginally cost-effective , print plus face-to-face approaches offer greater net benefits . The authors conclude that a program of brief , face-to-face “ detailing ” visits conducted by academic rather than commercial sources can be a highly cost-effective method for improving drug therapy decisions . Such an approach makes possible the enhancement of physicians ' clinical expertise without relying on restriction of drug choices In order to increase physicians ' adherence to recommended st and ards of medical care and to examine factors presumed to contribute to such changes , we conducted a r and omized , controlled trial using reading material s targeted to specific practice recommendations . Seventy-nine internal medicine residents completed baseline question naires stating their intentions to follow 13 common preventive care actions . They were r and omly assigned to receive one of two different sets of readings covering these care actions . Thus , each physician was in the experimental group for one set of readings ( A or B ) while serving as a control for the other set . The impact of the reading was determined by : the physicians ' knowledge of the recommended care actions detailed in the combined readings , their post-reading intentions , and clinical behavior when faced with patients having indications for the recommended actions . The 73 residents ( 92 % ) who read the material judged 39 % of the information to be new and 72 % useful . Residents had significantly better performance on the knowledge questions based on their own readings than did their control group peers for both sets of readings . For the Group A physicians , reading significantly ( P less than 0.05 ) increased intentions to follow one of the seven clinical actions while Group B residents increased their intentions in three out of six . Step-wise multiple regression analyses were used to predict physicians ' post-reading adherence to the recommended actions . For the Group A actions , pre-reading actions accounted for most of the variance in their post-reading actions . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Radiological tests are often used by general practitioners ( GPs ) . These tests can be overused and contribute little to clinical management . We aim ed to assess two methods of reducing GP requests for radiological tests in accordance with the UK Royal College of Radiologists ' guidelines on lumbar spine and knee radiographs . METHODS We assessed audit and feedback , and educational reminder messages in six radiology departments and 244 general practice s that they served . The study was a before- and -after , pragmatic , cluster r and omised controlled trial with a 232 factorial design . A r and om subset of GP patients ' records were examined for concordance with the guidelines . The main outcome measure was number of radiograph requests per 1000 patients per year . Analysis was by intention to treat . FINDINGS The effect of educational reminder messages ( ie , the change in request rate after intervention ) was an absolute change of -1.53 ( 95 % CI -2.5 to -0.57 ) for lumbar spine and of -1.61 ( -2.6 to -0.62 ) for knee radiographs , both relative reductions of about 20 % . The effect of audit and feedback was an absolute change of -0.07 ( -1.3 to 0.9 ) for lumbar spine of 0.04 ( -0.95 to 1.03 ) for knee radiograph requests , both relative reductions of about 1 % . Concordance between groups did not differ significantly . INTERPRETATION 6-monthly feedback of audit data is ineffective but the routine attachment of educational reminder messages to radiographs is effective and does not affect quality of referrals . Any department of radiology that h and les referrals from primary care could deliver this intervention to good effect Documentation of unexplained geographic variations in medical practice s [ 1 ] and use of interventions inappropriately [ 2 ] or before their effectiveness has been established [ 3 ] has led to the rapid proliferation of clinical practice guidelines . These systematic ally developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances [ 4 ] are an attempt to discourage ineffective medical practice s , encourage effective practice s , and improve health outcomes [ 5 - 10 ] . Despite increasing enthusiasm for guidelines , evidence Output:

Evidence from this review showed that PEMs appear to have small beneficial effects on professional practice . The results of this review suggest that when compared to no intervention , PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes . Despite this wide of range of effects reported for PEMs , clinical significance of the observed effect sizes is not known . There is insufficient information about how to optimise educational material s. The effectiveness of educational material s compared to other interventions is uncertain

MS2_1shot127

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : Inhaled corticosteroids ( ICSs ) are considered the most effective anti‐inflammatory therapy for asthma control and management ; however , there is substantial treatment response variability . Objective : We sought to identify genetic markers of ICS response by conducting the largest pharmacogenetic investigation to date in 2672 ICS‐treated patients with asthma . Methods : Genotyping and imputation was performed in fluticasone furoate ( FF ) or fluticasone propionate – treated patients with asthma from 3 phase IIB and 4 phase IIIA r and omized , double‐blind , placebo‐controlled , parallel group , multicenter studies . The primary end point analyzed was change in trough FEV1 ( & Dgr;FEV1 ) from baseline to 8 to 12 weeks of treatment . Results : More than 9.8 million common genetic variants ( minor allele frequency ≥ 1 % ) were analyzed to test for association with & Dgr;FEV1 . No genetic variant met the prespecified threshold for statistical significance . Conclusions : This study provides no evidence to confirm previously reported associations between c and i date genetic variants and ICS response ( & Dgr;FEV1 ) in patients with asthma . In addition , no variant satisfied the criterion for genome‐wide significance in our study . Common genetic variants are therefore unlikely to prove useful as predictive biomarkers of ICS response in patients with asthma The interpatient variability in response to asthma controllers is significant and associates with pharmacogenomic variability . The goal of the present study was to identify novel variants that associate with response to common asthma controllers : fluticasone , combination of fluticasone + salmeterol and montelukast with single nucleotide polymorphisms ( SNPs ) in β2-adrenergic receptor , corticosteroid and leukotriene pathway c and i date genes . Participants in a large clinical trial of step-down strategies volunteered for this pharmacogenetic study . A total of 169 SNPs in 26 c and i date genes were genotyped in 189 Caucasian participants with asthma who took either fluticasone ( 100 μg bid ) , fluticasone propionate ( 100 μg ) + salmeterol ( 50 μg ) ( FP/Salm ) or montelukast ( 5 or 10 mg ) each night for 16 weeks . Primary outcomes were the slopes of plots of Asthma Control Question naire ( ACQ ) scores versus time following r and omization ; and the percent change in percent predicted FEV1 ( ΔFEV1%pred ) from enrollment to the end of the study . Associations between SNPs and outcomes were analyzed using general linear models . False discovery rate and Bonferroni corrections were used to correct for multiple comparisons . In all , 16 SNPs in seven genes were significantly associated with outcomes . For FP/Salm , three SNPs in CHRM2 associated with ACQ slope ( P=2.8 × 10−5 ) , and rs1461496 in HSPA8 associated with ΔFEV1%pred . For fluticasone , five SNPs in CRHR1 ( P=1.9 × 10−4 ) , and three SNPs in COL2A1 associated with ACQ slope and ΔFEV1%pred , respectively . For montelukast , four SNPs in CHRM2 associated with ΔFEV1%pred and predicted an opposite effect compared with fluticasone ( P=9 × 10−3 ) . The present study indentified several novel SNPs that associate with response to common asthma controllers , and support further pharmacogenomic study and the use of genetic variants to personalize asthma treatment For patients with persistent asthma , the National Asthma Education and Prevention Program recommends the regular use of controller medications to provide long-term control , together with as-needed use of rescue medications ( 1 ) . Inhaled corticosteroids are currently the most commonly used controller medications ( 1 ) . Although inhalation into the airway has advantages in terms of both safety and efficacy , problems with compliance with inhaled agents may limit their real-world effectiveness , especially in elderly and pediatric patients ( 2 , 3 ) . Cysteinyl leukotrienes are important pro-inflammatory mediators of asthma ( 4 ) . Recent clinical studies of leukotriene receptor antagonists ( 5 - 7 ) and a 5-lipoxygenase inhibitor ( 8) have shown these agents to have clinical benefit in patients with chronic asthma , and treatment guidelines now consider these agents alternative , first-line controller medications ( 1 ) . Recent studies showed that montelukast , a potent and specific leukotriene receptor antagonist ( 9 ) , had efficacy in adult ( over a 12-week period ) and pediatric ( over an 8-week period ) patient with chronic asthma and had a tolerability profile similar to that of placebo ( 10 - 12 ) . To date , no comparisons of leukotriene receptor antagonists and inhaled corticosteroids have been published . Our placebo-controlled , parallel-group study , which was primarily design ed to compare the effect of montelukast with that of placebo in a phase III clinical development trial , also compared montelukast and inhaled beclomethasone in patients with chronic asthma who require the daily use of a controller medication . Methods Patients Healthy , nonsmoking , male and female patients 15 years of age and older were eligible to participate if they had had asthma for at least 1 year before the initial study evaluation . Each patient also had to have 1 ) an FEV1 between 50 % and 85 % of predicted value , 2 ) an increase of at least 15 % in absolute FEV1 after the use of inhaled -agonist on at least two of three visits during period 1 [ see below ] , 3 ) a daytime asthma symptom score of at least 64 [ of a possible 336 ] , and 4 ) average daily use of at least one puff of as-needed , short-acting , inhaled -agonist ( salbutamol ) . Patients were excluded from the study if they had used inhaled and oral corticosteroids , cromolyn , or nedocromil within 4 weeks before the initial evaluation ; had used long-acting -agonists , antimuscarinics , and newly instituted theophylline within 2 weeks before the initial evaluation ; or had used long-acting antihistamines ( for example , they could not have used astemizole within 3 months of the initial evaluation , and they could not have used terfenadine or loratadine within 2 weeks of the initial evaluation ) . Intermittent use of short-acting antihistamines was allowed , and immunotherapy was permitted if it had been started at least 6 months before the initial study evaluation and if the monthly dose remained constant . Protocol Our r and omized , double-dummy , placebo-controlled , parallel-group trial had a 2-week , single-blind placebo run-in period ( period 1 ) ; a 12-week , double-blind treatment period ( period 2 ) ; and a 3-week , double-blind placebo washout period [ period 3 ] . Eligible patients were r and omly assigned to one of three treatment regimens : 1 ) montelukast , 10 mg once daily in the evening ; 2 ) inhaled beclomethasone , 200 g twice daily ; or 3 ) placebo . The ratio of montelukast recipients to beclomethasone recipients to placebo recipients was 3:2:2 , with a blocking factor of 7 , according to a single , computer-generated allocation schedule . Patients , investigators , and coordinating center staff were blinded to the treatment schedule until all corrections to the data base were completed . During period 3 , a subset of patients originally assigned to receive active treatment ( approximately 40 , as determined by the allocation schedule ) was switched to placebo in a blinded manner . The other patients originally assigned to receive active treatment continued to receive that treatment . This allowed us to assess withdrawal from therapy . The study was done at 36 clinical centers in 19 countries in Europe , Africa , Australia , Central America , and South America . The study protocol and informed consent were approved by local ethics review committees . All participants gave written informed consent before participation ; consent of parents or guardians was obtained for patients younger than 18 years of age . Patients were recruited from the patient pool of each clinical study center and through local newspaper advertisements . Medication The study medication consisted of 10-mg montelukast film-coated tablets , placebo tablets that were identical in appearance to the montelukast tablets , beclomethasone ( 100 g/puff ) in inhalers ( Allen & Hanburys , Stockley Park , United Kingdom ) , and placebo in inhalers identical to those used for beclomethasone . Patients were instructed to take one tablet at bedtime and to take two puffs from the inhaler ( using the AeroChamber spacer device [ Clement Clark , Columbus , Ohio ] ) at bedtime and in the morning . Short-acting , inhaled -agonist ( salbutamol , 100 g/puff ) ( Allen & Hanburys ) was to be used as needed . Patients with worsening episodes of asthma that required additional therapy were treated with oral corticosteroids according to a st and ard protocol . Patients who had more than two worsening episodes of asthma requiring corticosteroid therapy were dropped from the study . Measurements Central ized spirometry training was done according to st and ard American Thoracic Society criteria before the start of the study . Spirometry was done at each visit after inhaled -agonist therapy had been withheld for at least 6 hours , theophylline therapy had been withheld for at least 24 hours , and antihistamine therapy had been withheld for at least 48 hours . At least three spirometry maneuvers were done , and the largest FEV1 was reported . Spirometry data were transmitted electronically to a central data base and monitored continuously for quality , and feedback was given to the study centers ( 13 ) . If quality was not maintained , sites were visited by coordinating center personnel . Answers to four questions on daytime asthma symptoms and one question on nocturnal awakenings were collected on a daily diary card , as were morning and evening peak expiratory flow rate and daily use of as-needed salbutamol . With respect to daytime asthma symptoms , patients used a 7-point scale ( on which 0 means best and 6 means worst ) to rate the severity of symptoms , their frequency , the degree to which they were bothersome , and their impact on daily activities . These ratings were combined into a mean daily score . Nocturnal awakenings were evaluated by the patient 's response ( on a four-point scale ) to a single question ( 14 ) . The validation of these questions has been published elsewhere ( 14 ) . Peak expiratory flow was measured in the morning and in the evening immediately before study medication was taken . The best of three measurements was recorded . Prespecified end points other than peak expiratory flow included peripheral blood eosinophil counts , global evaluations by physicians and patients ( on a 7-point scale , on which 6 means very much worse and 0 means very much better ) ( 7 ) , and asthma-specific quality of life ( 15 ) . Asthma outcome end points , including asthma attacks ( defined as worsening asthma requiring oral corticosteroid treatment or an unscheduled visit to a physician , emergency department , or hospital ) , percentage of days with asthma exacerbations , and percentage of asthma-control days ( as defined elsewhere [ 11 , 16 ] ) , were also evaluated . The diary card , the Asthma Quality -of-Life Question naire ( 15 ) , and the global evaluation questions were translated from English into appropriate local language s and were vali date d for linguistic equivalence and cultural differences ( 17 ) . Patient compliance with study therapy was determined by weighing inhalers and counting tablets . The weight of a full canister was determined by averaging the weights of at least 50 canisters of beclomethasone and placebo . A st and ard puff weight was determined by repeatedly actuating and weighing 10 canisters . Laboratory safety tests , including hematologic tests , serum biochemistry analysis , and urinalysis , were done at prespecified visits , and the results were analyzed by a central laboratory . The central laboratory also determined eosinophil counts with an automated cell counter . Statistical Analysis Our primary objective was to compare montelukast with placebo with respect to two prespecified primary end points : FEV1 and daytime symptom score . Other objectives were to compare beclomethasone with placebo and to compare montelukast with beclomethasone in a stepwise manner in accordance with the Dunnet-Tamhane approach , with the comparison of montelukast and beclomethasone prespecified as an estimation of the difference using 95 % CIs ( 18 ) . No multiplicity adjustments were made for each of the secondary end points , which were prespecified as supportive . The analysis for each efficacy end point included all patients who had a measurement taken at baseline and at least one measurement taken after r and omization . Treatment responses were calculated as the average change or percentage change from baseline to period 2 ; the baseline value was the average value for period 1 . With SAS software ( SAS Institute , Inc. , Cary , North Carolina ) , we used an analysis of variance ( ANOVA ) model to estimate treatment group means and between-group differences and to construct 95 % CIs by using the least-square means and the differences in least-square means . The model contained factors for treatment , study center , and stratum ( theophylline use ) . The consistency of the treatment effect across study centers , strata , and subgroups ( which were formed according to sex , age , ethnicity , history of allergic rhinitis , and history of exercise-induced asthma ) was assessed by interaction testing done using the ANOVA model with an TBX21 encodes for the transcription factor T-bet Output:

There is little overlap between identified variants and method ologies vary largely . However , in vitro and /or in silico analyses provide additional evidence that genes discovered in these GWAS ( e.g. GLCCI1 , FBXL7 , T gene , ALLC , CMTR1 ) might play a direct or indirect role in asthma/treatment response pathways . Single nucleotide polymorphisms located in GLCCI1 , NR3C1 and the 17q21 locus were positively replicated in independent population s. Although none of the genetic markers has currently reached clinical practise , these studies might provide novel insights in the complex pathways underlying corticosteroids response in asthmatic patients

MS2_1shot128

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Some scientific studies , with controversial results , have evaluated the efficacy in reducing pain of some different local anesthetic molecules , which were administered at different dosages and in different ways . The primary goal of this r and omized , controlled , prospect i ve study ( Clinical Trials.gov ID NCT00599144 ) was to assess the effectiveness of 0.5 % bupivacaine for pain control after video-laparoscopic cholecystectomy at its optimal dosage of 2 mg/kg infiltrated in the muscular fasciae of the trocars , or positioned in the gallbladder soaking a sheet of regenerated oxidized cellulose ( Tabotamp ® ) . Methods A total of 45 patients underwent elective video-laparoscopic cholecystectomy . They were r and omized in three groups each made of 15 patients : group A ( bupivacaine-soaked Tabotamp ® positioned in the gallbladder bed ) , group B ( bupivacaine infiltrated in the muscular fasciae of the trocars ’ seat ) , group C ( control group , not using local anesthetic ) . Six and twenty-four hours after the intervention , the nature of the pain and its intensity were recorded with the use of a Visual Analogue Scale ( VAS ) . Results Six hours after the intervention , VAS average was 29.6 ± 10.92 for group A , 25.86 ± 16.06 for group B , and 36.13 ± 16.62 for group C. At 24 h , we recorded 19.26 ± 15.81 , 18.53 ± 12.3 , and 20.46 ± 20.08 for groups A , B , and C , respectively ( p > 0.05 ) . Comparing groups A and B between them and with the control group at 6 and 24 h , we deduced how only the first group showed a statistically significant advantage ( p < 0.05 ) in reducing visceral and shoulder pain compared with the two other groups . Wound infiltration result ed in being statistically favorable in reducing parietal pain only when compared with Group A. For groups A and B , bupivacaine significantly reduced the use of postoperative pain killers . Conclusion Bupivacaine , either infiltrated in trocars ’ wounds or kept soaked in a regenerated oxidized cellulose sheet positioned in the gallbladder bed , although safe and not economically dem and ing , can increase postoperative comfort Background The aim of this study was to test the use of preincisional and intraperitoneal levobupivacaine ( L-B ) 0.25 % in laparoscopic cholecystectomies for postoperative analgesia . Methods A total of 108 patients under general anesthesia were r and omly assigned to receive preincisional local infiltration of 20 ml solution and intraperitoneal instillation of another 20 ml solution . Group A received for local infiltration and intraperitoneal instillation normal saline ( NS ) . Group B received for local infiltration L-B 0.25 % and for intraperitoneal instillation NS . Group C received for local infiltration NS and for intraperitoneal instillation L-B 0.25 % . Group D received both for local infiltration and intraperitoneal instillation L-B 0.25 % . Abdominal and right shoulder pain were recorded for 24 h postoperatively . Results The pain scores were lower in group D than in the other groups during rest , cough , and movement ( p < 0.05 ) . Rescue analgesic treatment was significantly lower in patients of group D ( 35 % ) as compared with that of group A ( 84 % ) ( p < 0.05 ) . The incidence of right shoulder pain was significantly lower in groups C ( 22 % ) and D ( 18 % ) than in any of the other groups ( p < 0.05 ) . Conclusions The combination of preincisional local infiltration and intraperitoneal instillation of L-B 0.25 % shows an advantage for postoperative analgesia after laparoscopic cholecystectomy BACKGROUND Following laparoscopic cholecystectomy , an effective post-operative pain control is necessary , at least during the first 24 hours . We present a r and omized , double-blind trial on the effect of the combined use of intravenous parecoxib , and metamizol or paracetamol on piritramide consumption using a patient-controlled analgesia ( PCA ) pump in patients recovering from laparoscopic cholecystectomy . METHODS 120 patients were r and omly allocated to four patient groups treated with normal saline or one of non-opioid analgesics ( parecoxib 40 mg twice daily , metamizol 1 g three times daily , paracetamol 1 g three times daily ) in addition to piritramide using the PCA pump . Beginning in the post-anesthesia care unit ( PACU ) , patients were asked every 2 h for 6 hours and afterwards once every 6 h to quantify their pain experience at rest while piritramide consumption was recorded . RESULTS In all groups , piritramide consumption was high in PACU . Only metamizol significantly reduced piritramide consumption compared to the others upon discharge from PACU . Overall , cumulative piritramide consumption was slightly lower in the metamizol group and higher in the NaCl group ; however , these findings were statistically not significant . VAS scores were highest upon arrival in PACU and dropped almost continuously after surgery . A significantly lower postoperative pain intensity was only found in the parecoxib group at 24 h after surgery compared to the metamizol group . CONCLUSION The efficacy of tested additive medications on piritramide consumption and pain relief is weak and there is no clear-cut difference between the non-opioid drugs used BACKGROUND The complexity of pain after laparoscopic cholecystectomy ( LC ) needs multi-module analgesia . Opioids are widely used for perioperative pain but associated with numerous adverse effects . We investigated the effect of parecoxib administrated preoperatively and postoperatively for analgesia after ambulatory laparoscopic cholecystectomy . METHODS 120 patients scheduled for ambulatory LC with general anesthesia were r and omly assigned to three groups : group A received 40 mg parecoxib injection 30 - 45 min before anesthesia induction and 4 ml saline injection when gallbladder was removed ; group B received 4 ml saline injection 30 - 45 min before anesthesia induction and 40 mg parecoxib injection when gallbladder was removed ; group C received 4 ml saline injection 30 - 45 min before anesthesia induction and the time when gallbladder was removed . We recorded the time achieve to modified Aldrete 's score > 9 in the post-anesthesia care unit ( PACU ) and modified Post-Anesthetic Discharge Scoring System ( PADSS ) > 9 in ambulatory unit . The visual analog scale ( VAS ) was used to assess the degree of the postoperative pain in the first 24 h , and the numbers of patients who need additional analgesic and postoperative adverse effects were also recorded . RESULTS Patients of group A had a shorter length of stay ( LOS ) in PACU compared to these of group B and group C ( 32.4 ± 7.2 min vs. 39.1 ± 10.4 min and 42.2 ± 7.6 min , P < 0.05 ) . Patients of group A also had a shorter discharge time compared to these of group B and group C ( 148.4 ± 39.3 min vs. 187.9 ± 47.7 min and 223.4 ± 52.5 min , P < 0.05 ) . Moreover , patients of group A experienced reduced pain intensity , less postoperative side effect , and less additional analgesic requirement . CONCLUSION Preoperative administration of parecoxib for postoperative analgesia provided significant effect on reducing PACU length of stay ( LOS ) and discharge time , and improving patient outcome after ambulatory LC AIM To determine the efficacy of perioperative parecoxib injection on postoperative pain relief after laparoscopic cholecystectomy . METHODS A prospect i ve , double-blind , r and omized , placebo-controlled study was conducted on 70 patients who underwent elective laparoscopic cholecystectomy under general anesthesia at Siriraj Hospital , Bangkok , from January 2006 to December 2007 . Patients were r and omized to receive either 20 mg parecoxib infusion 30 min before induction of anesthesia and at 12 h after the first dose ( treatment group ) , or normal saline infusion , in the same schedule , as a placebo ( control group ) . The degree of the postoperative pain was assessed every 3 h in the first 24 h after surgery , and then every 12 h the following day , using a visual analog scale . The consumption of analgesics was also recorded . RESULTS There were 40 patients in the treatment group , and 30 patients in the control group . The pain scores at each time point , and analgesic consumption did not differ between the two groups . However , there were fewer patients in the treatment group than placebo group who required opioid infusion within the first 24 h ( 60 % vs 37 % , P = 0.053 ) . CONCLUSION Perioperative administration of parecoxib provided no significant effect on postoperative pain relief after laparoscopic cholecystectomy . However , preoperative infusion 20 mg parecoxib could significantly reduce the postoperative opioid consumption BACKGROUND Pain is the most common complaint of patients on the first day after laparoscopic cholecystectomy ( LC ) . The aim of this study was to compare the efficacy of local anesthesia with bupivacaine and intravenous parecoxib on postoperative abdominal pain relief up to 24 h after surgery . METHODS One hundred and eighty patients who underwent LC were r and omized to one of three groups with sixty patients each : Group A received 50 mg 0.5 % bupivacaine subcutaneously at trocar sites before incision closure ; Group B received intravenous parecoxib ( 40 mg ) after entering the recovery room ; Group C did not receive postoperative analgesia unless needed and was served as control . The postoperative pain at 1 , 2 , 4 , 8 , 12 , and 24 h after the operation was assessed using a visual analog scale ( VAS ) . Secondary outcomes , including intraoperative and postoperative complications , the incidence of shoulder pain , pethidine requirements , postoperative nausea and vomiting , and hospital stay were also recorded . RESULTS At 1 , 2 , and 4 hours after surgery , VAS pain scores were significantly lower in group A and B compared with group C ( P < 0.05 for all ) . There was no significant difference among the three groups at 8 , 12 , and 24 hours after the procedure ( P > 0.05 for all ) . A repeated- measures ANOVA analysis revealed that VAS pain scores over the first 24 hours after LC were significantly lower in group A and B compared with group C ( P = 0.014 and P = 0.029 for between-group comparison , respectively ) . Furthermore , the percentage of patients requiring postoperative rescue analgesics was significantly higher in group C as compared with group A and group B ( P = 0.018 ) . CONCLUSION Local anesthesia with bupivacaine and intravenous parecoxib are both effective at decreasing postoperative pain and pethidine requirements after LC BACKGROUND Intraperitoneal local anesthesia ( IPLA ) during elective laparoscopic cholecystectomy ( el-LC ) decreases post-operative pain . None of the studies have explored the efficacy of IPLA at emergency laparoscopic cholecystectomy ( em-LC ) . A longer operative duration , the greater frequency of washing , and the inflammation associated with cholecystitis or pancreatitis are a few reasons why it can not be assumed that a benefit in pain scores will be seen in em-LC with IPLA . This study was undertaken to assess the efficacy of IPLA in patients undergoing em-LC . METHODS Double-blind r and omized sham controlled trial was conducted of 41 consecutive subjects undergoing em-LC . IPLA was delivered by a combination of injection to the diaphragmatic and topical wash over the liver and gallbladder with bupivacaine or saline . The primary outcome was visual analogue scale pain scores until discharge . Secondary outcomes included pain scores in theatre recovery and analgesic consumption . RESULTS One patient had a procedure converted to open and was excluded . There was no significant difference in pain scores in the ward or theatre recovery . Analgesic use , respiratory rate , oxygen saturation , duration to ambulation , eating , satisfaction scores , and time to discharge were comparable between the two groups . CONCLUSIONS IPLA during em-LC does not influence postoperative pain . Other modalities of analgesia should be explored for decreasing the interval between diagnosis of acute admission and em-LC AIM To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery . METHODS From October 2006 to September 2007 , 72 patients undergoing laparoscopic cholecystectomy ( LC ) were r and omized into two groups of 36 patients . One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline . A visual analog scale was used to assess post Output:

Conclusions : Parecoxib can substantially promote postoperative pain relief in patients with laparoscopic cholecystectomy

MS2_1shot129

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Recent studies have cast doubt on the effectiveness and efficiency of school based dental screening programmes in improving dental attendance or improving dental health . In 2002 the National Dental Inspection Programme was introduced in Scotl and which categorises children by their dental health and informs parents of the findings via a personalised letter home and encourages dental registration . In addition , epidemiological data for local and national planning purpose s is collected . This replaced an earlier school screening system in Lothian where a generic letter urging registration was sent to children who were identified as not being registered with a dentist . The objective of this study is to compare dental registration s rates among unregistered children in these two school inspection systems with a system where letters were sent home but no dental inspection was carried out . Methods The study was design ed as a single blinded , cluster r and omised , controlled trial involving 12,765 12–13-year-old children attending all 65 state Secondary schools in Lothian and Fife during the academic year 2003/4.After stratifying for school size and range of social deprivation , schools were r and omly allocated to one of four groups:1 . ' Traditional ' inspection , letter to unregistered children only,2 . Letter sent home to unregistered children only , no inspection,3 . National Dental Inspection Programme , letter to all children,4 . Control group in which the children were neither inspected nor sent a letter . Dental Registration status was compared at baseline and 3 months post inspection . Results The registration levels in both the ' Traditional ' screening and the NDIP inspection groups rose 3 months post inspection ( 14 % and 15.8 % respectively ) but were not significantly different from one another or the control group which rose by 15.8 % ( p > 0.05 ) . The group who were sent a letter home but were not inspected also has a rise in registration levels of 18.1 % which was not significantly different from either of the groups who were inspected or the control group ( p > 0.05 ) . The only significant predictors of registration were previous registration ( p < 0.05 ) and within those who previously registered , the length of time since last registration ( P < 0.001 ) . Conclusion Neither of the two dental inspection methods nor a letter home to unregistered children result ed in a significant rise in registration rates in 12–13-year-olds compared to a control group of children who received no intervention Dental screening of children in schools is undertaken in many countries . There is no evidence that this activity is effective . The objective of our study was to determine if school dental screening of children reduces untreated disease or improves attendance at the population level . A four-arm cluster-r and omized controlled trial was undertaken in the northwest of Engl and . In total , 16,864 children aged 6–9 years in 168 schools were r and omly allocated to 3 test groups , which received screening according to different models , and a control , which received no intervention . There were no significant differences in caries increment in the primary and secondary dentitions or in the proportions of children attending a dentist after screening between the control group and the 3 intervention arms . School dental screening delivered according to 3 different models was not effective at reducing levels of active caries and increasing attendance in the population under study The purpose of this study was to evaluate the effectiveness of a screening program and referral system in stimulating dental attendance of children in need of treatment at Bapuji Dental College and Hospital of Davangere , India . A total of fourteen schools in the Davangere area were selected r and omly and divided into two groups : seven schools that had a dental screening program ( study group , n=2100 children ) , and seven schools that did not have one ( control group , n=2400 children ) . The attendance rate by members of the study group was determined during the three-month period from the date of initiating the school screening program . During this same period the students who visited the college from the control group underwent a dental examination . Chi-square tests were used to test the difference between different variables . The response rate for seeking treatment was 31 percent for the study group ( 34.2 percent for males ; 26.2 percent for females ) and 10 percent for the control group ( 9.6 percent for males ; 10.5 percent for females ) . In both the groups , the treatment need was highest for dental caries ( study group=36.3 percent , control group=11.1 percent ) and least for fluorosis ( study group=21.2 percent , control group=1.2 percent ) . The study demonstrated that screening and motivation significantly improved the percentage of school children who sought dental care UNLABELLED The school dental screening programme has been in existence from the beginning of the 20th century yet its value in encouraging attendance among children with a dental health need is not fully established . OBJECTIVE To evaluate the effectiveness of school dental screening in promoting dental attendance among children with a treatment need and to examine the relative importance of screening , social class and other factors in dental attendance . METHODS Sixty-four participating schools were assigned to study and control groups using a stratified , blocked r and omisation technique . The study group children received the st and ard school dental screening and the dental attendance of those with a positive screening result was assessed after 2 months by means of a question naire issued to the children 's parents . The control group children were not , at this stage , screened , yet their parents received the same question naire assessing dental attendance over the 2-month period . However , only question naires from control group children who had a positive result at a subsequent screening were retained for analysis . RESULTS A total of 2,321 children were screened , with 980 having a positive result . The mean dmft of those screening positive was 4.85 . In all , 664 completed question naires were returned , giving a response rate of 67.8 % . Dental attendance was reported among 45.5 % of the study group ( n=352 ) in the 2 months following screening . In the same period , 27.6 % of the control group ( n=312 ) cl aim ed attendance . The effect was found to be significant among the high employed group ( P<0.01 ) and the unemployed group ( P<0.05 ) . CONCLUSION School dental screening was capable of stimulating dental attendance . The strong effect among the lowest socio-economic group shows that school dental screening may be used to decrease dental health inequalities Output:

Conclusions : There is evidence of marginally increased dental attendance rate of 16 % following screening .

MS2_1shot130

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain ( CLBP ) when managed in a hospital by either a regional pain clinic or a chiropractor . DESIGN The study was a pragmatic , r and omized , controlled trial . SETTING The trial was performed at a National Health Service ( NHS ) hospital outpatient clinic ( pain clinic ) in the United Kingdom . SUBJECTS AND INTERVENTIONS Patients with CLBP ( i.e. , symptom duration of > 12 weeks ) referred to a regional pain clinic ( outpatient hospital clinic ) were assessed and r and omized to either chiropractic or pain-clinic management for a period of 8 weeks . The study was pragmatic , allowing for normal treatment protocol s to be used . Treatment was administered in an NHS hospital setting . OUTCOME MEASURES The Rol and -Morris Disability Question naire ( RMDQ ) and Numerical Rating Scale were used to assess changes in perceived disability and pain . Mean values at weeks 0 , 2 , 4 , 6 , and 8 were calculated . The mean differences between week 0 and week 8 were compared across the two treatment groups using Student 's t-tests . Ninety-five percent ( 95 % ) confidence intervals ( CIs ) for the differences between groups were calculated . RESULTS R and omization placed 12 patients in the pain clinic and 18 in the chiropractic group , of which 11 and 16 , respectively , completed the trial . At 8 weeks , the mean improvement in RMDQ was 5.5 points greater for the chiropractic group ( decrease in disability by 5.9 ) than for the pain-clinic group ( 0.36 ) ( 95 % CI 2.0 points to 9.0 points ; p = 0.004 ) . Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group ( p = 0.023 ) . CONCLUSIONS This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a sub population of patients with CLBP Abstract Objective To estimate the effect of adding exercise classes , spinal manipulation delivered in NHS or private premises , or manipulation followed by exercise to “ best care ” in general practice for patients consulting with back pain . Fig 1 Progress of the UK BEAM trial Design Pragmatic r and omised trial with factorial design . Setting 181 general practice s in Medical Research Council General Practice Research Framework ; 63 community setting s around 14 centres across the United Kingdom . Participants 1334 patients consulting their general practice s about low back pain . Main outcome measures Scores on the Rol and Morris disability question naire at three and 12 months , adjusted for centre and baseline scores . Results All groups improved over time . Exercise improved mean disability question naire scores at three months by 1.4 ( 95 % confidence interval 0.6 to 2.1 ) more than “ best care . ” For manipulation the additional improvement was 1.6 ( 0.8 to 2.3 ) at three months and 1.0 ( 0.2 to 1.8 ) at 12 months . For manipulation followed by exercise the additional improvement was 1.9 ( 1.2 to 2.6 ) at three months and 1.3 ( 0.5 to 2.1 ) at 12 months . No significant differences in outcome occurred between manipulation in NHS premises and in private premises . No serious adverse events occurred . Conclusions Relative to “ best care ” in general practice , manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months ; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months ; and exercise achieved a small benefit at three months but not 12 months Study Design . A prospect i ve r and omized controlled trial . Objectives . To examine the effectiveness of combined manipulative treatment , stabilizing exercises , and physician consultation compared with physician consultation alone for chronic low back pain . Summary of Background Data . Strong evidence exists that manual therapy provides more effective short-term pain relief than does placebo treatment in the management of chronic low back pain . The evidence for long-term effect is lacking . Methods . Two hundred four chronic low back pain patients , whose Oswestry disability index was at least 16 % , were r and omly assigned to either a manipulative-treatment group or a consultation group . All were clinical ly examined , informed about their back pain , provided with an educational booklet , and were given specific instructions based on the clinical evaluation . The treatment included four sessions of manipulation and stabilizing exercises aim ing to correct the lumbopelvic rhythm . Question naires inquired about pain intensity , self-rated disability , mental depression , health-related quality of life , health care costs , and production costs . Results . At the baseline , the groups were comparable , except for the percentage of employees ( P = 0.01 ) . At the 5- and 12-month follow-ups , the manipulative-treatment group showed more significant reductions in pain intensity ( P < 0.001 ) and in self-rated disability ( P = 0.002 ) than the consultation group . However , we detected no significant difference between the groups in health-related quality of life or in costs . Conclusions . The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation alone . The present study showed that short , specific treatment programs with proper patient information may alter the course of chronic low back pain Abstract This single-blind r and omised clinical trial compared osteopathic manipulative treatment with chemonucleolysis ( used as a control of known efficacy ) for symptomatic lumbar disc herniation . Forty patients with sciatica due to this diagnosis ( confirmed by imaging ) were treated either by chemonucleolysis or manipulation . Outcomes ( leg pain , back pain and self-reported disability ) were measured at 2 weeks , 6 weeks and 12 months . The mean values for all outcomes improved in both groups . By 12 months , there was no statistically significant difference in outcome between the treatments , but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks . A similar number from both groups required additional orthopaedic intervention ; there were no serious complications . Crude cost analysis suggested an overall financial advantage from manipulation . Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis , it can be considered as an option for the treatment of symptomatic lumbar disc herniation , at least in the absence of clear indications for surgery . Further study into the value of manipulation at a more acute stage is warranted OBJECTIVE Our earlier findings suggest that patients with musculoskeletal complaints have lower numbers and percentages of natural killer ( NK ) cells than asymptomatic subjects . This study examines patient lymphocyte profiles , as a secondary outcome measure , in a trial of manipulative therapies to treat chronic low back pain ( LBP ) of mechanical origin . DESIGN The patients were compared in a r and omized controlled trial . Baseline measures were collected at the initial visit ; all patients were scheduled for 11 treatments in 14 days . Treatment consisted of either a high-force , high-velocity , low-amplitude manipulation procedure ; a low-force , high-velocity , low-amplitude procedure or a series of educational lectures on lower back pain . Posttreatment measures were collected at the final treatment session ; follow-up measures were obtained 2 wk later . SETTING The study was conducted at a chiropractic teaching clinic in the suburban Chicago area . PARTICIPANTS Individuals over 18 were eligible if they were new patients or repeat patients with a 6 month 's hiatus , if the chief complaint was LBP of greater than 50 days ' duration , if pain was elicited with palpation over one or more of the facet joints from the spinal levels between L1 and S1 and including the sacroiliac joints , and if there was absence of pain referral or if pain referral was only scleratogenous in nature . Criteria for excluding patients included hard neurologic signs , systemic disease potentially affecting the musculoskeletal system , contraindication to spinal manipulation such as osteoporosis , fracture or other bony pathology , or treatment with medication intended to relieve symptoms associated with their LBP . Eligibility was determined by a staff diagnostic team independent of the attending physician . Three hundred sixty-seven of 1,275 consecutive new patients met the eligibility criteria . Of these , 209 participated . These results are for 201 patients from whom flow cytometric data were obtained . OUTCOME MEASURES Both absolute numbers and percentages of B-lymphocytes , T-lymphocytes , T-Helper ( TH ) , T-Suppressor ( TS ) and NK lymphocytes were determined . Blood sample s were collected at the same time that the primary outcome measures were obtained . Cells were stained with two-color monoclonal antibodies directed against specific cell surface antigens , and each lymphocyte sub population was quantified directly from lysed whole blood with a Coulter Epics Profile II flow cytometer . RESULTS Thirty-five patients dropped out before the follow-up visit and technical problems result ed in the loss of data from 17 more and the exclusion of some sub population data . In all , 148 cases were analyzed for B cells , 146 for TH , TS and NK cells and 138 for cells that carried both the NK and TS marker . A one-way analysis of variance revealed no significant differences in the lymphocyte profiles at baseline among the three groups . All sub population baseline values were within reported reference ranges for normal adult population s. However , the percentage of NK cells ( 9.1 % ) was below the published minimum critical value . A repeated measures analysis of variance was used to determine whether treatment effects changed over time , that is , treatment-time interaction . The cell types for which the interaction tests were at or near statistical significance were : TH cells ( p = .0208 ) , total T cell percent ( p = .0928 ) and absolute total T cells ( p = .0908 ) . Interaction tests for differences in either percent or absolute counts of B cells , TS cells , or NK cells were not statistically significant . CONCLUSIONS This is the first report of lymphocyte profiles in patients with diagnosed chronic LBP . Our finding of a lower percentage of NK cells in these patients confirms our earlier finding that patients with musculoskeletal problems have a lower percentage of NK cells than do asymptomatic subjects . However , manipulative therapy was not shown to have a clinical ly significant effect on either the absolute Abstract The inability to predict outcome in patients with low back/neck pain leads to inappropriate or unnecessary treatment . The aims of the study were to identify prognostic factors for disability at 1‐year follow‐up in patients with back pain visiting primary care , and to compare the effect of these in two treatment strategies – chiropractic and physiotherapy . Data were taken from a r and omised trial on patients with back/neck pain visiting the general practitioner , in which patients were allocated to chiropractic and physiotherapy as primary management . Three hundred and twenty‐three patients , aged 18–60 years , who had no contraindications to manipulation and who had not been treated within the previous month were included in the study . Multiple regression analysis was used to identify prognostic factors . Dependent variables were mean Oswestry score and mean change in Oswestry score at 12‐month follow‐up . The multiple regression analysis revealed five significant ( P<0.001–0.01 ) prognostic factors ; duration of current episode , Oswestry score at entry , expectations of treatment , number of localisations , and well‐being . Besides , the regression coefficients for the significant factors were compared between the two treatment strategies . No significant difference in effect or regression coefficients for the prognostic factors were seen between the two treatment strategies . Twelve per cent of the patients had poor prognostic factors ( duration ≥1 month , more than one localisation , low expectations of treatment and low well‐being ) at entry . These patients had a mean Oswestry score above 20 % at 1‐year follow‐up . Clinical decision models for the management of patients with back pain visiting primary care that consider prognostic factors need to be implemented and prospect ively evaluated Background Reporting numbers needed to treat ( NNT ) improves interpretability of trial results . It is unusual that continuous outcomes are converted to numbers of individual responders to treatment ( i.e. , those who reach a particular threshold of change ) ; and deteriorations prevented are only rarely considered . We consider how numbers needed to treat can be derived from continuous outcomes ; illustrated with a worked example showing the methods and challenges . Methods We used data from the UK BEAM trial ( n = 1 , 334 ) of physical treatments for back pain ; originally reported as showing , at best , small to moderate benefits . Participants were r and omised to receive ' best care ' in general practice , the comparator treatment , or one of three manual and /or exercise treatments : ' best care ' plus manipulation , exercise , or manipulation followed by exercise . We used established consensus thresholds for improvement in Rol and -Morris disability question naire scores at three and twelve months to derive NNTs for improvements and for benefits ( improvements gained+deteriorations prevented ) . Results At three months , NNT estimates ranged from 5.1 ( 95 % CI 3.4 to 10.7 ) to 9.0 ( 5.0 to 45.5 ) for exercise , 5.0 ( 3.4 to 9.8 ) to 5.4 ( 3.8 to 9.9 ) for manipulation , and 3.3 ( 2.5 to 4.9 ) to 4.8 ( 3.5 to 7.8 ) for manipulation followed by exercise . Corresponding between-group mean differences in the Rol and -Morris disability question naire were 1.6 ( 0.8 to 2.3 ) , 1.4 ( 0.6 to 2.1 ) , and 1.9 ( 1.2 to 2.6 ) points . Conclusion In contrast to small mean differences originally reported , NNTs were small and could be attract Output:

There is varying quality of evidence ( ranging from low to high ) that SMT has a statistically significant short-term effect on pain relief and functional status when added to another intervention . There is very low quality evidence that SMT is not statistically significantly more effective than inert interventions or sham SMT for short-term pain relief or functional status . Data were particularly sparse for recovery , return-to-work , quality of life , and costs of care . No serious complications were observed with SMT . High quality evidence suggests that there is no clinical ly relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain .

MS2_1shot131

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Practice guidelines recommend various types of exercise and manipulative therapy for chronic back pain but there have been few head‐to‐head comparisons of these interventions . We conducted a r and omized controlled trial to compare effects of general exercise , motor control exercise and manipulative therapy on function and perceived effect of intervention in patients with chronic back pain . Two hundred and forty adults with non‐specific low back pain ⩾3 months were allocated to groups that received 8 weeks of general exercise , motor control exercise or spinal manipulative therapy . General exercise included strengthening , stretching and aerobic exercises . Motor control exercise involved retraining specific trunk muscles using ultrasound feedback . Spinal manipulative therapy included joint mobilization and manipulation . Primary outcomes were patient‐specific function ( PSFS , 3–30 ) and global perceived effect ( GPE , −5 to 5 ) at 8 weeks . These outcomes were also measured at 6 and 12 months . Follow‐up was 93 % at 8 weeks and 88 % at 6 and 12 months . The motor control exercise group had slightly better outcomes than the general exercise group at 8 weeks ( between‐group difference : PSFS 2.9 , 95 % CI : 0.9–4.8 ; GPE 1.7 , 95 % CI : 0.9–2.4 ) , as did the spinal manipulative therapy group ( PSFS 2.3 , 95 % CI : 0.4–4.2 ; GPE 1.2 , 95 % CI : 0.4–2.0 ) . The groups had similar outcomes at 6 and 12 months . Motor control exercise and spinal manipulative therapy produce slightly better short‐term function and perceptions of effect than general exercise , but not better medium or long‐term effects , in patients with chronic non‐specific back pain OBJECTIVE To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain ( LBP ) . DESIGN A prospect i ve , cohort study of patients with nonradicular LBP referred to physical therapy ( PT ) . SETTING Outpatient PT clinics . PARTICIPANTS Fifty-four patients with nonradicular LBP . INTERVENTION A st and ardized stabilization exercise program . MAIN OUTCOME MEASURE Treatment response ( success or failure ) was categorized based on changes in the Oswestry Disability Question naire scores after 8 weeks . RESULTS Eighteen subjects were categorized as treatment successes , 15 as treatment failures , and 21 as somewhat improved . After using regression analyses to determine the association between st and ardized examination variables and treatment response status , preliminary clinical prediction rules were developed for predicting success ( positive likelihood ratio [ LR ] , 4.0 ) and failure ( negative LR , .18 ) . The most important variables were age , straight-leg raise , prone instability test , aberrant motions , lumbar hypermobility , and fear-avoidance beliefs . CONCLUSIONS It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination . The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Study Design . R and omized controlled trial . Objective . This is the companion study to a previous publication that presented 8-week pain , disability , and trunk muscle motor control results . The objective of this study was to compare the effect of 8 weeks of specific trunk exercises and stationary cycling on outcomes measures of catastrophizing and fear-avoidance beliefs ( FAB ) in patients with chronic nonspecific low back pain , and provide 6-month outcome data for all self-report measures . Summary of Background Data . It is thought that any form of moderate-to-vigorous physical activity is sufficient to address catastrophizing and FAB , and concomitant levels of pain and disability . Methods . Sixty-four patients with low back pain were r and omly assigned to 8 weeks of specific trunk exercise group ( SEG ) , or stationary cycling group ( CEG ) . Self-rated pain , disability , catastrophizing and FAB scores were collected before , immediately after ( 8 wk ) , and 6 months after the training program . Clinical ly meaningful improvements were defined as greater than a 30 % reduction from baseline in pain and disability scores . “ Intention-to-treat ” principles were used for missing data . Per- protocol analysis was performed on participants who attended at least two-thirds of the exercise sessions . Results . At 8 weeks , disability was significantly lower in the SEG compared with the CEG ( d = 0.62 , P = 0.018 ) . Pain was reduced from baseline in both the groups after training ( P < 0.05 ) , but was lower for the SEG ( P < 0.05 ) . FAB scores were reduced in the SEG at 8 weeks , and in the CEG at 6 months . No between-group differences in FAB scores were observed . Similar reductions in catastrophizing in each group were observed at each time point . At 6 months , the overall data pattern suggested no long-term difference between groups . Per- protocol analysis of clinical ly meaningful improvements suggests no between-group differences for how many patients are likely to report improvement . Conclusion . Inferential statistics suggest greater improvements at 8 weeks , but not 6 months , for the SEG . Inspection of clinical ly meaningful changes based on a minimum level of adherence suggests no between-group differences . If a patient with low back pain adheres to either specific trunk exercises or stationary cycling , it is reasonable to think that similar improvements will be achieved . Level of Evidence : Background Exercise benefits patients with chronic nonspecific low back pain ; however , the most effective type of exercise remains unknown . Objective This study compared outcomes after motor control exercises , sling exercises , and general exercises for low back pain . Design This was a r and omized controlled trial with a 1-year follow-up . Setting The study was conducted in a primary care setting in Norway . Patients The participants were patients with chronic nonspecific low back pain ( n=109 ) . Interventions The interventions in this study were low-load motor control exercises , high-load sling exercises , or general exercises , all delivered by experienced physical therapists , once a week for 8 weeks . Measurements The primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up . Secondary outcome measures were self-reported activity limitation ( assessed with the Oswestry Disability Index ) , clinical ly examined function ( assessed with the Fingertip-to-Floor Test ) , and fear-avoidance beliefs after intervention . Results The postintervention assessment showed no significant differences among groups with respect to pain ( overall group difference ) or any of the outcome measures . Mean ( 95 % confidence interval ) group differences for pain reduction after treatment and after 1 year were 0.3 ( −0.7 to 1.3 ) and 0.4 ( −0.7 to 1.4 ) for motor control exercises versus sling exercises , 0.7 ( −0.6 to 2.0 ) and 0.3 ( −0.8 to 1.4 ) for sling exercises versus general exercises , and 1.0 ( −0.1 to 2.0 ) and 0.7 ( −0.3 to 1.7 ) for motor control exercises versus general exercises . Limitations The nature of the interventions made blinding impossible . Conclusions This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain BACKGROUND Pilates programs are widely used as a form of regular exercise in a broad range of population s investigating their effectiveness for chronic low back pain ( CLBP ) treatment . OBJECTIVE The aim of this study was to compare the effects of a Pilates program and a trunk strengthening exercise program on functional disability and health-related quality of life ( HRQOL ) in women with nonspecific CLBP . METHODS A total of 101 volunteer women with CLBP provided data with a 3-month follow-up . They were r and omized to either a Pilates ( n= 37 ) , trunk strengthening exercise ( n= 36 ) or a control group ( n= 28 ) , exercising for a period of 8 weeks , three times a week . Data were collected on HRQOL using the Short-Form 36 Health Survey ( SF-36v2 ) , and functional disability using the Rol and Morris Disability Question naire prior to program initiation , mid-intervention , immediately after program termination , and three months post-intervention . RESULTS The Pilates participants reported greater improvements on self-reported functional disability and HRQOL compared with participants in the trunk strengthening exercise and control groups ( p < 0.05 ) . The effects were retained for a period of three months after program termination for the Pilates group and to a lesser extent for the trunk strengthening exercise group . CONCLUSIONS An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP Study Design . The study was a r and omized controlled trial . Treatment was for 8 weeks , with follow-up posttreatment and at 6- , 12- , and 36- months . Objective . The purpose was to evaluate the effect of a grade d exercise intervention emphasizing stabilizing exercises in patients with nonspecific , recurrent low back pain ( LBP ) . Summary of Background Data . Exercise therapy is recommended and widely used as treatment for LBP . Although stabilizing exercises are reportedly effective in the management of certain subgroups of LBP , such intervention protocol s have not yet been evaluated in relation to a more general exercise regimen in patients with recurrent LBP , all at work . Methods . Seventy-one patients recruited consecutively ( 36 men , 35 women ) with recurrent nonspecific LBP seeking care at an outpatient physiotherapy clinic were r and omized into 2 treatment groups ; grade d exercise intervention or daily walks . The primary outcome was perceived disability and pain at 12-month follow-up . Secondary outcomes included physical health , fear-avoidance , and self-efficacy beliefs . Results . Of the participants , 83 % provided data at the 12-month follow-up and 79 % at 36 months . At 12 months , between-group comparison showed a reduction in perceived disability in favor of the exercise group , whereas such an effect for pain emerged only immediately postintervention . Ratings of physical health and self-efficacy beliefs also improved in the exercise group over the long term , though no changes were observed for fear-avoidance beliefs . Conclusion . A grade d exercise intervention , emphasizing stabilizing exercises , for patients with recurrent LBP still at work seems more effective in improving disability and health parameters than daily walks do . However , no such positive results emerged for improvement regarding pain over a longer term , or for fear-avoidance beliefs BACKGROUND Movement control impairment is a clinical subgroup of non-specific low back pain which can be assessed reliably . There is a strong correlation between tactile acuity and movement control suggesting these two treatments might have additive effects . The first research aim was to determine if patients with a motor control impairment demonstrated improvement in outcome with combined tactile acuity and motor control training . The second aim was to determine if tactile acuity training enhanced the effect of motor control training . METHOD The primary study was a single-arm cohort study conducted in three physiotherapy practice s in the German-speaking part of Switzerl and . 40 patients ( 23 males and 17 females ) suffering from non-specific low back pain ( NSLBP ) and movement control impairment were treated . Patients were assessed at baseline and immediately post treatment . Treatment included exercises to lumbopelvic control and graphesthesia training to improve tactile acuity . Treatment effects were evaluated using the Rol and Morris disability question naire ( RMQ ) and the patient-specific functional scale ( PSFS ) . The performance on a set of six movement control tests and lumbar two-point discrimination were also assessed . The results of this cohort study were compared with a historic control group which was comparable with the primary study but included only motor control exercises . RESULTS All the outcomes improved significantly with the combined training ( RMQ - 2.2 pts . , PSFS - 2.8 pts . ; MCTB - 2.02 pts . & TPD - 17.07 mm ; all p < 0.05 ) . In comparison to the outcomes of the historic control , there was no significant differences in movement control , patient-specific functional complaints or disability between the groups . CONCLUSIONS The results of this study , based on a before and after intervention comparison , showed that outcome improved significantly following combined tactile acuity and motor control training . However , compared to an earlier study , the tactile acuity training did not have an additional effect to the results . The use of historical controls does not control for allocation bias and the results obtained here require verification in a r and omized controlled trial The present aim was to compare the effects of stabilizing training with those of Output:

The subgroups ' effects are less conclusive and no clear direction of the sustainability effect at short versus mid versus long-term , of the type of the comparator , or of the dose of the training is given . Low quality studies overestimated the effect of motor control exercises

MS2_1shot132

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Older people often need comprehensive treatment , including many medications , and polypharmacy is common . The aims of this cross-sectional investigation were to examine the potentially inappropriate medication during the hospitalization and to identify the factors that may influence such inappropriateness among elderly in Italy . Methods A sample of 605 individuals aged 65 years and older admitted in non-academic public acute care hospitals was r and omly selected . Prescription of inappropriate medications were evaluated during the period from the day of admission to a r and omly preselected day ( index day ) . Beers Criteria were used to evaluate appropriateness . Results At least one potentially inappropriate medication prescription from the day of hospital admission to the index day has been observed in 188 patients ( 31.1 % ) , and respectively 84.1 % and 15.9 % of them had received one or two inappropriate medications . A total of 15 medications was prescribed inappropriately to these 188 patients , for 215 times with a total of 1143 doses . The multivariate logistic regression analysis revealed that the significant predictors for having at least one potentially inappropriate medication prescription during the hospitalization were : patients having an elementary education level , a lower pre-admission performance-based measure of basic activities of daily living , having received an inappropriate drug before the hospitalization , a hospital stay in the general and in the specialties surgical wards , a longer length of hospital stay from the admission to the index day , and having received a higher number of drugs from the day of the hospital admission to the index day . The most prevalent inappropriate medications administered were ketorolac ( 27.4 % ) , amiodarone ( 19.1 % ) , and clonidine ( 11.2 % ) . Conclusions This study supports the need for clinical guidelines implementation to assist physicians in choosing the most appropriate drugs for the elderly and for effective education of all physicians Background The use of potentially inappropriate medications ( PIMs ) is common in the older population . Inappropriate medications as well as polypharmacy expose older people to a greater risk of adverse drug reactions and may result in hospitalizations . Objective To evaluate the prevalence of PIMs among acutely hospitalized patients aged ≥65 years in an acute medical unit , and to investigate the relationship between use of PIMs and weakness . Setting This longitudinal observational study was undertaken in the Acute Medical Unit , Hvidovre Hospital , University of Copenhagen , Denmark . Method Patients aged ≥65 years admitted to the acute medical unit during the period October to December 2011 were included . Patients were interviewed at admission and at a follow-up visit 30 days after discharge . Data included information about medications , social status , functional status , cognitive status , h and grip strength , health-related quality of life , visual acuity , days of hospitalization , and comorbidities , and was prospect ively collected . Polypharmacy was defined as regular use of 5 or more drugs . The Charlson Comorbidity Index was used to categorize comorbidities . Main outcome measure The prevalence of PIMs and the association with PIMs and functional status h and grip strength , HRQOL , comorbidities , social demographic data and vision . Results Seventy-one patients ( 55 % men ) with a median age of 78.7 years participated . The median number of medications was eight per person . Eighty percent were exposed to polypharmacy . PIMs were used by 85 % of patients , and PIMs were associated with low functional status ( p = 0.032 ) , low h and grip strength ( p = 0.006 ) , and reduced health-related quality of life ( p = 0.005 ) , but not comorbidities ( p = 0.63 ) , age ( p = 0.60 ) , sex ( p = 0.53 ) , education ( p = 0.94 ) , cognition ( p = 0.10 ) , pain ( p = 0.46 ) , or visual acuity ( p = 0.55 ) . Conclusions Use of PIMs was very common among older people admitted to an acute medical unit . The use of PIMs is associated with low functional status , low h and grip strength , and reduced health-related quality of life Purpose Adverse drug events ( ADEs ) lead to adverse clinical outcomes such as hospitalization . There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy . This study aim ed to evaluate ( i ) the prevalence of ADEs at the time of admission to hospital , ( ii ) the causality , severity , and preventability of the ADEs , and ( iii ) the clinical and pharmacological characteristics associated with the ADEs . Methods This is a prospect i ve cross-sectional study ( county of Osona , Catalonia , Spain ) . We included patients who required palliative care as identified by the NECPAL CCOMS-ICO tool who were hospitalized in an acute geriatric unit ( AGU ) . A system of alerts ( trigger tool ) was used together with a multidisciplinary review for the detection of the ADEs . Results Over the course of 10 months , 235 patients were recruited . Seventy-six ADEs affecting 24.68 % of the sample were identified , and of these , 23 ( 30.26 % of the ADEs ; 8.51 % of the sample ) were directly related to hospitalization . The multivariate logistic regression analysis identified the following risk factors : presence of extreme polypharmacy ( ≥10 medications ) ( OR = 3.02 ; 95 % CI = 1.48–6.19 ) , anticholinergic burden according to the Anticholinergic Drug Scale ( ADS ) ( OR = 2.32 ; 95 % CI = 1.13–4.78 ) , and treatment complexity according to the Medication Regimen Complexity Index ( MRCI ) scale ( OR = 2.90 ; 95 % CI = 1.44–5.83 ) . The vast majority ( 94.45 % ) of the ADEs were considered to be preventable . There were no differences in the survival of the patients . Conclusions ADEs are common , largely preventable , and implicated in the hospitalization of patients who require palliative care BACKGROUND Beers criteria and screening tool of older person 's prescriptions ( STOPP ) criteria are widely used to assess potentially inappropriate drug use ( PIDU ) . OBJECTIVE the aims of the present study are ( i ) to assess the prevalence of PIDU based on 2012 Beers criteria and STOPP criteria and ( ii ) to determine the impact of PIDU , as defined by these criteria , on health outcomes among older in-hospital patients . DESIGN prospect i ve observational study . SETTING AND SUBJECTS a total of 871 in-hospital patients participating to the CRIteria to Assess Appropriate Medication Use among Elderly Complex Patients project . METHODS outcome measures were ( i ) adverse drug reactions ( ADR ) ; ( ii ) decline in functional status ; ( iii ) combined outcome ( ADR or declined in functional status ) . RESULTS the prevalence of PIDU was 58.4 % applying Beers criteria , 50.4 % applying STOPP criteria and 75.0 % combining both sets of criteria . PIDU defined based on STOPP criteria was significantly associated with ADR [ odds ratio ( OR ) 2.36 ; 95 % confidence interval ( CI ) 1.10 - 5.06 ] , and decline in physical function ( OR : 2.00 ; 95 % CI : 1.10 - 3.64 ) , while , despite a positive trend , no significant association was observed for Beers criteria or the combination of both criteria . The combined outcome was significantly associated with PIDU defined based on Beers ( OR : 1.74 ; 95 % CI : 1.06 - 2.85 ) , STOPP criteria ( OR : 2.14 ; 95 % CI : 1.32 - 3.47 ) or both ( OR 2.02 ; 95 % CI : 1.06 - 3.84 ) . CONCLUSIONS PIDU is common in hospitalised older adults and the combination of Beers and STOPP criteria might lead to the identification of a larger number of cases of PIDU than the application of a single set of criteria . STOPP criteria significantly predict all in-hospital outcomes considered , while Beers criteria were significantly associated with the combined outcome only Background The elderly population is increasing worldwide . Due to age-related physiological changes that affect the pharmacokinetics and pharmacodynamics of drugs , the elderly are predisposed to adverse drug reactions . Prescribing of potentially inappropriate medications ( PIMs ) has been found to be prevalent among the elderly and PIM use has been associated with hospitalisations and mortality . Objectives This study aims to identify the prevalence and nature of pre-admission inappropriate prescribing by using the STOPP ( screening tool of older people ’s prescriptions ) criteria amongst a sample of hospitalised elderly in patients in South Australia . Setting Medical , surgical and rehabilitation wards of a public teaching hospital in Adelaide , South Australia . Main outcome measure Pre-admission prevalence of PIM . Method Medication management plans of 100 patients of ≥65 years old were prospect ively studied to determine the prevalence of pre-admission PIM use . Sixty-five criteria of STOPP were applied to identify PIMs . Results The total number of pre-admission medications screened during the study period was 949 ; the median number of medicines per patient was nine ( range 2–28 ) . Overall the STOPP criteria identified 138 PIMs in 60 % of patients . The most frequently encountered PIM was opiates prescribed in patients with recurrent falls ( 12.3 % ) , followed by benzodiazepines in fallers ( 10.1 % ) and proton pump inhibitors when prescribed for peptic ulcer disease for long-term at maximum doses ( 9.4 % ) . The number of medications were found to have a positive correlation with pre-admission PIM use ( rs = 0.49 , P < 0.01 ) . Conclusions Pre-admission PIM use is highly prevalent among the studied population . Strategies to reduce PIM use should be undertaken by physicians and pharmacists . The use of the STOPP criteria in clinical practice to reduce prescriptions of inappropriate medications requires further investigation Background It is advocated that interventions to improve clinical practice should be developed using a systematic approach and intervention development methods should be reported . However , previous interventions aim ed at ensuring that older people receive appropriate polypharmacy have lacked details on their development . This study formed part of a multiphase research project which aim ed to develop an intervention to improve appropriate polypharmacy in older people in primary care . Methods The target behaviours for the intervention were prescribing and dispensing of appropriate polypharmacy to older patients by general practitioners ( GPs ) and community pharmacists . Intervention development followed a systematic approach , including previous mapping of behaviour change techniques ( BCTs ) to key domains from the Theoretical Domains Framework that were perceived by GPs and pharmacists to influence the target behaviours . Draft interventions were developed to operationalise selected BCTs through team discussion . Selection of an intervention for feasibility testing was guided by a subset of the APEASE ( Affordability , Practicability , Effectiveness/cost-effectiveness , Acceptability , Side-effects/safety , Equity ) criteria . Results Three draft interventions comprising selected BCTs were developed , targeting patients , pharmacists and GPs , respectively . Following assessment of each intervention using a subset of the APEASE criteria ( affordability , practicability , acceptability ) , the GP-targeted intervention was selected for feasibility testing . This intervention will involve a demonstration of the behaviour and will be delivered as an online video . The video demonstrating how GPs can prescribe appropriate polypharmacy during a typical consultation with an older patient will also demonstrate salience of consequences ( feedback emphasising the positive outcomes of performing the behaviour ) . Action plans and prompts/cues will be used as complementary intervention components . The intervention is design ed to facilitate the prescribing of appropriate polypharmacy in routine practice . Conclusion A GP-targeted intervention to improve appropriate polypharmacy in older people has been developed using a systematic approach . Intervention content has been specified using an established taxonomy of BCTs and selected to maximise feasibility . The results of a future feasibility study will help to determine if the theory-based intervention requires further refinement before progressing to a larger scale r and omised evaluation INTRODUCTION STOPP ( Screening Tool of Older Persons ' potentially inappropriate Prescriptions ) is a new , systems-defined medicine review tool . We compared the performance of STOPP to that of established Beers ' criteria in detecting potentially inappropriate medicines ( PIMs ) and related adverse drug events ( ADEs ) in older patients presenting for hospital admission . METHODS we prospect ively studied 715 consecutive acute admissions to a university teaching hospital . Diagnoses , reason for admission and concurrent medications were recorded . STOPP and Beers ' criteria were applied . PIMs with clear causal connection or contribution to the principal reason for admission were determined . RESULTS median patient age ( interquartile range ) was 77 ( 72 - 82 ) years . Median number of prescription medicines was 6 ( range 0 - 21 ) . STOPP identified 336 PIMs affecting 247 patients ( 35 % ) , of whom one-third ( n = 82 ) presented with an associated ADE . Beers ' criteria identified 226 PIMs affecting 177 patients ( 25 % ) , of whom 43 presented with an associated ADE . STOPP-related PIMs contributed to 11.5 % of all admissions . Beers ' criteria -related PIMs contributed to significantly fewer admissions ( 6 % ) . CONCLUSION STOPP criteria Output:

Our findings suggest a high prevalence of PIMs in older in patients with and without cognitive impairment .

MS2_1shot133

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Radiofrequency ablation ( RFA ) is safe and effective for eradicating Barrett 's esophagus ( BE ) and BE-associated early neoplasia . Most RFA studies have limited the baseline length of BE ( < 10 cm ) , and therefore little is known about RFA for longer BE . OBJECTIVE To assess the safety and efficacy of RFA with or without prior endoscopic resection ( ER ) for BE ≥ 10 cm containing neoplasia . DESIGN Prospect i ve trial . SETTING Two tertiary-care centers . PATIENTS This study involved consecutive patients with BE ≥ 10 cm with early neoplasia . INTERVENTION Focal ER for visible abnormalities , followed by a maximum of 2 circumferential and 3 focal RFA procedures every 2 to 3 months until complete remission . MAIN OUTCOME MEASUREMENTS Complete remission , defined as endoscopic resolution of BE and no intestinal metaplasia ( CR-IM ) or neoplasia ( CR-neoplasia ) in biopsy specimens . RESULTS Of the 26 patients included , 18 underwent ER for visible abnormalities before RFA . The ER specimens showed early cancer in 11 , high- grade intraepithelial neoplasia ( HGIN ) in 6 , and low- grade intraepithelial neoplasia ( LGIN ) in 1 . The worst residual histology , before RFA and after any ER , was HGIN in 16 patients and LGIN in 10 patients . CR-neoplasia and CR-IM were achieved in 83 % ( 95 % confidence interval [ CI ] , 63%-95 % ) and 79 % ( 95 % CI , 58%-93 % ) , respectively . None of the patients had fatal or severe complications and 15 % ( 95 % CI , 4%-35 % ) had moderate complications . During a mean ( ± st and ard deviation ) follow-up of 29 ( ± 9.1 ) months , no neoplasia recurred . LIMITATIONS Tertiary-care center , short follow-up . CONCLUSION ER for visible abnormalities , followed by RFA of residual BE is a safe and effective treatment for BE ≥ 10 cm containing neoplasia , with a low chance of recurrence of neoplasia or BE during follow-up OBJECTIVES : Patients with Barrett 's esophagus ( BE ) have an increased risk of developing esophageal adenocarcinoma ( EAC ) . As the absolute risk remains low , there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs . The aim of this study was to identify such predictors of progression to high- grade dysplasia ( HGD ) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors . METHODS : We included 713 patients with BE ( ≥2 cm ) with no dysplasia ( ND ) or low- grade dysplasia ( LGD ) in a multicenter , prospect i ve cohort study . Data on age , gender , body mass index ( BMI ) , reflux symptoms , tobacco and alcohol use , medication use , upper gastrointestinal ( GI ) endoscopy findings , and histology were prospect ively collected . As part of this study , patients with ND underwent surveillance every 2 years , whereas those with LGD were followed on a yearly basis . Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance . RESULTS : After 4 years of follow-up , 26/713 ( 3.4 % ) patients developed HGD or EAC , with the remaining 687 patients remaining stable with ND or LGD . Multivariable analysis showed that a known duration of BE of ≥10 years ( risk ratio ( RR ) 3.2 ; 95 % confidence interval ( CI ) 1.3–7.8 ) , length of BE ( RR 1.11 per cm increase in length ; 95 % CI 1.01–1.2 ) , esophagitis ( RR 3.5 ; 95 % CI 1.3–9.5 ) , and LGD ( RR 9.7 ; 95 % CI 4.4–21.5 ) were significant predictors of progression to HGD or EAC . In a prediction model , we found that the annual risk of developing HGD or EAC in BE varied between 0.3 % and up to 40 % . Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC ( < 1 % ) , whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression ( 18–40 % ) . CONCLUSIONS : In patients with BE , the risk of developing HGD or EAC is predominantly determined by the presence of LGD , a known duration of BE of ≥10 years , longer length of BE , and presence of esophagitis . One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE BACKGROUND Barrett 's esophagus ( BE ) may lead to high- grade dysplasia ( HGD ) and adenocarcinoma . The objective was to examine the impact of treating patients with BE and with HGD by using porfimer sodium ( POR ) and photodynamic therapy ( PDT ) for ablating HGD and reducing the incidence of esophageal adenocarcinoma . METHODS The design was a multicenter , partially blinded ( pathology ) , r and omized clinical trial conducted in patients with BE who have HGD . There were 30 contributing centers . A total of 485 patients were screened , with 208 in the intent-to-treat population and 202 in the safety population . Patients were r and omized on a 2:1 basis to compare PDT with POR plus omeprazole ( PORPDT ) with omeprazole only ( OM ) . The main outcome measurement was complete HGD ablation occurring at any time during the study period . RESULTS There was a significant difference ( p < 0.0001 ) in favor of PORPDT ( 106/138 [ 77 % ] ) compared with OM ( 27/70 [ 39 % ] ) in complete ablation of HGD at any time during the study period . The occurrence of adenocarcinoma in the PORPDT group ( 13 % ) ( n=18 ) was significantly lower ( p < 0.006 ) compared with the OM group ( 28 % ) [ corrected ] ( n=20 ) . The safety profile showed 94 % of patients in the PORPDT group and 13 % of patients in the OM group had treatment-related adverse effects . The limitations of the study were that PDT therapy may have had to be applied more than once and that patients spent more time in treatment . The patients and the physicians were not blinded to the treatment . CONCLUSIONS PORPDT in conjunction with omeprazole is an effective therapy for ablating HGD in patients with BE and in reducing the incidence of esophageal adenocarcinoma BACKGROUND The aim of this study was to evaluate the endoscopic and the histologic effects of a balloon-based bipolar radiofrequency electrode for ablation of porcine and human esophageal epithelium . METHODS All procedures were performed with a balloon-based , bipolar radiofrequency system that creates a circumferential , thin-layer epithelial ablation zone within the esophagus . In Phase I , multiple ablations were created in 10 farm swine , followed by acute euthanasia and histologic assessment for completeness of epithelial removal and ablation depth . In Phase II , multiple ablations were created in 19 farm swine , with varying power and energy density , followed by endoscopy at 2 and 4 weeks to assess stricture formation . In Phase III , 3 ablations were created in 12 farm swine , with varying energy density ( 5 , 8 , 10 , 12 , 15 , or 20 J/cm 2 ) at 350 W. Animals were euthanized at 48 hours . Histologic examination determined the percentage of epithelium removed and the ablation depth . In Phase IV , 3 patients underwent esophageal epithelial ablation before esophagectomy , creating separate lesions proximal to the tumor . Completeness of epithelial ablation and ablation depth was quantified histologically . RESULTS In Phase I , complete removal of esophageal epithelium was achieved at energy density setting s of 9.7 to 29.5 J/cm 2 . In Phase II , 9.7 and 10.6 J/cm 2 produced no stricture , whereas more than 20 J/cm 2 produced a stricture in every case . In Phase III , 8 - 20 J/cm 2 result ed in 100 % epithelial ablation . Five and 8 J/cm 2 spared the muscularis mucosae , whereas 10 J/cm 2 caused injury to the muscularis mucosae but preserved the submucosa . In Phase IV , histologic examination demonstrated full-thickness epithelial removal in areas of electrode contact . Ablation extended only to the muscularis mucosae , without injury to submucosa . CONCLUSIONS In the porcine and the human esophagus , circumferential , full-thickness ablation of epithelium without direct injury to the submucosa is possible and was well tolerated . In all cases , depth of ablation was linearly related to energy density of treatment OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To assess the dose-response , safety , and efficacy of circumferential endoscopic ablation of Barrett 's esophagus ( BE ) by using an endoscopic balloon-based ablation device ( HALO360 System ) . DESIGN This study was conducted in 2 serial phases ( dosimetry phase and effectiveness phase ) to evaluate a balloon-based ablation device that delivers a pre-set amount of energy density ( J/cm2 ) to BE tissue . The dosimetry phase evaluated the dose-response and the safety of delivering 6 to 12 J/cm2 . The effectiveness phase used 10 J/cm2 ( delivered twice [ x2 ] ) for all patients , followed by EGD with biopsies at 1 , 3 , 6 , and 12 months . A second ablation procedure was performed if BE was present at 1 or 3 months . Patients received esomeprazole 40 mg twice a day for 1 month after ablation , and 40 mg every day thereafter . Postablation symptoms were quantified by using a 14-day symptom diary ( scale , 0 - 100 ) . A complete response ( CR ) was defined as all biopsy specimens negative for BE at 12 months . SETTING Eight U.S. centers , between September 2003 and September 2005 . PATIENTS Patients were 18 to 75 years of age , with a diagnosis of BE ( without dysplasia ) , with histopathology reconfirmation of the diagnosis within 6 months of enrollment . RESULTS In the dosimetry phase , 32 patients ( 29 men ; mean age , 56.8 years ) were enrolled . Median symptom scores returned to a score of 0 of 100 by day 3 . There were no dose-related serious adverse events , and the outcomes at 1 and 3 months permitted the selection of 10 J/cm2 ( x2 ) for the subsequent effectiveness phase of the study . In the effectiveness phase , 70 patients ( 52 men , 18 women ; Output:

Treatment of BE with RFA results in CE-D and CE-IM in a high proportion of patients , with few recurrences of IM after treatment and a low rate of adverse events .

MS2_1shot134

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To assess the prevalence of rheumatic diseases in Greek urban , suburban , and rural adult general population s. METHODS This cross-sectional population based epidemiological study of rheumatic diseases in Greece ( the ESORDIG Study ) was conducted on the total adult population of 2 urban , one suburban , and 4 rural communities ( 8547 subjects ) , as well as on 2100 out of 5686 r and omly selected subjects in one suburban and one rural community . The study , based on a st and ardized question naire and clinical evaluation and laboratory investigation when necessary , was carried out by rheumatologists who visited the target population at their homes . Either established classification criteria or criteria set for the purpose s of the study were used for diagnosis . RESULTS A total of 8740 subjects participated in the study ( response rate 82.1 % ) . The overall age and sex adjusted prevalence ( prevalence(asa ) ) of rheumatic diseases in the total target adult population was 26.9 % ( 95 % CI 26.2 - 27.6 ) , being significantly higher among women ( 33.7 % ) than men ( 19.9 % ) ( p < 0.0005 ) . Disease prevalence(asa ) increased significantly with age ( p < 0.0005 ) . The most common disease group was low back pain , with a prevalence(asa ) of 11.0 % , followed by symptomatic peripheral osteoarthritis ( 7.9 % ) , neck pain ( 4.8 % ) , miscellaneous rheumatic disorders ( 4.4 % ) , soft tissue rheumatism disorders ( 4.3 % ) , and inflammatory rheumatic disease ( 2.1 % ) . Logistic regression analysis showed a significant positive association of female or male sex , age > or= 50 years , high body mass index , low level of education , moderate or heavy alcohol consumption , and high socioeconomic level with particular diseases or disease groups . CONCLUSION These findings indicate rheumatic diseases are very common in the general adult population of Greece ; 26.9 % of adults currently have active or chronic rheumatic disease in remission BACKGROUND AND OBJECTIVES A prospect i ve , double-blind , r and omized , and controlled trial was conducted in patients with knee osteoarthritis ( OA ) to evaluate the efficacy of infrared low-power Gallium-Arsenide ( Ga-As ) laser therapy ( LPLT ) and compared two different laser therapy regimes . STUDY DESIGN / MATERIAL S AND METHODS Ninety patients were r and omly assigned to three treatment groups by one of the nontreating authors by drawing 1 of 90 envelopes labeled ' A ' ( Group I : actual LPLT consisted of 5 minutes , 3 J total dose + exercise ; 30 patients ) , ' B ' ( Group II : actual LPLT consisted of 3 minutes , 2 J total dose + exercise ; 30 patients ) , and ' C ' ( Group III : placebo laser group + exercise ; 30 patients ) . All patients received a total of 10 treatments , and exercise therapy program was continued during study ( 14 weeks ) . Subjects , physician , and data analysts were unaware of the code for active or placebo laser until the data analysis was complete . All patients were evaluated with respect to pain , degree of active knee flexion , duration of morning stiffness , painless walking distance and duration , and the Western Ontario and Mc Master Universities Osteoarthritis Index ( WOMAC ) at week 0 , 6 , 10 , and 14 . RESULTS Statistically significant improvements were indicated in respect to all parameters such as pain , function , and quality of life ( QoL ) measures in the post-therapy period compared to pre-therapy in both active laser groups ( P < 0.01 ) . Improvements in all parameters of the Group I and in parameters , such as pain and WOMAC of the Group II , were more statistically significant when compared with placebo laser group ( P < 0.05 ) . CONCLUSIONS Our study demonstrated that applications of LPLT in different dose and duration have not affected results and both therapy regimes were a safe and effective method in treatment of knee OA BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time The purpose of this study was to compare the effectiveness of transcutaneous nerve stimulation ( TENS ) , electroacupuncture ( EA ) , and ice massage with placebo treatment for the treatment of pain . Subjects ( n = 100 ) diagnosed with osteoarthritis ( OA ) of the knee were treated with these modalities . The parameters for evaluating the effectiveness of treatment include pain at rest , stiffness , 50 foot walking time , quadriceps muscle strength , and knee flexion degree . The results showed ( a ) that all three methods could be effective in decreasing not only pain but also the objective parameters in a short period of time ; and ( b ) that the treatment results in TENS , EA and ice massage were superior to placebo Background : Low level laser therapy ( LLLT ) has gained increasing popularity in the management of tendinopathy and arthritis . Results from in vitro and in vivo studies have suggested that inflammatory modulation is one of several possible biological mechanisms of LLLT action . Objective : To investigate in situ if LLLT has an anti-inflammatory effect on activated tendinitis of the human Achilles tendon . Subjects : Seven patients with bilateral Achilles tendinitis ( 14 tendons ) who had aggravated symptoms produced by pain inducing activity immediately before the study . Method : Infrared ( 904 nm wavelength ) LLLT ( 5.4 J per point , power density 20 mW/cm2 ) and placebo LLLT ( 0 J ) were administered to both Achilles tendons in r and om blinded order . Results : Ultrasonography Doppler measurements at baseline showed minor inflammation through increased intratendinous blood flow in all 14 tendons and measurable resistive index in eight tendons of 0.91 ( 95 % confidence interval 0.87 to 0.95 ) . Prostagl and in E2 concentrations were significantly reduced 75 , 90 , and 105 minutes after active LLLT compared with concentrations before treatment ( p = 0.026 ) and after placebo LLLT ( p = 0.009 ) . Pressure pain threshold had increased significantly ( p = 0.012 ) after active LLLT compared with placebo LLLT : the mean difference in the change between the groups was 0.40 kg/cm2 ( 95 % confidence interval 0.10 to 0.70 ) . Conclusion : LLLT at a dose of 5.4 J per point can reduce inflammation and pain in activated Achilles tendinitis . LLLT may therefore have potential in the management of diseases with an inflammatory component OBJECTIVE To determine the minimal perceptible clinical improvement ( MPCI ) in patients with osteoarthritis ( OA ) with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire , and patient and investigator global assessment of disease status in r and omized clinical trials for treatment of OA . METHODS Subjects with OA of the knee or hip were r and omized to receive either rofecoxib 12.5 or 25 mg once daily , ibuprofen 800 mg 3 times daily , or placebo for 6 weeks . The WOMAC and global assessment s were completed at baseline and Weeks 2 , 4 , and 6 . A patient global assessment of response to therapy ( 0 to 4 scale ) was used to " anchor " the WOMAC scores . MPCI was defined as the difference in mean change from baseline in WOMAC ( 100 mm normalized visual analog scale , VAS ) between patients with 0 = " None " global response to therapy and patients with 1 = " Poor " global response to therapy . RESULTS MPCI was determined to be 9.7 , 9.3 , and 10.0 mm for the WOMAC pain , physical function and stiffness subscales , respectively , and 11.1 mm for WOMAC question 1 : Pain walking on a flat surface . The MPCI for the investigator was 0.4 with investigator assessment of disease status reported on a 0 to 4 Likert scale . Of note , the estimated MPCI for the WOMAC and investigator globals were similar irrespective of treatment , sex , age , or geographic region . CONCLUSION In this analysis , mean changes of roughly 9 to 12 mm ( 100 mm normalized VAS ) on WOMAC scales were perceptible changes to patients with hip and knee OA . A mean decrease of 0.4 in global disease status ( 0 to 4 Likert scale ) as assessed by the investigator corresponded to the patients ' MPCI . Underst and ing the minimal perceptible differences may permit a better assessment of the clinical relevance of therapeutic interventions in OA OBJECTIVE This study examined the optimal stimulation duration of transcutaneous electrical nerve stimulation ( TENS ) for relieving osteoarthritic knee pain and the duration ( as measured by half-life ) of post-stimulation analgesia . SUBJECTS Thirty-eight patients received either : ( i ) 20 minutes ( TENS20 ) ; ( ii ) 40 minutes ( TENS40 ) ; ( iii ) 60 minutes ( TENS60 ) of TENS ; or ( iv ) 60 minutes of placebo TENS ( TENS(PL ) ) 5 days a week for 2 weeks . METHODS A visual analogue scale recorded the magnitude and pain relief period for up to 10 hours after stimulation . RESULTS By Day10 , a significantly greater cumulative reduction in the visual analogue scale scores was found in the TENS40 ( 83.40 % ) and TENS60 ( 68.37 % ) groups than in the TENS20 ( 54.59 % ) and TENS(PL ) ( 6.14 % ) groups ( p < 0.000 ) , such a group difference was maintained in the 2-week follow-up session ( p < 0.000 ) . In terms of the duration of post-stimulation analgesia period , the duration for the TENS40 ( 256 minutes ) and TENS60 ( 258 minutes ) groups was more prolonged than in the other 2 groups ( TENS20 = 168 minutes , TENS(PL ) = 35 minutes ) by Day10 ( p < 0.000 ) . However , the TENS40 group produced the longest pain relief period by the follow-up session . CONCLUSION 40 minutes is the optimal treatment duration of TENS , in terms of both the magnitude ( VAS scores ) of pain reduction and the duration of post-stimulation analgesia for knee osetoarthritis & NA ; Transcutaneous electrical nerve stimulation ( TENS ) is a popular form of electrostimulation . Despite an extensive research base , there remains no consensus regarding the parameter selection required to achieve maximal hypoalgesic effects . The aim of this double blind , sham‐controlled study was to investigate the relative hypoalgesic effects of different TENS parameters ( frequency , intensity and stimulation site ) upon experimentally induced mechanical pain . Two hundred and forty participants were recruited in order to provide statistical analysis with 80 % power at & agr;=0.05 . Subjects were r and omised to one of the six TENS groups , a control , and a sham TENS group ( n=30 , 15 males , 15 females , per group ) . TENS groups differed in their combinations of stimulation ; frequency ( 4 or 11 Output:

Within 4 weeks of the commencement of treatment manual acupuncture , static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo . Follow-up data up to 12 weeks were sparse , but positive effects seemed to persist for at least 4 weeks after the course of LLLT , EA and TENS treatment was stopped . Conclusion TENS , EA and LLLT administered with optimal doses in an intensive 2–4 week treatment regimen , seem to offer clinical ly relevant short-term pain relief for OAK

MS2_1shot135

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Opioid misuse can complicate chronic pain management , and the non-medical use of opioids is a growing public health problem . The incidence and risk factors for opioid misuse in patients with chronic pain , however , have not been well characterized . We conducted a prospect i ve cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice . Methods One-hundred and ninety-six opioid-treated patients with chronic , non-cancer pain of at least three months duration were monitored for opioid misuse at pre-defined intervals . Opioid misuse was defined as : 1 . Negative urine toxicological screen ( UTS ) for prescribed opioids ; 2 . UTS positive for opioids or controlled substances not prescribed by our practice ; 3 . Evidence of procurement of opioids from multiple providers ; 4 . Diversion of opioids ; 5 . Prescription forgery ; or 6 . Stimulants ( cocaine or amphetamines ) on UTS . Results The mean patient age was 52 years , 55 % were male , and 75 % were white . Sixty-two of 196 ( 32 % ) patients committed opioid misuse . Detection of cocaine or amphetamines on UTS was the most common form of misuse ( 40.3 % of misusers ) . In bivariate analysis , misusers were more likely than non-misusers to be younger ( 48 years vs 54 years , p < 0.001 ) , male ( 59.6 % vs. 38 % ; p = 0.023 ) , have past alcohol abuse ( 44 % vs 23 % ; p = 0.004 ) , past cocaine abuse ( 68 % vs 21 % ; p < 0.001 ) , or have a previous drug or DUI conviction ( 40 % vs 11 % ; p < 0.001 % ) . In multivariate analyses , age , past cocaine abuse ( OR , 4.3 ) , drug or DUI conviction ( OR , 2.6 ) , and a past alcohol abuse ( OR , 2.6 ) persisted as predictors of misuse . Race , income , education , depression score , disability score , pain score , and literacy were not associated with misuse . No relationship between pain scores and misuse emerged . Conclusion Opioid misuse occurred frequently in chronic pain patients in a pain management program within an academic primary care practice . Patients with a history of alcohol or cocaine abuse and alcohol or drug related convictions should be carefully evaluated and followed for signs of misuse if opioids are prescribed . Structured monitoring for opioid misuse can potentially ensure the appropriate use of opioids in chronic pain management and mitigate adverse public health effects of diversion PURPOSE To define the dose ratio between morphine and methadone in relation to the previous morphine dose and the number of days needed to achieve the same level of analgesia in a group of patients with advanced cancer with pain who switched from morphine to oral methadone . PATIENTS AND METHODS A cross-sectional prospect i ve study of 38 consecutive cancer patients who switched from morphine to oral methadone was performed . The intensity of pain before , during , and after the switching period was assessed through a four-point verbal Likert scale . The relationship between previous morphine dose and the final equianalgesic methadone dose , dose ratio between morphine and methadone , and the number of days required to achieve equianalgesia have been examined by means of Pearson 's correlation coefficient , scatter plots , and Cuzick 's test for trend respectively . RESULTS Before the switch , the median oral equivalent daily dose of morphine was 145 mg/d ; after the switch , the median equianalgesic oral methadone dose was 21 mg/d . A median time of 3 days ( range , 1 to 7 days ) was necessary to achieve the equianalgesia with oral methadone ; the lower the preswitching morphine dose , the fewer days necessary to achieve equianalgesia with oral methadone ( P < .001 ) . Dose ratios ranged from 2.5:1 to 14.3:1 ( median , 7.75:1 ) , which indicated that , in most cases , the dose ratio was much higher than that suggested by the published equianalgesic tables . A strong linear positive relationship between morphine and methadone equianalgesic doses was obtained ( Pearson 's correlation coefficient , 0.91 ) . The dose ratio increased with the increase of the previous morphine dose with a much higher increase at low morphine doses . CONCLUSION The results of our study confirm that methadone is a potent opioid , more potent than believed . Caution is recommended when switching from any opioid to methadone , especially in patients who are tolerant to high doses of opioids Driving has been regarded as an activity of daily living that is important in maintaining a person 's independence in the community , access to employment , and social activities . Many patients , however , using opioid medications on a regular basis ( Chronic Opioid Analgesic Therapy : COAT ) to ameliorate their intractable pain have been restricted from driving out of concern that skills would be impaired and driving safety compromised by these medications . Yet there are no driving studies which have explored the effects of using opioid analgesics for an extended period of time . This pilot study was design ed to determine the effects of medically prescribed , stable opioid use on the driving abilities of patients with persistent , nonmalignant pain . Sixteen patients with chronic nonmalignant pain on COAT , who met criteria for participation in the study , underwent a comprehensive off-road driving evaluation using measures which have been shown to be sensitive in predicting on-road driving performance . The evaluation consisted of a pre-driver evaluation ( PDE ) , a simulator evaluation ( SDE ) , and behavioral observation during simulator performance . Patients in the COAT group were compared to a historical control group of 327 cerebrally compromised patients ( CComp ) who had undergone the same evaluation and then passed an on-road , behind-the-wheel evaluation ( BTW Pass ; n = 162 ) or failed ( BTW Fail ; n = 165 ) . Results revealed that COAT patients generally outperformed the CComp patients as a group by equaling or exceeding PDE and SDE scores of the BTW Fail patients as well as the BTW Pass patients on all measures that differentiated the groups . Notably , COAT patients had a relatively poorer performance than CComp patients on specific neuropsychometric tests in the PDE ; however , the differences were not statistically significant and did not imply a systematic pattern of scores that reflected domain-specific deficits . Behaviorally , COAT patients were generally superior to CComp patients , also ; however , COAT patients had greater difficulty in following instructions and as well as a tendency toward impulsivity , like the BTW fail group . While there was general support for the notion that COAT did not significantly impair the perception , cognition , coordination , and behavior measured in off-road tests that have been regarded as requisite for on-road driving , method ological problems may limit the generalizability of results and recommendations are made for research beyond a pilot study UNLABELLED Physical dependence or withdrawal is an expected effect of prolonged opioid therapy . Oxytrex ( oxycodone + ultralow-dose naltrexone ) is an investigational drug shown here to minimize physical dependence while providing strong analgesia with twice-daily dosing . In this 719-patient , double-blind , placebo- and active-controlled Phase III clinical trial in chronic low back pain , patients were r and omized to receive placebo , oxycodone qid , or oxytrex qid or bid . Each oxytrex tablet contains 1 microg naltrexone ; oxytrex bid and qid treatments provide 2 and 4 microg naltrexone/day , respectively . Following a washout , patients with pain > or=5 on a 0 - 10 scale were dose-escalated weekly from 10 up to 80 mg/day until reaching adequate pain relief ( < or=2 ) or a tolerable level of side effects . Following titration , the dose was fixed for 12 weeks . Active treatment groups attained comparable analgesia despite significantly lower drug use ( P = .03 ) by oxytrex patients . Patients taking oxytrex bid reported 55 % less physical dependence than patients on oxycodone ( P = .01 ) by the Short Opiate Withdrawal Scale 24 h after treatment cessation . Oxytrex bid patients also reported decreased moderate-to-severe constipation ( by 44 % , P = .01 ) , somnolence ( by 33 % , P = .03 ) , and pruritus ( by 51 % , P < .001 ) . This is the first large well controlled study to show strong analgesia with minimal withdrawal symptoms and better safety compared with oxycodone . PERSPECTIVE Previous clinical data have shown ultralow-dose naltrexone enhances and prolongs oxycodone analgesia , and pre clinical data also show a suppression of opioid tolerance and dependence . A cellular mechanism of action has been demonstrated to be the prevention of aberrant G protein signaling by mu opioid receptors caused by chronic opioid administration Objective To evaluate the outcomes associated with the use of controlled-release ( CR ) oxycodone for up to 3 years in the treatment of noncancer pain . Methods Adult patients who previously participated in controlled trials of CR oxycodone for osteoarthritis pain , diabetic neuropathy pain , or low back pain , and who continued to require opioid analgesia for moderate or severe pain , were enrolled in an open-label , uncontrolled , registry study . Data collected over time included dose , pain severity on a numeric scale , treatment acceptability , adverse events , and descriptions of problematic drug-related behavior . Results Two hundred thirty-three patients were enrolled . When the study closed , 141 , 86 , and 39 patients had taken CR oxycodone for at least 1 , 2 , and 3 years , respectively ; mean duration of treatment was 541.5 days . Among the 219 intent-to-treat patients ( received at least 1 dose and provided at least 1 postdose study observation ) , the mean ( SD , range ) daily dose was 52.5 ( ±38.5 , 10.0 to 293.5 ) mg . Before the end of month 3 , 44 % required an increase in total daily dose ; this dropped to 23 % during months 4 to 6 , to 17 % during months 10 to 12 , and remained at approximately 10 % for each time interval thereafter ( range 8 % to 13 % ) . Among the large majority of patients with stable or lower dose requirements after the initial 3 months of treatment , the average pain intensity ratings were unchanged or improved for approximately 70 % to 80 % of patients at all subsequent time points through month 33 , and for 54 % ( 7/13 patients ) at month 36 . A decrease in pain was initially seen by the end of month 3 , and for the majority of patients , the Average Pain Intensity score remained the same , better , or minimally worse ( <3 points ) for the remainder of the 3-year study period . The most common adverse events were constipation and nausea , and the incidence of these events declined over time on treatment . Investigators reported 6 cases ( 2.6 % ) of possible drug misuse but no evidence of de novo addiction was observed . Discussion These registry data demonstrate that a subgroup of patients with noncancer pain experienced prolonged relief with tolerable side effects and modest need for dose escalation during long-term therapy with CR oxycodone ABSTRACT Background : Short-acting opioids are commonly used to treat breakthrough pain ( BTP ) and rapid-onset formulations are being developed to improve the effectiveness of this approach . Fentanyl buccal tablet ( FBT ) is a new formulation of fentanyl that enhances transbuccal drug delivery via an effervescent reaction and may provide relatively rapid-onset analgesia . FBT was evaluated for BTP in opioid-treated patients with chronic low back pain – the first such study in a population with chronic non-cancer pain . Design : R and omized , double-blind , placebo-controlled . Patients and setting : Patients with chronic low back pain receiving long-term opioid therapy at 16 pain treatment centers in the United States . Procedures : Following open-label titration to identify an effective FBT dose , patients were r and omly assigned to one of three double-blind dose sequences ( six doses of FBT , three placebo ) to treat nine BTP episodes . Pain intensity ( PI ) , measured on an 11-point scale ( 0 = no pain ; 10 = worst pain ) , and other outcomes were assessed for 2 h after dosing . Data analysis : The primary efficacy measure was the sum of pain intensity differences ( PIDs ) for the first 60 min ( SPID60 ) ; secondary efficacy measures included PIDs at other time points , pain relief ( PR ) , meaningful PR , time to meaningful PR , use of supplementary BTP medication , and self/investigator-reported adverse events . Results : Of the 124 patients screened , 105 patients were enrolled , 84 identified an effective FBT dose , and 77 entered the double-blind phase . SPID60 significantly favored FBT ( p < 0.0001 ) . All secondary measures also favored FBT , with PIDs and PR showing significant differences versus placebo as early as 10 and 15 min , respectively . An improvement in PI score of ≥ 33 % occurred in a significantly larger proportion of FBT-treated episodes versus placebo from 15 min ( 20 % vs. 11 % , p < 0.01 ) through 2 h ( 65 % vs. 28 % , p < 0.0001 ) . Patients were approximately Output:

Although evidence is limited , the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain .

MS2_1shot136

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The objective of this r and omized controlled trial was to assess the effects of a 1‐year behavioral contract intervention on immunosuppressant therapy ( IST ) adherence and healthcare utilizations and costs among adult renal transplant recipients ( RTRs ) . The sample included adult RTRs who were at least 1 year posttransplant , taking tacrolimus or cyclosporine and served by a specialty pharmacy . Pharmacy refill records were used to measure adherence and monthly question naires were used to measure healthcare utilizations . Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey . Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS . Rate ratios and 95 % confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment . One hundred fifty RTRs were enrolled in the study . Intervention group RTRs ( n = 76 ) had higher adherence than control group RTRs ( n = 74 ) over the study period ( p < 0.01 ) . And 76.1 % of the intervention group compared with 42.7 % of the control group was not hospitalized during the 1‐year study period ( RR = 1.785 ; 95 % CI : 1.314 , 2.425 ) , result ing in cost savings . Thus , evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs Russell C , Conn V , Ashbaugh C , Madsen R , Wakefield M , Webb A , Coffey D , Peace L. Taking immunosuppressive medications effectively ( TIMELink ) : a pilot r and omized controlled trial in adult kidney transplant recipients . Clin Transplant 2011 : 25 : 864–870 . © 2010 John Wiley & Sons BACKGROUND Non-adherence to immunosuppressants is a major cause of renal transplant failure . Interventions to improve adherence need to target modifiable risk factors . METHODS Adherence was measured using the ' gold st and ard ' measure of electronic monitoring in 58 adult renal transplant recipients from a UK transplant unit . Subjects were identified from a stratified r and om sample of 153 recipients recruited to a larger cross-sectional study comparing different measures of adherence . Inclusion criteria included age over 18 years and a functioning renal transplant , transplanted 6 - 63 months previously . Exclusion criteria included residence outside the region served by the unit and inability to give informed consent . Health beliefs , depression and functional status were measured using st and ardized question naires ( Beliefs about Medicines Question naire , Illness Perception Question naire , Revised Clinical Interview Schedule and SF-36 ) and semi-structured interview . Transplant and demographic details were collected from the notes . RESULTS Seven [ 12 % , 95 % confidence interval ( CI ) 4 - 20 % ] subjects missed at least 20 % of days medication and 15 ( 26 % , 15 - 37 % ) missed at least 10 % of days . Lower belief in the need for medication and having a transplant from a live donor were the major factors associated with non-adherence . Depression was common , although not strongly associated with non-adherence . CONCLUSIONS Beliefs about medication are a promising target for interventions design ed to improve adherence . The lower adherence in recipients of transplants from live donors needs confirming but may be clinical ly important in light of the drive to increase live donation The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Background Mobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities ( eg , hypertension , diabetes ) . These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients ’ physiological data . This technology is also relatively inexpensive , has an intuitive interface , and provides the capability for real-time personalized feedback to help motivate patient self-efficacy . Automated summary reports of patients ’ adherence and blood pressure can easily be uploaded to providers ’ networks helping reduce clinical inertia by reducing regimen alteration time . Objective The aim of this study was to assess the feasibility , acceptability , and preliminary outcomes of a prototype mobile health ( mHealth ) medication and blood pressure ( BP ) self-management system for kidney transplant patients with uncontrolled hypertension . Methods A smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design . The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback . A 3-month proof-of-concept r and omized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray . Participants r and omized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging . Controls received st and ard of care and their adherence continued to be monitored with the medication tray reminders turned off . Providers received weekly summary reports of patient medication adherence and BP readings . Results Participation and retention rates were 41/55 ( 75 % ) and 31/34 ( 91 % ) , respectively . The prototype system appears to be safe , highly acceptable , and useful to patients and providers . Compared to the st and ard care control group ( SC ) , the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations . Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the st and ard care group ( 7 adjustments in 5 patients versus 3 adjustments in 3 patients ) during the 3-month trial based on the information provided in the weekly reports . Conclusions These data support the acceptability and feasibility of the prototype mHealth system . Further trials with larger sample sizes and additional biomarkers ( eg , whole blood medication levels ) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control after kidney transplantation over longer time periods . Trial Registration Clinical trials.gov NCT01859273 ; http:// clinical trials.gov/ct2/show/NCT01859273 ( Archived by WebCite at http://www.webcitation.org/6IqfCa3A3 ) ONCOMPLIANCE posttransplant is postulated to account for up to one third of graft failures due to chronic graft dysfunction . Due to its covert nature , determining the extent of the problem is not easy , and traditional methods tend to underestimate the true scale . More recently , methods of electronic monitoring have been introduced that tend to give a more accurate picture . One hundred stable renal transplant patients ( transplanted 1 year ) were approached and asked if they would use a “ smart top ” pill bottle ( Aardex , Switzerl and ) for their azathioprine/ prednisolone . The tops contain a microprocessor that records the date and time on each occasion the bottle is opened . This information can then be downloaded onto a computer via a modem at their regular clinic visits . The patients were r and omly assigned to groups ; 75 were given smart top bottles , and the other 25 were given plain tops . This latter group received regular interviews by a nurse practitioner and pill counts to assess their compliance . Of 92 patients whose data was available after 3 months ( 93 days ) , 11 ( 46 % ) of the plain top group and 31 ( 46 % ) of the smart top group missed at least one dose in the 3-month period . Twenty-two ( 33 % ) of the smart top group took extra doses in the 3-month period , none of the plain top group were found to have taken extra doses . Only 13 ( 54 % ) of the plain top group and 25 ( 37 % ) of the smart top group were 100 % compliant in the 3-month period ( not significant , chi-square test ) . Both electronic monitoring and nurse practitioner interviews with pill counting appear to be equally sensitive for detecting missed doses , but electronic monitoring measures timing of dosage and can also pick up when consecutive doses are missed . It also picks up when extra doses are taken . Missed doses and extra doses can cancel each other out when pill counts alone are used , which probably accounts for the higher 100 % compliance rate in the plain top group . METHOD One hundred stable renal transplant patients more than 1 year posttransplant were asked if they would use a smart top bottle for their regular once-daily azathioprine or prednisolone . Smart top bottles are medicine bottles with a microprocessor in the cap that records the date and time on each occasion the bottle is opened and closed . This information can then be downloaded onto a computer data base via a special modem at their regular outpatient visits . The patients were r and omly placed into one of two groups . Twenty-five of the patients were given a pill bottle with an ordinary lid on it . They were asked to bring their pill bottles with them to their regular outpatient clinic appointments , at approximately 3-month intervals , along with any remaining medication . They were then interviewed by a nurse practitioner about their compliance , and their remaining tablets were counted . The other 75 patients were given smart top bottles that they were asked to bring with them to their regular out patient appointments . The information was then downloaded from the lid onto the computer data base Background : Hypertension frequently accompanies diabetes mellitus , worsening prognosis and complicating medical care for patients . Low medication adherence with multiple medications is a major factor in the inadequate achievement of blood pressure treatment goals . Widespread access to mobile phones offers a new opportunity to communicate with patients and enhance disease self-management . Methods : We recruited 50 high-risk urban patients with hypertension , who are using at least two prescription medications for hypertension , into an open-label trial using medication reminder software on a mobile phone . Medication adherence was assessed by review of pharmacy refill rates before , during , and after availability of the medication reminder software ( pre-activation , activation , and post-activation phase , respectively ) . Results : Forty-eight patients completed the study . All subjects were insured by Medicaid , 96 % were African-American , and the majority had diabetes mellitus . The proportion of days covered for each study phase was as follows : Pre-activation phase = 0.54 , activation phase = 0.58 , and post-activation phase = 0.46 . A significant difference was found between the activation and post-activation phases ( p = .001 ) . The increase in measured adherence between the pre-activation and activation phases approached significance ( p = .057 ) . Forty-six patients completed the pre- and post-Morisky medication adherence survey . The median score rose from 2.0 at baseline to 3.0 at study completion ( p < .001 ) . Average blood pressure and level of control during study period improved significantly after initiation of the study and remained improved from baseline through the course of the study . The 48 subjects who completed the study reported a high level of satisfaction with the medication reminder application at the final study visit . Conclusions : A mobile-phone-based automated medication reminder system shows promise in improving medication adherence and blood pressure in high-cardiovascular-risk individuals Readers will be familiar with the CONSORT guidelines for the reporting of r and omised controlled trials . These guidelines were design ed to improve the reporting of RCTs and are of considerable use to research ers design ing and reporting studies as well as to editors and to systematic review ers . However , a major limitation of CONSORT is that they are limited to RCTs and there are far more research design s than RCTs . Some topics just can not be investigated using RCTs and yet it may often be desirable to try to identify whether or not there is a causal link between two factors . It is therefore very welcome to see the development of the TREND statement ( www.trend-statement.org/asp/trend.asp ) — the Transparent Reporting of Evaluations with NonR and omised design s. As the authors state these guidelines are developing — there is room for alteration and improvement but their prime focus is to encourage the transparency or clarity of reporting . In view of the evolutionary state of these guidelines , I would encourage research ers , editors and review ers to become familiar with them and to start using them . As they are used , areas , primarily of omission , will become apparent . The first area that needs exp and ing , in my opinion , is that more detail is required describing the characteristics of each population subgroup . I consider that more prominence of the potential for confounding factors needs to be acknowledged . As CONSORT has helped both investigators and review ers improve the quality of RCTs and systematic review s there is the possibility for TREND to do the Background With effective agents available to prevent posttransplantation acute organ rejection , medication adherence becomes a key factor for successful treatment outcomes after renal transplantation . A once-daily , modified-release oral formulation of tacrolimus has been developed to simplify dosing and improve medication adherence . Methods Adherence Measurement in Stable Renal Transplant Patients Following Conversion From Prograft to Advagraf is a r and omized multicenter controlled trial to evaluate adherence between a tacrolimus once-daily regimen and a tacrolimus twice-daily regimen using an electronic monitor to document drug intake . After enrolment , all patients continued the twice-daily regimen for 3 months and then were r and omized 2:1 between the two formulations Output:

Medication adherence rates were greatly enhanced when multidimensional interventions were implemented whereas one-off feedback from a nurse and financial assistance programmes offered little improvement . Dose administration aids when used in conjunction with self-monitoring also improved adherence . The number of patients who had a drug holiday ( at least 1-day interval without a dose ) was higher in a once-daily regimen than a twice-daily regimen . The findings of this review suggest an intervention targeting behavioural risk factors or a combination of behavioural , educational and emotional changes is effective in enhancing medication adherence .

MS2_1shot137

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Irritable bowel syndrome ( IBS ) is one of the most common functional gastrointestinal disorder which is associated with considerable sufferings of patient and Peppermint oil is volatile oil , its active principle is menthol-contain a cyclic monoterpine which has anti-spasmotic properties due to its ability to block calcium channel of intestinal smooth muscles . This study observed the efficacy of peppermint oil for relieving the symptoms and changes of quality of life ( QOL ) in diarrhea predominant IBS . This was a prospect i ve double blind r and omized placebo-controlled study conducted in the Bangab and hu Sheikh Mujib Medical University during July 2008 to September 2009 . Patients who fulfilled ROME II were initially selected but those had red flag signs or any organic disease was excluded from the study . Seventy four patients were enrolled in the study and r and omly allocated to receive either peppermint oil or placebo three times daily for six weeks . Changes of symptoms were assessed three week interval during treatment and two weeks after the end of treatment . Data were analyzed by paired and unpaired ' t ' test . Finally sixty five patients completed the trial . It was observed that , at six weeks of therapy abdominal pain is markedly improved ( mean±SD ) 4.94±1.30 in peppermint oil group compared with 6.15±1.24 in placebo group and the difference was statistically highly significant ( p>0.001 ) . But two weeks after end of trials pain score again increased ( 6.09±1.93 ) . Other symptoms and quality of life did not improve significantly . So the study result concludes that peppermint oil is effective in reliving only abdominal pain in diarrhea predominant IBS transiently In a r and omized , double-blind controlled trial , 42 children with irritable bowel syndrome ( IBS ) were given pH-dependent , enteric-coated peppermint oil capsules or placebo . After 2 weeks , 75 % of those receiving peppermint oil had reduced severity of pain associated with IBS . Peppermint oil may be used as a therapeutic agent during the symptomatic phase of IBS ABSTRACT To determine the efficacy and tolerability of an enteric-coated peppermint-oil formulation ( Colpermin ) , a prospect i ve , r and omized , double-blind , placebo-controlled clinical study was conducted in 110 out patients ( 66 men and 44 women ; 18–70 yr old ) with symptoms of irritable bowel syndrome . Patients took one capsule ( Colpermin or placebo ) 3–4 times daily , 15–30 min before meals , for 1 month . Fifty-two patients on Colpermin and 49 on placebo completed the study . Forty-one patients on Colpermin ( 79 % ) experienced an alleviation of the severity of abdominal pain ( 29 were pain free ) ; 43 ( 83 % ) had less abdominal distension , 43 ( 83 % ) had reduced stool frequency , 38 ( 73 % ) had fewer borborygmi , and 41 ( 79 % ) had less flatulence . Corresponding figures for the placebo group were : 21 patients ( 43 % ) with reduced pain ( four were pain free ) , 14 ( 29 % ) with reduced distension , 16 ( 32 % ) with reduced stool frequency , 15 ( 31 % ) with fewer borborygmi , and 11 ( 22 % ) with less flatulence . Symptom improvements after Colpermin were significantly better than after placebo ( p < 0.05 ; Mann-Whitney U-test ) . One patient on Colpermin experienced heartburn ( because of chewing the capsules ) and one developed a mild transient skin rash . There were no significant changes in liver function test results . The authors conclude that Colpermin was effective and well tolerated . ( Am J Gastroenterol 1998;93:2304–2305 . © 1998 by Am . Coll . of Gastroenterology The incidence of imported malaria in the UK has steadily increased during the past decade , ' with 1909 cases reported in 1978 . At St Thomas 's Hospital P falciparunz malaria is much commoner than P vivax and is mostly acquired in tropical Africa.2 Most of the malaria reported in Asian immigrants is P vivax,5 and , although the World Health Organisation has reported an increase in the incidence of falciparum malaria in Bangladesh , India , and Sri Lanka , ' we have not previously seen a falciparum infection in an Asian . Chloroquineresistant falciparum malaria has been reported in South-east Asia and South America for many years , but its occurrence in the Asian subcontinent and in East Africa is much more recent . Two cases of imported chloroquine-resistant falciparum infections have recently occurred in the UK ; both were from Kenya and one was fatal.4 Our patient would appear to have shown RI resistance to chloroquine in that parasites reappeared after 23 days , although the initial course of chloroquine had apparently eradicated the infection . We made no attempt to culture the malarial parasites to confirm in-vitro resistance . This patient probably acquired her malaria from blood transfusion in Bangladesh , and there have been no reports of chloroquine-resistant P falciparum being transmitted by this route , although transfusion malaria is known to be common and underreported in the developing countries , and many cases of falciparum are described.5 Malaria in our patient was initially diagnosed by chance when blood films were being examined . The patient at this time was relatively well and afebrile , and malaria was not suspected clinical ly . The resurgence of the falciparum was unexpected and delayed diagnosis in view of the many other possible causes of fever in a neutropenic postoperative patient with leukaemia . Malaria was not initially entertained as a likely diagnosis because of the apparently successful treatment with chloroquine . It is of interest that the clinical response to intravenous quinine was slow , particularly defervescence , and perhaps " quinine fever " may have been contributory . The disappearance of parasites was also slow ; indeed , the parasitaemia appeared unchanged after two infusions of quinine . Although we are unaware of the effect of severe neutropenia and immunosuppression on the clinical course of malaria , it seems likely that this patient was infected with a chloroquine-resistant strain of P falciparum Thirty-five patients with irritable bowel syndrome were r and omized to receive treatment in a stress management programme or conventional therapy which included the antispasmodic Colpermin . The stress management programme involved a median of six 40-min sessions with a physiotherapist during which patients were helped to underst and the nature of their symptoms , their relationship to stress and were taught relaxation exercises . Two thirds of those in the stress management programme found the programme effective in relieving symptoms and experienced fewer attacks of less severity . This benefit was maintained for at least 12 months . Few of those given conventional management had any benefit . A stress management programme would appear to be of value for patients with irritable bowel syndrome Output:

Although peppermint oil patients were significantly more likely to experience an adverse event , such events were mild and transient in nature . The most commonly reported adverse event was heartburn . CONCLUSIONS Peppermint oil is a safe and effective short-term treatment for IBS .

MS2_1shot138

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Seminal abnormalities are a common side effect of salazosulphapyridine ( SASP ) treatment . We evaluated semen qualities and sex hormone concentrations in 11 patients with inflammatory bowel disease ( IBD ) during SASP treatment and 4 months after replacing SASP with an oral slow-release preparation of 5-aminosalicylic acid ( 5-ASA ) . Significant improvement in sperm count ( p less than 0.01 ) , morphology ( p less than 0.02 ) , and motility ( p less than 0.02 ) could be observed during 5-ASA therapy , in comparison with SASP treatment . Three pregnancies occurred during the study period . The serum concentrations of gonadotrophins , prolactin , and sex hormone-binding globulin were normal in all patients and not significantly different in the two treatment periods . The mean total testosterone concentration decreased significantly ( p less than 0.02 ) after 5-ASA substitution , together with serum albumin ( p less than 0.005 ) , although all values remained within normal limits . The apparent free testosterone concentration was not significantly different in the two treatment periods . It is concluded that a significant improvement in semen quality can be obtained in male patients with IBD after replacing SASP with 5-ASA Sulphasalazine ( SASP ) is now accepted as an effective slow-acting antirheumatic drug for treating active rheumatoid arthritis ( RA ) , but has not been previously evaluated in psoriatic arthritis . An earlier open study suggested that it was well tolerated and potentially beneficial . The present double-blind placebo-controlled trial of 30 patients has now confirmed its efficacy . Greater improvement occurred in those patients on active treatment than on placebo , with more benefit being detected in those patients with the symmetrical polyarticular but seronegative pattern of arthritis associated with a high acute-phase response . SASP was stopped in 26 % because of side-effects but these were mild . No exacerbation or remission of psoriasis was observed . Further studies are in progress to determine the degree of efficacy of SASP in different clinical subgroups of psoriatic arthritis Sulphasalazine ( SASP ) and methotrexate ( MTX ) are well-established treatments for RA but the use of these drugs in combination has been avoided as both have antifolate activity . In this paper we report our experience with 32 patients treated with the combination MTX/SASP and compare the toxicity and tolerability of the combination with 63 patients treated with MTX alone . The median duration of exposure to the combination was 23 months . Nineteen patients have continued this regime for over 18 months . Five patients on MTX/SASP combination discontinued MTX , in four cases due to toxicity and in one because MTX/SASP was ineffective . In 17 patients on MTX alone , the drug was withdrawn permanently . In seven cases the cause was toxicity including two patients with severe reactions . In patients known to tolerate SASP alone , the combination of MTX/SASP is also well tolerated . In our experience of 48 patient-years of such combination therapy , there is no increase in toxicity compared to therapy with MTX alone in RA Desensitization to sulfasalazine was successful in 40/47 ( 85 % ) patients with IBD who previously had hypersensitivity reactions . The desensitization with sulfasalazine was well-tolerated with no serious complications in short- or long-term follow-up . The course of IBD was subsequently favorable in 35/40 ( 87 % ) for extended periods including 17/17 ( 100 % ) with ulcerative colitis . Desensitization should be attempted in patients who have had typical hypersensitivity reactions to sulfasalazine OBJECTIVE Case reports have suggested that minocycline , sulfasalazine , and penicillamine are associated with antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis . This study evaluated ANCA seroconversion due to these agents in serum sample s prospect ively collected in r and omized , double-blind , controlled trials . METHODS The sources of study sera were 3 clinical trials : 1 ) a 48-week trial of minocycline for early rheumatoid arthritis , with 64 patients receiving minocycline compared with 68 receiving placebo ; 2 ) a 37-week trial of sulfasalazine for rheumatoid arthritis , with 51 receiving sulfasalazine compared with 38 receiving placebo ; and 3 ) a 104-week trial of penicillamine for early systemic sclerosis , with 15 undergoing high-dose penicillamine treatment versus 12 receiving low-dose penicillamine . ANCA were measured in the baseline and study -end serum sample s by indirect immunofluorescence ( IIF ) for perinuclear ANCA ( pANCA ) and cytoplasmic ANCA ( cANCA ) patterns , and by antigen-specific enzyme-linked immunosorbent assay ( ELISA ) for antibodies to myeloperoxidase ( anti-MPO ) and proteinase 3 ( anti-PR3 ) . Laboratory personnel were blinded to the group identity of the sample s. ANCA results were interpreted using an ANCA scoring system that combines the results of IIF and ELISA testing . RESULTS No patient in any of the active study drug groups demonstrated ANCA seroconversion according to the final interpretation of the combined IIF and ELISA results . Twelve of the 248 patients ( 5 % ) were positive for anti-MPO with pANCA at baseline . No subject was positive for anti-PR3 with cANCA . There were no findings suggestive of vasculitis in any of these patients . CONCLUSION From our study results , there was no suggestion of ANCA seroconversion induced by minocycline , sulfasalazine , or penicillamine . However , these findings do not rule out the possibility of rare , sporadic cases of either ANCA seroconversion or true drug-induced vasculitis with these drugs Background The prognosis of patients suffering from WHO grade 3 and 4 astrocytic glioma remains poor despite surgery , radiation therapy and the use of current chemotherapy regimen . Indeed , the median survival of glioblastoma multiforme ( WHO grade 4 ) patients is at best 14.6 month with only 26.5 percents of the patients still alive after 2 years and the median survival of anaplastic astrocytomas ( WHO grade 3 ) is 19.2 month . Recent evidence suggests that the transcription factor NF-kappaB is constitutively expressed in malignant gliomas and that its inhibition by drugs like Sulfasalazine may block the growth of astrocytic tumors in vitro and in experimental models of malignant gliomas . Design ULg_GBM_04/1 is a prospect i ve , r and omized , double blind single-center phase 1–2 study . A total of twenty patients with progressive malignant glioma despite surgery , radiation therapy and a first line of chemotherapy will be recruited and assigned to four dosage regimen of Sulfasalazine . This medication will be taken orally t.i.d . at a daily dose of 1.5–3–4 or 6 g , continuously until complete remission , evidence of progression or drug intolerance . Primary endpoints are drug safety in the setting of malignant gliomas and tumor response as measured according to MacDonald 's criteria . An interim analysis of drug safety will be conducted after the inclusion of ten patients . The complete evaluation of primary endpoints will be conducted two years after the enrolment of the last patient or after the death of the last patient should this occur prematurely . Discussion The aim of this study is to evaluate the safety and efficacy of Sulfasalazine as a treatment for recurring malignant gliomas . The safety and efficacy of this drug are analyzed as primary endpoints . Overall survival and progression-free survival are secondary endpoint Sulfasalazine is accepted therapy for active ulcerative colitis , but side‐effects and intolerance are common . Balsalazide is an azo‐bonded pro‐drug which also releases 5‐aminosalicylic acid into the colon , but uses an inert carrier molecule In a double blind , single observer , 48 week study the effects of sulphasalazine ( 2 g daily ) and hydroxychloroquine ( 400 mg daily months 0 - 6 , thereafter 200 mg daily ) were compared in 60 patients with definite or classical rheumatoid arthritis . They had not been treated previously with second line drugs . The onset of response with sulphasalazine was earlier than with hydroxychloroquine . After 48 weeks a comparison of the treatments showed no statistically significant differences in disease activity variables . Adverse reaction was the main reason for withdrawal in the sulphasalazine group and lack of efficacy in the hydroxychloroquine group . All adverse reactions , one being agranulocytosis after eight weeks of sulphasalazine treatment , appeared in the first three months of treatment and were completely reversible OBJECTIVES To study the outcome in clinical practice of first DMARD and /or corticosteroid ( CS ) treatment in patients with recent onset rheumatoid arthritis ( RA ) . PATIENTS 245 patients with active RA , not previously treated with DMARDs or CS , were r and omised to one of two treatment groups , T1 = 7.5 - 15 mg of prednisolone ( PRE ) daily for one to three months followed , if needed , by methotrexate ( MTX ) in a weekly dose of 5 - 15 mg in addition to the lowest possible dose of PRE or T2 = sulfasalazine ( SAL ) , supplemented with lowest possible CS dose if needed . METHODS The EULAR individual response criteria were applied and remission was defined as a final DAS28 < 2.6 . Function was assessed by the HAQ and radiographic progression by Larsen scores . A patient who managed to remain on the allocated treatment for two years was described as a " completer " . RESULTS After 2 years of treatment , 70 % of the patients in T1 and 63 % in T2 were responders ( 30 % and 33 % " good responders " , respectively ) . In T1 29 % and in T2 19 % were in remission . There was a significant functional improvement in both groups but radiographic progression occurred . The mean decrease in HAQ and increase in the Larsen score were similar in the two groups . One-third of the patients were non-completers , 19 % from T1 and 47 % from T2 . Non-completers had , compared with completers , a significantly lower rate of individual response and remission . Completers and non-completers had similar functional improvement and similar radiological progression . CONCLUSIONS Individual response and remission was reduced in patients who did not complete their first DMARD/CS treatment option . Treatment failures were significantly more frequent in the sulfasalazine plus optional CS than in the CS plus optional methotrexate treatment group Sulfasalazine is well established in the treatment of active ulcerative colitis . Intolerance to sulfasalazine , however , is a common problem . Balsalazide has been design ed to deliver 5‐aminosalicylic acid to the colon without the poor tolerability of sulfasalazine OBJECTIVE To evaluate two monotherapies followed by step-up combination therapy with two or three complementary drugs in active rheumatoid arthritis ( RA ) in comparison with sulphasalazine ( SSZ ) alone . METHODS One hundred and twenty-six consecutive patients with early active RA were enrolled in this open controlled clinical trial . The primary end-point was 50 % improvement according to the ACR criteria ( ACR50 ) at 6 , 12 or 18 months . The secondary end-points were a full response ( Magnusson criteria ) and /or remission ( ACR criteria ) at 3 yr . Methotrexate ( MTX ) ( group 1 ) , cyclosporin A ( CsA ) ( group 2 ) or SSZ ( group 3 ) was used first . After 6 months , a combination of two drugs ( CsA and MTX ) was employed in groups 1 and 2 . SSZ was added after 12 months if improvement was less than ACR50 with the combination . Group 3 continued with SSZ alone . RESULTS After 6 months , 57 % of patients in group 1 , 31 % of group 2 ( MTX vs CsA , P=0.002 ) and 33 % of group 3 ( MTX vs SSZ , P=0.01 ) had reached ACR50 improvement according to intention-to-treat analysis . At month 12 after starting a drug combination , 67 % of group 1 and 76 % of group 2 had reached ACR50 compared with 24 % of group 3 . At the 18-month follow-up , 90 % of group 1 and 88 % of group 2 but only 24 % of group 3 had reached ACR50 . After 18 months , 62 % of group 1 , 60 % of group 2 and 48 % of group 3 showed side-effects and three , five and eight patients in the three groups respectively had dropped out of the study . At the 3-yr follow-up , 9 % of the patients in groups 1 and 2 and 7 % of group 3 were in remission according to the ACR criteria ; according to the Magnusson criteria , 40 % showed a full response in groups 1 and 2 but only 21 % did so in group 3 . CONCLUSION MTX appears to be the fastest-acting agent . A step-up approach with MTX plus CsA plus SSZ led to a 50 % improvement according to the ACR criteria in most patients . After 3 yr , 40 % of patients receiving combination therapy and 21 % of patients receiving monotherapy showed a full response , while 9 and 7 % respectively attained remission BACKGROUND Current disease management in rheumatoid arthritis ( RA ) has moved Output:

CONCLUSIONS The adverse effects of SSZ vary with the pattern of acetylation . Thus , in slow-acetylators , depending on the dosage of SSZ , the side effects increase significantly . In the Spanish population slow-acetylators prevalence is higher than in other ethnic groups . Therefore , one could infer that the incidence of adverse side effects by SSZ could be higher in the Spanish population than in others different ethnic groups . We found no evidence that the Spanish population was more likely to suffer adverse effects by SSZ than other ethnic groups

MS2_1shot139

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: We examined the effects of an 8-week exercise intervention on aerobic fitness , and roid and gynoid fat mass , and blood lipids in overweight and obese participants . Twenty-four sedentary participants ( average BMI = 30 ± 2 kg/m2 ; 18 females , 6 males ) were r and omized into either interval training and diet education ( INT group ) , continuous aerobic exercise and diet education ( CON group ) , or diet education only ( DIET group ) . Duration s of exercise sessions were similar ( ∼30 minutes ) , with both exercise groups completing the same amount of work . The INT and CON groups demonstrated significant improvements over time for ( p < 0.01 and p < 0.05 , ES = 1.1 and 1.2 , respectively ) and time to exhaustion on a grade d exercise test ( p < 0.01 and ES = 0.8 for both groups ) . Further , a large effect size ( 0.7 ) was recorded for the loss in and roid fat mass over time in the INT group only The aim of this study was to investigate the effects of very high intensity sprint interval training ( SIT ) on metabolic and vascular risk factors in overweight/obese sedentary men . Ten men ( age , 32.1 ± 8.7 years ; body mass index , 31.0 ± 3.7 kg m(-2 ) ) participated . After baseline metabolic , anthropometric , and fitness measurements , participants completed a 2-week SIT intervention , comprising 6 sessions of 4 to 6 repeats of 30-second Wingate anaerobic sprints on an electromagnetically braked cycle ergometer , with 4.5-minute recovery between each repetition . Metabolic , anthropometric , and fitness assessment s were repeated post-intervention . Both maximal oxygen uptake ( 2.98 ± 0.15 vs 3.23 ± 0.14 L min(-1 ) , P = .013 ) and mean Wingate power ( 579 ± 24 vs 600 ± 19 W , P = .040 ) significantly increased after 2 weeks of SIT . Insulin sensitivity index ( 5.35 ± 0.72 vs 4.34 ± 0.72 , P = .027 ) and resting fat oxidation rate in the fasted state ( 0.13 ± 0.01 vs 0.11 ± 0.01 g min(-1 ) , P = .019 ) were significantly higher and systolic blood pressure ( 121 ± 3 vs 127 ± 3 mm Hg , P = .020 ) and resting carbohydrate oxidation in the fasted state ( 0.03 ± 0.01 vs 0.08 ± 0.02 g min(-1 ) , P = .037 ) were significantly lower 24 hours post-intervention compared with baseline , but these changes were no longer significant 72 hours post-intervention . Significant decreases in waist ( 98.9 ± 3.1 vs 101.3 ± 2.7 cm , P = .004 ) and hip ( 109.8 ± 2.2 vs 110.9 ± 2.2 cm , P = .017 ) circumferences compared with baseline were also observed after the intervention . Thus , 2 weeks of SIT substantially improved a number of metabolic and vascular risk factors in overweight/obese sedentary men , highlighting the potential for this to provide an alternative exercise model for the improvement of vascular and metabolic health in this population Regular exercise training is recognized as a powerful tool to improve work capacity , endothelial function and the cardiovascular risk profile in obesity , but it is unknown which of high-intensity aerobic exercise , moderate-intensity aerobic exercise or strength training is the optimal mode of exercise . In the present study , a total of 40 subjects were r and omized to high-intensity interval aerobic training , continuous moderate-intensity aerobic training or maximal strength training programmes for 12 weeks , three times/week . The high-intensity group performed aerobic interval walking/running at 85 - 95 % of maximal heart rate , whereas the moderate-intensity group exercised continuously at 60 - 70 % of maximal heart rate ; protocol s were isocaloric . The strength training group performed ' high-intensity ' leg press , abdominal and back strength training . Maximal oxygen uptake and endothelial function improved in all groups ; the greatest improvement was observed after high-intensity training , and an equal improvement was observed after moderate-intensity aerobic training and strength training . High-intensity aerobic training and strength training were associated with increased PGC-1alpha ( peroxisome-proliferator-activated receptor gamma co-activator 1alpha ) levels and improved Ca(2 + ) transport in the skeletal muscle , whereas only strength training improved antioxidant status . Both strength training and moderate-intensity aerobic training decreased oxidized LDL ( low-density lipoprotein ) levels . Only aerobic training decreased body weight and diastolic blood pressure . In conclusion , high-intensity aerobic interval training was better than moderate-intensity aerobic training in improving aerobic work capacity and endothelial function . An important contribution towards improved aerobic work capacity , endothelial function and cardiovascular health originates from strength training , which may serve as a substitute when whole-body aerobic exercise is contra-indicated or difficult to perform OBJECTIVE To compare the response of blood glucose levels to intermittent high-intensity exercise ( IHE ) and moderate-intensity exercise ( MOD ) in individuals with type 1 diabetes . RESEARCH DESIGN AND METHODS Seven healthy individuals with type 1 diabetes were tested on two separate occasions , during which either a 30-min MOD or IHE protocol was performed . MOD consisted of continuous exercise at 40 % Vo(2peak ) , while the IHE protocol involved a combination of continuous exercise at 40 % Vo(2peak ) interspersed with 4-s sprints performed every 2 min to simulate the activity patterns of team sports . RESULTS Both exercise protocol s result ed in a decline in blood glucose levels . However , the decline was greater with MOD ( -4.4 + /- 1.2 mmol/l ) compared with IHE ( -2.9 + /- 0.8 mmol/l ; P < 0.05 ) , despite the performance of a greater amount of total work with IHE ( P < 0.05 ) . During 60 min of recovery from exercise , glucose levels remained higher in IHE compared with MOD ( P < 0.05 ) . Furthermore , glucose levels remained stable during recovery from IHE , while they continued to decrease after MOD ( P < 0.05 ) . The stabilization of blood glucose levels with IHE was associated with elevated levels of lactate , catecholamines , and growth hormone during early recovery from exercise ( P < 0.05 ) . There were no differences in free insulin , glucagon , cortisol , or free fatty acids between MOD and IHE . CONCLUSIONS The decline in blood glucose levels is less with IHE compared with MOD during both exercise and recovery in individuals with type 1 diabetes Background — Exercise training reduces the symptoms of chronic heart failure . Which exercise intensity yields maximal beneficial adaptations is controversial . Furthermore , the incidence of chronic heart failure increases with advanced age ; it has been reported that 88 % and 49 % of patients with a first diagnosis of chronic heart failure are > 65 and > 80 years old , respectively . Despite this , most previous studies have excluded patients with an age > 70 years . Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfa rct ion heart failure . Methods and Results — Twenty-seven patients with stable postinfa rct ion heart failure who were undergoing optimal medical treatment , including & bgr;-blockers and angiotensin-converting enzyme inhibitors ( aged 75.5±11.1 years ; left ventricular [ LV ] ejection fraction 29 % ; & OV0312;o2peak 13 mL · kg−1 · min−1 ) were r and omized to either moderate continuous training ( 70 % of highest measured heart rate , ie , peak heart rate ) or aerobic interval training ( 95 % of peak heart rate ) 3 times per week for 12 weeks or to a control group that received st and ard advice regarding physical activity . & OV0312;o2peak increased more with aerobic interval training than moderate continuous training ( 46 % versus 14 % , P<0.001 ) and was associated with reverse LV remodeling . LV end-diastolic and end-systolic volumes declined with aerobic interval training only , by 18 % and 25 % , respectively ; LV ejection fraction increased 35 % , and pro-brain natriuretic peptide decreased 40 % . Improvement in brachial artery flow-mediated dilation ( endothelial function ) was greater with aerobic interval training , and mitochondrial function in lateral vastus muscle increased with aerobic interval training only . The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups . No changes occurred in the control group . Conclusions — Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity , endothelial function , and quality of life in patients with postinfa rct ion heart failure . These findings may have important implication s for exercise training in rehabilitation programs and future studies Aims : Exercise is recommended as prevention , management , and control of all stages of hypertension . There are still controversies about the optimal training dose , frequency , and intensity . We aim ed to study the effect of aerobic interval training on blood pressure and myocardial function in hypertensive patients . Methods and results : A total of 88 patients ( 52.0 ± 7.8 years , 39 women ) with essential hypertension were r and omized to aerobic interval training ( AIT ) ( > 90 % of maximal heart rate , correlates to 85–90 % of VO2max ) , isocaloric moderate intensity continuous training ( MIT ) ( ∼70 % of maximal heart rate , 60 % of VO2max ) , or a control group . Exercise was performed on a treadmill , three times per week for 12 weeks . Ambulatory 24-hour blood pressure ( ABP ) was the primary endpoint . Secondary endpoints included maximal oxygen uptake ( VO2max ) , mean heart rate/24 hour , flow mediated dilatation ( FMD ) , total peripheral resistance ( TPR ) , and myocardial systolic and diastolic function by echocardiography . Systolic ABP was reduced by 12 mmHg ( p < 0.001 ) in AIT and 4.5 mmHg ( p = 0.05 ) in MIT . Diastolic ABP was reduced by 8 mmHg ( p < 0.001 ) in AIT and 3.5 mmHg ( p = 0.02 ) in MIT . VO2max improved by 15 % ( p < 0.001 ) in AIT and 5 % ( p < 0.01 ) in MIT . Systolic myocardial function improved in both exercise groups , diastolic function in the AIT group only . TPR reduction and increased FMD were only observed in the AIT group . Conclusions : This study indicates that the blood pressure reducing effect of exercise in essential hypertension is intensity dependent . Aerobic interval training is an effective method to lower blood pressure and improve other cardiovascular risk factors Musa , DI , Adeniran , SA , Dikko , AU , and Sayers , SP . The effect of a high-intensity interval training program on high-density lipoprotein cholesterol in young men . J Strength Cond Res 23(2 ) : 587 - 592 , 2009-This study examined the impact of an 8-week program of high-intensity interval training on high-density lipoprotein cholesterol ( HDL-C ) , total cholesterol ( TC ) , and the atherogenic index ( TC/HDL-C ) in 36 untrained men ages 21 - 36 years . Participants were r and omly assigned to an interval training group ( n = 20 ) or a control group ( n = 16 ) . Participants in the experimental group performed 3.2 km of interval running ( 1:1 work : rest ratio ) 3 times a week for 8 weeks at an intensity of 90 % of maximal heart rate ( ∼423 kcal per session ) . Results indicated significant pre- to posttraining changes in HDL-C ( 1.1 vs. 1.3 mmol·L−1 , p < 0.0001 ) and TC/HDL-C ( 3.8 vs. 3.1 , p < 0.0001 ) but no significant changes in TC ( 3.9 vs. 3.8 mmol·L−1 , p > 0.05 ) with interval training . It was concluded that an 8-week program of high-intensity interval training is effective in eliciting favorable changes in HDL-C and TC/HDL-C but not TC in young adult men with normal TC levels . Our findings support the recommendations of high-intensity interval training as an alternative mode of exercise to improve blood lipid profiles for individuals with acceptable physical fitness levels Low-volume sprint interval training ( SIT ) , or repeated sessions of brief , intense intermittent exercise , elicits metabolic adaptations that resemble traditional high-volume endurance training ( ET ) . The effects of these different forms of exercise training on vascular structure and function remain largely unexplored . To test the hypothesis that SIT and ET would similarly improve peripheral Output:

Short-term ( ST ) HIIT ( < 12 weeks ) significantly improved maximal oxygen uptake ( VO2 max ; SMD 0.74 , 95 % CI 0.36 to 1.12 ; p<0.001 ) , diastolic blood pressure ( DBP ; SMD −0.52 , 95 % CI −0.89 to −0.16 ; p<0.01 ) and fasting glucose ( SMD −0.35 , 95 % CI −0.62 to −0.09 ; p<0.01 ) in overweight/obese population s. Long-term ( LT ) HIIT ( ≥12 weeks ) significantly improved waist circumference ( SMD −0.20 , 95 % CI −0.38 to −0.01 ; p<0.05 ) , % body fat ( SMD −0.40 , 95 % CI −0.74 to −0.06 ; p<0.05 ) , VO2 max ( SMD 1.20 , 95 % CI 0.57 to 1.83 ; p<0.001 ) , resting heart rate ( SMD −0.33 , 95 % CI −0.56 to −0.09 ; p<0.01 ) , systolic blood pressure ( SMD −0.35 , 95 % CI −0.60 to −0.09 ; p<0.01 ) and DBP ( SMD −0.38 , 95 % CI −0.65 to −0.10 ; p<0.01 ) in overweight/obese population s. HIIT demonstrated no effect on insulin , lipid profile , C reactive protein or interleukin 6 in overweight/obese population s. In normal weight population s , ST-HIIT and LT-HIIT significantly improved VO2 max , but no other significant effects were observed . Current evidence suggests that ST-HIIT and LT-HIIT can increase VO2 max and improve some cardiometabolic risk factors in overweight/obese population

MS2_1shot140

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND AND OBJECTIVES Mechanical failure may reduce the efficacy of condoms . Little is known about frequency and determinants of condom failure in groups at high risk of sexually transmitted diseases ( STD ) . GOAL To measure condom breakage and slippage rates and evaluate potential determinants of failure among women attending a public STD clinic . STUDY DESIGN Women attending an STD clinic participated in a 6-month prospect i ve study of barrier contraception for the prevention of STD . They completed sexual diaries that were review ed at monthly follow-up visits . No data were collected from the male partners . Baseline characteristics of the participants and time-dependent behaviors were evaluated as potential determinants of condom failure . RESULTS Of 21,852 condoms used by 892 women , 500 broke during intercourse ( 2.3 % ) and 290 slipped ( 1.3 % ) . Breakage was more common among young , black , single nulliparae who engaged in high-risk behavior . Slippage was more common among married women with children . Failure rates decreased with condom use , with coital frequency , and with use of spermicides . CONCLUSION User characteristics and experience are determinants of breakage and slippage , which are often regarded only as the effect of product design flaws . Attention to modifiable determinants of failure may improve user counseling and product labeling Summary Background Sexual behaviour and relationships are key components of wellbeing and are affected by social norms , attitudes , and health . We present data on sexual behaviours and attitudes in Britain ( Engl and , Scotl and , and Wales ) from the three National Surveys of Sexual Attitudes and Lifestyles ( Natsal ) . Methods We used a multistage , clustered , and stratified probability sample design . Within each of the 1727 sample d postcode sectors for Natsal-3 , 30 or 36 addresses were r and omly selected and then assigned to interviewers . To over sample individuals aged 16–34 years , we r and omly allocated addresses to either the core sample ( in which individuals aged 16–74 years were eligible ) or the boost sample ( in which only individuals aged 16–34 years were eligible ) . Interviewers visited all sample d addresses between Sept 6 , 2010 , and Aug 31 , 2012 , and r and omly selected one eligible individual from each household to be invited to participate . Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview . We analysed data from this survey , weighted to account for unequal selection probabilities and non-response to correct for differences in sex , age group , and region according to 2011 Census figures . We then compared data from participants aged 16–44 years from Natsal-1 ( 1990–91 ) , Natsal-2 ( 1999–2001 ) , and Natsal-3 . Findings Interviews were completed with 15 162 participants ( 6293 men , 8869 women ) from 26 274 eligible addresses ( 57·7 % ) . 82·1 % ( 95 % CI 81·0–83·1 % ) of men and 77·7 % ( 76·7–78·7 % ) of women reported at least one sexual partner of the opposite sex in the past year . The proportion generally decreased with age , as did the range of sexual practice s with partners of the opposite sex , especially in women . The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16–44 years when compared with Natsal-1 has generally been sustained in Natsal-3 , but in men has generally not risen further . However , in women , the number of male sexual partners over the lifetime ( age-adjusted odds ratio 1·18 , 95 % CI 1·08–1·28 ) , proportion reporting ever having had a sexual experience with genital contact with another woman ( 1·69 , 1·43–2·00 ) , and proportion reporting at least one female sexual partner in the past 5 years ( 2·00 , 1·59–2·51 ) increased in Natsal-3 compared with Natsal-2 . While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2 , we recorded an expansion of heterosexual repertoires — particularly in oral and anal sex — over time . Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3 . Interpretation Sexual lifestyles in Britain have changed substantially in the past 60 years , with changes in behaviour seeming greater in women than men . The continuation of sexual activity into later life — albeit reduced in range and frequency — emphasises that attention to sexual health and wellbeing is needed throughout the life course . Funding Grants from the UK Medical Research Council and the Wellcome Trust , with support from the Economic and Social Research Council and the Department of Health OBJECTIVE To evaluate the cost-effectiveness and cost benefit of Safer Choices , a school-based human immunodeficiency virus , other sexually transmitted diseases , and unintended pregnancy prevention intervention for high school students . METHODS The baseline cost-effectiveness and cost benefit were derived in 4 steps : ( 1 ) estimation of intervention costs ; ( 2 ) adaptation of the Bernoulli model to translate increases in condom use into cases of human immunodeficiency virus and other sexually transmitted diseases averted , and development of a model to translate increases in contraceptive use into cases of pregnancy averted ; ( 3 ) translation of cases averted into medical costs and social costs averted ; and ( 4 ) calculation of the net benefit of the program . Multivariable sensitivity analysis was performed to determine the robustness of the base-case results . RESULTS Under base-case assumptions , at an intervention cost of $ 105,243 , Safer Choices achieved a 15 % increase in condom use and an 11 % increase in contraceptive use within 1 year among 345 sexually active students . An estimated 0.12 cases of human immunodeficiency virus , 24.37 cases of chlamydia , 2.77 cases of gonorrhea , 5.86 cases of pelvic inflammatory disease , and 18.5 pregnancies were prevented . For every dollar invested in the program , $ 2.65 in total medical and social costs were saved . Results of most of the scenarios remained cost saving under a wide range of model variable estimates . CONCLUSIONS The Safer Choices program is cost-effective and cost saving in most scenarios considered . School-based prevention programs of this type warrant careful consideration by policy makers and program planners . Program cost data should be routinely collected in evaluations of adolescent prevention programs Objectives : This study investigated the impact of a small media campaign to reduce syphilis through testing , treatment , and condom use in two urban predominantly African-American communities with high syphilis rates . Methods : Data were collected from intervention and comparison zip codes using cross sectional street intercept interviews at baseline and 2 years later ( n = 1630 ) following a small media syphilis prevention campaign with role model story posters , billboards , and other merch and ise . Community businesses and a community based organisation served as partners , distributing condoms and small media . Results : Comparing intervention with comparison zip codes , there were significant increases in condom use in last sexual act , and some aspects of knowledge of syphilis . However , there was significant cross contamination of media impact , with respondents in the comparison zip code seeing an average of two media items compared with three in the intervention zip code . Media exposure was associated with significant increases in knowledge of syphilis , testing , and condom use . Conclusions : Targeted community based small media interventions using community partners for distribution are effective in increasing syphilis knowledge , testing , and condom use OBJECTIVES This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago . METHODS A total of 7119 students from 12 r and omly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey . RESULTS New York students , compared with Chicago students , reported equal rates of sexual activity but higher rates of condom use at last intercourse ( odds ratio [ OR ] = 1.36 ) . For higher-risk students ( those with three or more sexual partners in the past 6 months ) , condom use was greater in New York ( OR = 1.85 ) than in Chicago . CONCLUSIONS Condom availability has a modest but significant effect on condom use and does not increase rates of sexual activity . These findings suggest that school-based condom availability can lower the risk of HIV and other sexually transmitted diseases for urban teenagers in the United States CONTEXT Condoms made of latex are not comfortable or appropriate for all consumers . Polyurethane condoms may provide a needed alternative . METHODS In a double-masked study , 805 monogamous couples were r and omized to use either the polyurethane condom or the latex condom for six months . Couples recorded the frequency of intercourse , of condom use and of breakage and slippage throughout the trial in coital diaries and in detailed reports on the first five uses . Breakage and slippage rates were determined , and typical-use and consistent-use pregnancy rates were calculated using life-table analysis , adjusted for use of emergency contraception . RESULTS The six-month pregnancy rate during typical use ( adjusted for use of emergency contraception ) was 4.8 % for the polyurethane condom and 6.3 % for the latex condom . Similarly adjusted pregnancy rates during consistent use over six completed menstrual cycles--2.4 % for the polyurethane condom and 1.1 % for the latex condom -- did not differ significantly . Clinical failure rates ( including breakage and slippage occurring during either intercourse or withdrawal ) were 8.5 % for the polyurethane condom and 1.6 % for the latex condom . In general , male participants were more satisfied with the latex condom , and users of latex were significantly less likely to drop out of the study for condom-related reasons than were users of polyurethane . CONCLUSIONS Although polyurethane and latex condoms provide equivalent levels of contraceptive protection , the polyurethane condom 's higher frequency of breakage and slippage suggests that this condom may confer less protection from sexually transmitted infections than does the latex condom OBJECTIVES This study examined the feasibility of using high-value coupons to induce condom purchase and evaluated execution factors that can influence the effectiveness of this form of promotion . METHODS Two levels of coupon discount value ( 10 % off and 75 % off ) were used to promote condom purchase among young adults . Coupons were distributed according to a widespread strategy or a more focused in-store disbursement method . RESULTS Redemption of coupons distributed through the widespread disbursement strategy was negligible . In contrast , coupons from the in-store distribution method , particularly the higher value coupon , result ed in a high redemption rate . CONCLUSIONS This research provides strong evidence that discount coupons , particularly high-value ones distributed at the purchase location , can be used successfully as a condom promotional incentive Output:

Schemes for black ethnic minorities and MSM could also be cost-effective even with relatively high costs and small effect sizes . Conclusion CDPs for young people are likely to be cost-effective or cost-saving . CDPs for other high-risk population s may also be cost-effective if they can increase condom use , since high HIV prevalence in these groups imposes a considerable health and cost burden

MS2_1shot141

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Findings that early changes in proteinuria independently predict long-term glomular filtration rate ( GFR ) decline ( Delta GFR ) would highlight proteinuria as a major determinant of progression in chronic renal disease . METHODS We investigated whether percent changes ( 3 months vs. baseline ) in proteinuria ( adjusted for concomitant changes in GFR ) and residual proteinuria at 3 months , predicted Delta GFR [ over a median ( IQ range ) follow up of 31.3 ( 24.5 to 50.3 ) months ] in 273 patients with proteinuric chronic nephropathies enrolled in the Ramipril Efficacy In Nephropathy ( REIN ) study . RESULTS Short-term changes and residual proteinuria ( r = -0.23 , P = 0.0001 for both ) significantly correlated with Delta GFR and , at multivariate analyses , independently predicted Delta GFR ( beta = -0.23 , P = 0.0002 ; beta = -0.21 , P = 0.0004 , respectively ) . For comparable levels of residual proteinuria , patients with greater short-term reduction had slower Delta GFR ( -0.28 + /- 0.04 mL/min/1.73 m2/ vs. -0.53 + /- 0.07 mL/min/1.73 m2/month , P = 0.04 ) . On ramipril and conventional treatment , specular short-term changes in proteinuria ( -18.2 + /- 3.5 % vs. 24.2 + /- 6.7 % , P < 0.0001 , respectively ) were associated with significantly different Delta GFRs . However , similar changes in proteinuria result ed in a difference in Delta GFR ( ramipril , 0.39 + /- 0.07 mL/min/1.73 m2/month ; conventional therapy , 0.74 + /- 0.11 mL/min/1.73 m2/month ; P < 0.01 ) that was sevenfold higher ( 0.35 vs. 0.05 mL/min/1.73 m2/month ) in patients with basal proteinuria > or =3 g/24 hours as compared to those with basal proteinuria 1 to 3 g/24 hours ( ramipril , 0.25 + /- 0.06 mL/min/1.73 m2/month ; conventional therapy , 0.30 + /- 0.07 mL/min/1.73 m2/month ; P = NS ) . CONCLUSION Regardless of blood pressure control and treatment r and omization , short-term changes in proteinuria and residual proteinuria reliably predict long-term disease progression . Reducing proteinuria is renoprotective , particularly in nephrotic patients . As for arterial hypertension , proteinuria should be a specific target for renoprotective treatment BACKGROUND Considerable evidence suggests that hyperhomocysteinemia is an independent vascular risk factor that promotes atherosclerosis by inducing endothelial dysfunction . Although folic acid reduces hyperhomocysteinemia , the effect on adverse vascular events is unknown . We hypothesized that in patients with chronic renal failure , a condition associated with both hyperhomocysteinemia and atherosclerosis , treatment with folic acid would improve endothelial function . METHODS AND RESULTS In a prospect i ve , double-blind protocol , 100 patients ( mean age 62 years , 67 men ) with predialysis chronic renal failure were r and omized to 5 mg folic acid or placebo daily for 12 weeks . Endothelial function was assessed by measuring ( 1 ) endothelium-dependent dilation of the brachial artery , ( 2 ) combined serum nitrite/nitrate concentrations , and ( 3 ) plasma von Willebr and factor concentration . Baseline characteristics of the 2 groups were similar . At the end of the study , both serum and red cell folate concentrations were greater in the folic acid group than the placebo group [ mean ( 95 % CI ) 39.0 ( 29.8 to 51.0 ) versus 7.7 ( 6.6 to 8.9 ) microg/L and 739 ( 613 to 891 ) versus 220 ( 184 to 262 ) microg/L , respectively ; both P<0.001 ] . Despite a reduction in hyperhomocysteinemia in the folic acid group compared with the placebo group [ 15.1 ( 14.1 to 16.2 ) versus 20.1 ( 18.2 to 22.2 ) micromol/L ; P<0.001 ] , there were no significant differences in endothelium-dependent dilation , combined serum nitrite/nitrate concentrations , or plasma von Willebr and factor concentration between the 2 groups . CONCLUSIONS High-dose folic acid lowers but fails to normalize hyperhomocysteinemia in patients with predialysis chronic renal failure . This was not accompanied by an improvement of endothelial function and suggests that treatment with folic acid may not reduce the burden of vascular disease in uremia OBJECTIVE To investigate the effect of benfotiamine on urinary albumin excretion ( UAE ) and the tubular damage marker kidney injury molecule-1 ( KIM-1 ) in patients with type 2 diabetes and nephropathy . RESEARCH DESIGN AND METHODS Patients with type 2 diabetes and UAE equivalent to 15–300 mg/24 h , despite ACE inhibitors ( ACE-Is ) or angiotensin receptor blockers ( ARBs ) , were r and omly assigned to 12 weeks of benfotiamine ( 900 mg/day ) ( n = 39 ) or placebo ( n = 43 ) . RESULTS Compared with placebo , benfotiamine treatment result ed in significant improvement of thiamine status ( P < 0.001 ) . Benfotiamine treatment did not significantly decrease 24-h UAE or 24-h KIM-1 excretion . CONCLUSIONS In patients with type 2 diabetes and nephropathy , high-dose benfotiamine treatment for 12 weeks in addition to ACE-Is or ARBs did not reduce UAE or KIM-1 excretion , despite improvement of thiamine status Population -based studies report differences in folate status indicators among Mexican American ( MA ) , African American ( AA ) and Caucasian ( CA ) women . It is unclear , however , whether these differences are due to variations in dietary folate intake . The present study was design ed to investigate the influence of ethnicity/race on folate status parameters in MA , AA , and CA women ( 18 - 45 y ; n = 14 in each group ) under conditions of strictly controlled folate intake . In addition , the adequacy of the 1998 folate U.S. recommended dietary allowance ( RDA ) , 400 micro g/d as dietary folate equivalents ( DFE ) , for non-Caucasian women was assessed . Subjects ( n = 42 ) with the methylenetetrahydrofolate reductase 677 CC genotype consumed a low-folate diet ( 135 micro g DFE/d ) for 7 wk followed by repletion with 400 ( 7 MA , 7 AA , 7 CA ) or 800 micro g DFE/d ( 7 MA , 7 AA , 7 CA ) for 7 wk . AA women had lower ( P < /= 0.05 ) blood folate concentrations and excreted less ( P < /= 0.05 ) urinary folate throughout folate depletion and repletion with 400 and /or 800 micro g DFE/d compared with MA and /or CA women . MA women had lower ( P < /= 0.05 ) plasma total homocysteine ( tHcy ) throughout folate depletion and during repletion with 400 micro g DFE/d relative to the other ethnic/racial groups . Repletion with the 1998 folate U.S. RDA led to normal blood folate and plasma tHcy for all 3 ethnic/racial groups . Collectively , these data demonstrate that ethnicity/race is an important determinant of folate status under conditions of strictly controlled dietary folate intake and support the adequacy of the 1998 folate U.S. RDA for the 3 largest ethnic/racial groups in the United States BACKGROUND In a recent uncontrolled retrospective report we suggested that the long-term supplementation of high-dose , i.v . folinic acid combined with high-dose i.v . pyridoxine was highly effective in correcting plasma total homocysteine ( tHcy ) concentrations in haemodialysis patients . To confirm these findings , we conducted a r and omized , controlled trial aim ed at evaluating whether i.v . or oral folinic acid provided improved tHcy-lowering efficacy in haemodialysis patients compared with oral folic acid . METHODS In a 6-month prospect i ve , r and omized , controlled trial , 60 chronic haemodialysis patients , matched for age , gender , dialysis duration , and average screening pre-treatment-fasting tHcy levels , were given either 50 mg/week of i.v . calcium folinate ( group 1 ) , 50 mg/week of oral calcium folinate ( group 2 ) , or 45 mg/week oral folic acid ( group 3 ) . All 60 patients also received 750 mg/week of i.v . vitamin B6 and 3 mg/week of oral vitamin B12 . RESULTS Fasting tHcy decreased significantly and to a similar extent in the three groups after 2 months of treatment and remained stable at 4 and 6 months ( 16.6+/-3.5 , 18.3+/-4 , and 19.1+/-3.1 , in groups 1 , 2 , and 3 , respectively , P = NS ) . Mean percentage reduction at 6 months was also similar in the three treatment groups ( 46 , 43 , and 42 % in groups 1 , 2 , and 3 , respectively , P = NS ) . CONCLUSIONS These findings show that the tHcy-lowering effects of high-dose i.v . folinic acid , oral folinic acid , or oral folic acid were comparable , suggesting that the hyperhomocysteinaemia observed in haemodialysis patients is not due to abnormal folate metabolism . Furthermore , they are compatible with the view that other abnormalities are also involved in the impaired clearance of homocysteine in uraemic patients OBJECTIVE Hyperhomocysteinemia is an independent risk factor for atherosclerotic vascular disease in chronic hemodialysis patients . This stratified r and omized controlled trial was design ed to measure the effect of high dose oral vitamin B6 , vitamin B12 , and folic acid on homocysteine levels , and to evaluate the effect on atherosclerosis as measured by Intima-Media Thickness ( IMT ) of carotid arteries . MATERIAL AND METHOD Fifty-four chronic hemodialysis patients with hyperhomocysteinemia were r and omized to receive oral 15 mg folic acid , 50 mg vitamin B6 , and 1 mg vitamin B12 daily ( treatment group ) or oral 5 mg folic acid alone ( control group ) for 6 months . Homocysteine level and IMT were measured in both groups . RESULTS At 6 months , homocysteine levels in the treatment group were significantly reduced from 27.94 + /- 8.54 to 22.71 + /- 3.68 mmol/l ( p = 0.009 ) and were not significantly increased from 26.81 + /- 7.10 to 30.82 + /- 8.76 mmol/l in control group ( p = 0.08 ) . Mean difference between both groups was statistically significant ( p = 0.002 ) . There was no significant difference of IMT of carotid arteries , however , a tendency that the treatment group would have less thickness was observed ( 0.69 + /- 0.29 mm and 0.62 + /- 0.16 mm , p = 0.99 ) . CONCLUSION Treatment of hyperhomocysteinemia in chronic hemodialysis patients with daily oral 15 mg folic acid , 50 mg vitamin B6 , and 1 mg vitamin B12 for 6 months decreases homocysteine levels and tends to reduce IMT of carotid arteries . A long term study for the prevention of atherosclerosis is warranted Background / Aims : Treatments of diabetic nephropathy ( DN ) delay the onset of end-stage renal disease . We report the results of safety/tolerability studies in patients with overt nephropathy and type 1/type 2 diabetes treated with pyridoxamine , a broad inhibitor of advanced glycation . Methods : The two 24-week studies were multicenter Phase 2 trials in patients under st and ard-of-care . In PYR-206 , patients were r and omized 1:1 and had baseline serum creatinine ( bSCr ) ≤2.0 mg/dl . In PYR-205/207 , r and omization was 2:1 and bSCr was ≤2.0 for PYR-205 and ≧2.0 but ≤3.5 mg/dl for PYR-207 . Treated patients ( 122 active , 90 placebo ) received 50 mg pyridoxamine Output:

No significant difference in the risk of all-cause mortality with pyridoxamine or combination therapy was reported . None of the vitamin B derivatives used either alone or in combination improved kidney function : increased in creatinine clearance , improved the GFR ; neither were effective in controlling blood pressure significantly compared to placebo or active control . There is an absence of evidence to recommend the use of vitamin B therapy alone or combination for delaying progression of DKD . Thiamine was found to be beneficial for reduction in albuminuria in a single study ; however , there was lack of any improvement in kidney function or blood pressure following the use of vitamin B preparations used alone or in combination .

MS2_1shot142

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The second stage of labour is associated with relative fetal hypoxia and progressive metabolic acidosis . Maternal analgesia can increase the danger , especially for the high-risk fetus . In 152 patients the effect on the fetus of pethidine alone , pethidine + trichloroethylene , or pethidine + Entonox was assessed by fetal scalp blood sampling . Fetal pH , Pco2 , and Po2 were measured and base excess was calculated . Capillary sample s were also taken 45 to 60 minutes after birth in 88 of the babies to estimate the rate of neonatal recovery . Entonox proved safer than trichloroethylene , and babies treated with it maintained their Po2 before birth , had better Apgar scores at birth , and one hour later were significantly less acidotic and much better oxygenated OBJECTIVE To study the pain relief effectiveness of the combined spinal-epidural analgesia ( CSEA ) and the inhalation of nitrous oxide , and the influences on the mothers and infants . METHODS The 300 cases of pregnant women were r and omly divided into 3 groups : CSEA group , nitrous oxide group and control group . The nitrous oxide group was that pregnant women inhaled nitrous oxide premixed with oxygen ( 50%:50 % ) , the pregnant women of the CSEA group were injected fentanyl and bupivacaine in the subarachnoid and epidural space , analgesic was not used in the control group . The degree of labor pain , duration of the labor , way of delivery , bleeding volume , rate of anoxia of newborn , blood gas analysis to maternal radius artery and fetal umbilical blood among 3 groups were observed . RESULTS The effect for analgesia labor of the CSEA group was much better than that of the nitrous oxide group ( P < 0.01 ) . In the first stage of labor and total stage of labor , the CSEA group was shorter than the others ( P < 0.05 ) , but there was no difference between the nitrous oxide group and the control group ( P > 0.05 ) . In the second stage of labor , the 3 groups were alike to each other . The bleeding volume of caesarean section ( 373 + /- 77 ) ml in the nitrous oxide group was much more than the other 2 groups , there was no difference between the CSEA group ( 259 + /- 78 ) ml and the control group ( 239 + /- 89 ) ml . The rate of obstetric forceps of CSEA group was higher than the control group ( P < 0.01 ) , and the rate of caesarean section of the nitrous oxide group was much higher than the CSEA group . The blood gas analysis to maternal radius artery and fetal umbilical blood and the rate of anoxia of newborn of 3 groups revealed no significant difference . CONCLUSIONS The effectiveness of the combined spinal-epidural analgesia CSEA for analgesia labor is confirmed and has rarely side-effect , and it can be the first choice , and the inhalation of nitrous oxide can safely provide effective labor analgesia , too The use of subanaesthetic concentration of inhalational anaesthetic for vaginal delivery offers many advantages to the mother and newborn‐ Desflurane , with the characteristics of rapid onset and minimal metabolism , may provide better analgesia and safety for labour pain control Methoxyflurane ( 0·35 % ) in air and nitrous oxide/oxygen ( 50%/50 % ) self-administered intermittently in the usual way have been compared as analgesics for labour . There were 25 patients in each group . Objective assessment by an anaesthetist showed that methoxyflurane is the more effective analgesic , and this was supported by the opinion of the multiparae . Nausea and vomiting were significantly less with methoxyflurane . Fifty per cent . nitrous oxide in oxygen given intermittently does not appear to be the best analgesic concentration . Nevertheless , since a considerable variation in sensitivity exists , it would probably be unwise to consider the introduction of higher concentrations for use by unsupervised midwives . This trial confirms the predictions made by us using a method for screening inhalational analgesics , in which methoxyflurane and nitrous oxide were given continuously In a r and omised controlled trial epidural analgesia with bupivacaine 0·5 % ( mean dose 112·8 mg ) was compared with pethidine ( mean dose 200 mg ) and inhalational analgesia in primipara ( 28 and 30 mothers ) and multipara ( 17 and 18 mothers ) . Mothers who had an uneventful pregnancy and labour and agreed to have either treatment were studied during labour and followed‐up at interviews for 5 months after delivery . Epidural block was rated significantly superior in respect of pain relief and comfort , there were no differences between the groups in reports of perineal discomfort . Twice as many primipara required forceps delivery after epidural block . Very few mothers , in each group , reported something missing in their experience of childbirth . Two thirds of each group would use the same method again . Epidural block can therefore be recommended to uncommitted mothers as a satisfying and effective method of pain relief for labour Since Minnitt ’ introduced an apparatus for the self-administration of nitrous oxide in air during labour , many attempts have been made to improve its effectiveness . One investigatorZ suggested the substitution of air by oxygen , so that a higher concentration of nitrous oxide could be used . It was found3 that 70 % nitrous oxide with 30 % oxygen was the optimum analgesic mixture but this led to a small and unacceptable incidence of mothers who became unconscious4 and therefore 50 % nitrous oxide with 50 % oxygen is recommended for use by midwives . The arterial concentration of nitrous oxide , which is relatively insoluble , rapidly equilibrates with the inspired concentration but when used intermittently for short periods there is always a vital delay between starting self-administration and reaching an effective arterial concentration . On stopping self-administration between uterine contractions nitrous oxide is almost completely eliminated , so that the start of each inhalation is a re-induction . Timing is therefore crucial to successful pain relief with nitrous oxide analge ~ ia.~ When breathed continuously , the inspired concentration being adjusted by an anaesthetist , the optimum mean concentration of nitrous oxide for pain relief in labour was 41.2%.6 However , when 50 % nitrous oxide with 50 % oxygen is self-administered intermittently during labour , in the usual way , the mean peak arterial concentration is equivalent to 26.4 % nitrous oxide concentration . ’ In an attempt to reduce the vital need for accurate timing a low concentration of nitrous oxide has been administered continuously by the nasal route , and in volunteers,8 and mothers in labour.g This raised the end-tidal concentration at the beginning of each period of selfadministration . This study extends those investigations . During labour , the reduction in time to reach specified end-expired nitrous oxide concentrations has been measured during each period of inhalation and the effectiveness of a nasal supplement to intermittent inhalation of Entonox has been assessed Background Intermittent self-administered nitrous oxide has long had widespread use as an analgesic in labor , but its efficacy has not been adequately established . Questions about its effect on maternal oxygenation between labor contractions also have been raised . Methods Twenty-six women were recrulted to participate in a r and omized , double-blind , cross-over , placebo-controlled study to assess the effect of intermittent nitrous oxide inhalation on labor pain and maternal hemoglobin oxygen saturation ( SpO2 ) during the first stage of labor . Visual analog scale pain scores for each of five consecutive labor contractions were measured after administration of either nitrous oxide or compressed air . Results Mean visual analog scale pain scores for five contractions were 5.1 , 5.2 , 5.7 , 5.2 , and 5.6 ( nitrous oxide ) and 4.9 , 5.2 , 6.1 , 5.6 , and 5.7 ( compressed air ) . There were no statistically significant differences in pain when nitrous oxide as compared with compressed air was administered . Pain scores did not differ significantly over time as a function of inhaled substance ( F = 0.41 , P = 0.53 ) . The mean lowest SpO2 observed between these contractions after self-administration of nitrous oxide and air were 97 , 97 , 97 , 97 , and 97 % ( nitrous oxide ) and 97 , 96 , 96 , 96 , and 96 % ( compressed air ) . SpO2 was significantly higher after nitrous oxide administration ( F = 8.8 , P = 0.007 ) . Conclusions While intermittent self-administered 50 % nitrous oxide in oxygen does not appear to predispose parturient women to hemoglobin oxygen desaturation , its analgesic effect has yet to be clearly demonstrated This study aims to investigate the effectiveness of nitrous oxide on pain of labor contractions and on maternal SaO2 . The patients were r and omized to receive either a pre-prepared mixture of 50 % nitrous oxide and oxygen or 50 % oxygen by a coin . Study drugs started as early as the onset of pain with each contraction . The patient herself administered gases via a facemask connected to the uni-directional valve which enables the patients to breathe fresh gas in each inspiration . The gas administration was continued to the end of contraction pain at which the patient breathed the room air . Variables such as SaO2 , blood pressure , pain and side effects were recorded . 534 ASA I and II parturients , aged from 16 to 35 years , scheduled for elective labor from September 2004 to 2006 were evaluated . Four patients were lost from the study . The mean age of patients was 25.5+/-4.3 years . During the first three measurements , the SaO2 was significantly higher in control group . In addition , the mean arterial pressure was comparable between groups except two first measurements in which the control group was higher . All the Visual Analogue Scale ( VAS ) values were significantly lower in nitrous oxide group . There were no significant differences in 1st and 5th min apgar scores between groups . All of the side effects were significantly higher among patients in nitrous oxide . In conclusion , our data indicate that using nitrous oxide 50 % provides significant pain relief . Nonetheless , it is associated with few side effects , nitrous oxide can be quickly implemented during advanced painful labor A comparison of the analgesic efficacy of Entonox ( 50 % nitrous oxide in oxygen ) and Entonox with 0.2 % isofturane was made in 18 consenting mothers during the first stage of labour . The inhalational gases were self‐administered during contractions over a 3 h study period using a st and ard Entonox dem and valve and breathing system . Isoflurane 0.2 % was added from an Ohmeda Isotec drawover vaporizer and the inspired concentration ofisoflurane was analysed continuously using a Date x Ultima analyser . Linear analogue scores for pain were significantly lower ( p < 0.001 ) during the Entonox‐isoflurane administration compared with Entonox alone . Drowsiness was not a clinical problem and there was a high acceptance rate for Entonox‐isoflurane inhalational analgesia during labour BACKGROUND We determined the optimal inspired sevoflurane concentration for use during labour as 0.8 % in our previous study . This study compared sevoflurane at a concentration of 0.8 % and Entonox((R ) ) ( nitrous oxide 50 % : oxygen 50 % ) for analgesia during labour in 32 healthy parturients . METHODS Each mother underwent two open-label , three-part sequences in r and om order , Entonox-sevoflurane-Entonox or sevoflurane-Entonox-sevoflurane . In each part the agent was self-administered during 10 contractions . A 100 mm visual analogue scores for pain relief and sedation was completed immediately after each contraction . RESULTS Two patients withdrew during administration of sevoflurane ( because of its odour ) and five during Entonox ( requesting epidural analgesia ) . Of the remaining women , data were available for analysis from 29 participants : median ( IQR [ range ] ) pain relief scores were significantly higher for sevoflurane 67 ( 55 - 74 [ 33 - 100 ] ) mm than for Entonox 51 ( 40 - 69.5 [ 13 - 100 ] ) mm ( P<0.037 ) . Nausea and vomiting were more common in the Entonox group [ relative risk 2.7 ( 95 % CI 1.3 - 5.7 ) ; P=0.004 ] . No other adverse effects were observed in the mothers or babies . There was significantly more sedation with sevoflurane than with Entonox { 74 ( 66.5 - 81 [ 32.5 - 100 ] ) and 51 ( 41 - 69.5 [ 13 - 100 ] ) mm , respectively ; P<0.001}. Twenty-nine patients preferred sevoflurane to Entonox and found its sedative effects helpful . CONCLUSIONS We conclude that self-administered sevoflurane at subanaesthetic concentration ( 0.8 % ) can provide useful pain relief during the first stage of labour , and to a greater extent than Entonox . Although greater sedative effects were experienced with sevoflurane , it was preferred to Enton Output:

The highest score for pain relief is the most positive in contrast to ' pain intensity ' in which the higher score is more negative . AUTHORS ' CONCLUSIONS Inhaled analgesia appears to be effective in reducing pain intensity and in giving pain relief in labour . However , substantial heterogeneity was detected for pain intensity . Furthermore , nitrous oxide appears to result in more side effects compared with flurane derivatives . Flurane derivatives result in more drowsiness when compared with nitrous oxide . When inhaled analgesia is compared with no treatment or placebo , nitrous oxide appears to result in even more side effects such as nausea , vomiting , dizziness and drowsiness . There is no evidence for differences for any of the outcomes comparing one strength verus a different strength of inhaled analgesia , comparing different delivery systems or comparing inhaled analgesia with TENS

MS2_1shot143

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective To assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab ( Avastin ) and ranibizumab ( Lucentis ) for neovascular age-related macular degeneration ( nAMD ) from a UK National Health Service ( NHS ) perspective . Design A within-trial cost-utility analysis with a 2-year time horizon , based on a multicentre factorial , non-inferiority r and omised controlled trial . Setting 23 hospital ophthalmology clinics . Participants 610 patients aged ≥50 years with untreated nAMD in the study eye . Interventions 0.5 mg ranibizumab or 1.25 mg bevacizumab given continuously ( monthly ) or discontinuously ( as-needed ) for 2 years . Main outcome measures Quality -adjusted life-years ( QALYs ) . Results Total 2-year costs ranged from £ 3002/patient ( $ 4700 ; 95 % CI £ 2601 to £ 3403 ) for discontinuous bevacizumab to £ 18 590/patient ( $ 29 106 ; 95 % CI £ 18 258 to £ 18 922 ) for continuous ranibizumab . Ranibizumab was significantly more costly than bevacizumab for both continuous ( + £ 14 989/patient ( $ 23 468 ) ; 95 % CI £ 14 522 to £ 15 456 ; p<0.001 ) and discontinuous treatment ( + £ 8498 ( $ 13 305 ) ; 95 % CI £ 7700 to £ 9295 ; p<0.001 ) , with negligible difference in QALYs . Continuous ranibizumab would only be cost-effective compared with continuous bevacizumab if the NHS were willing to pay £ 3.5 million ( $ 5.5 million ) per additional QALY gained . Patients receiving continuous bevacizumab accrued higher total costs ( + £ 599 ( $ 938 ) ; 95 % CI £ 91 to £ 1107 ; p=0.021 ) than those receiving discontinuous bevacizumab , but also accrued non-significantly more QALYs ( + 0.020 ; 95 % CI −0.032 to 0.071 ; p=0.452 ) . Continuous bevacizumab therefore cost £ 30 220 ( $ 47 316 ) per QALY gained versus discontinuous bevacizumab . However , bootstrapping demonstrated that if the NHS is willing to pay £ 20 000/QALY gained , there is a 37 % chance that continuous bevacizumab is cost-effective versus discontinuous bevacizumab . Conclusions Ranibizumab is not cost-effective compared with bevacizumab , being substantially more costly and producing little or no QALY gain . Discontinuous bevacizumab is likely to be the most cost-effective of the four treatment strategies evaluated in this UK trial , although there is a 37 % chance that continuous bevacizumab is cost-effective . Trial registration number IS RCT N92166560 OBJECTIVE To describe effects of ranibizumab and bevacizumab when administered monthly or as needed for 2 years and to describe the impact of switching to as-needed treatment after 1 year of monthly treatment . DESIGN Multicenter , r and omized clinical trial . PARTICIPANTS Patients ( n = 1107 ) who were followed up during year 2 among 1185 patients with neovascular age-related macular degeneration who were enrolled in the clinical trial . INTERVENTIONS At enrollment , patients were assigned to 4 treatment groups defined by drug ( ranibizumab or bevacizumab ) and dosing regimen ( monthly or as needed ) . At 1 year , patients initially assigned to monthly treatment were reassigned r and omly to monthly or as-needed treatment , without changing the drug assignment . MAIN OUTCOME MEASURES Mean change in visual acuity . RESULTS Among patients following the same regimen for 2 years , mean gain in visual acuity was similar for both drugs ( bevacizumab-ranibizumab difference , -1.4 letters ; 95 % confidence interval [ CI ] , -3.7 to 0.8 ; P = 0.21 ) . Mean gain was greater for monthly than for as-needed treatment ( difference , -2.4 letters ; 95 % CI , -4.8 to -0.1 ; P = 0.046 ) . The proportion without fluid ranged from 13.9 % in the bevacizumab-as-needed group to 45.5 % in the ranibizumab monthly group ( drug , P = 0.0003 ; regimen , P < 0.0001 ) . Switching from monthly to as-needed treatment result ed in greater mean decrease in vision during year 2 ( -2.2 letters ; P = 0.03 ) and a lower proportion without fluid ( -19 % ; P < 0.0001 ) . Rates of death and arteriothrombotic events were similar for both drugs ( P > 0.60 ) . The proportion of patients with 1 or more systemic serious adverse events was higher with bevacizumab than ranibizumab ( 39.9 % vs. 31.7 % ; adjusted risk ratio , 1.30 ; 95 % CI , 1.07 - 1.57 ; P = 0.009 ) . Most of the excess events have not been associated previously with systemic therapy targeting vascular endothelial growth factor ( VEGF ) . CONCLUSIONS Ranibizumab and bevacizumab had similar effects on visual acuity over a 2-year period . Treatment as needed result ed in less gain in visual acuity , whether instituted at enrollment or after 1 year of monthly treatment . There were no differences between drugs in rates of death or arteriothrombotic events . The interpretation of the persistence of higher rates of serious adverse events with bevacizumab is uncertain because of the lack of specificity to conditions associated with inhibition of VEGF OBJECTIVE To develop and test the psychometric properties of a 25-item version of the National Eye Institute Visual Function Question naire ( NEI VFQ-25 ) . DESIGN Prospect i ve observational cohort study of persons with 1 of 5 chronic eye diseases or low vision who were scheduled for nonurgent visits in ophthalmology practice s and a reference sample of persons without eye disease . SETTING Eleven university-based ophthalmology practice s and the NEI Clinical Center . PATIENTS Eligible participants had to have 1 of the following eye conditions : age-related cataracts , age-related macular degeneration , diabetic retinopathy , primary open-angle glaucoma , cytomegalovirus retinitis , or low vision from any cause . Seven of the 12 sites also enrolled persons in a reference sample . Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error . All eligible persons had to be 21 years or older , English speaking , and cognitively able to give informed consent and participate in a health status interview . MEASUREMENTS AND MAIN RESULTS To provide the data needed to create the NEI VFQ-25 , all subjects completed an interview that included the 51-item NEI VFQ . Estimates of internal consistency indicate that the subscales of the NEI VFQ-25 are reliable . The validity of the NEI VFQ-25 is supported by high correlations between the short- and long-form versions of the measure , observed between-group differences in scores for persons with different eye diseases of varying severity , and the moderate-to-high correlations between the NEI VFQ-25 subscales that have the most to do with central vision and measured visual acuity . CONCLUSIONS The reliability and validity of the NEI VFQ-25 are comparable to those of the 51-item NEI VFQ field test version of the survey . This shorter version will be more feasible in setting s such as clinical trials where interview length is a critical consideration . In addition , preliminary analyses indicate that the psychometric properties of the NEI VFQ-25 are robust for the eye conditions studied ; this suggests that the measure will provide reproducible and valid data when used across multiple conditions of varying severity Objectives To evaluate the efficacy and safety of intravitreous bevacizumab injections for the treatment of neovascular age related macular degeneration . Design Prospect i ve , double masked , multicentre , r and omised controlled trial . Setting Three ophthalmology centres in the United Kingdom . Participants 131 patients ( mean age 81 ) with wet age related macular degeneration r and omised 1:1 to intervention or control . Interventions Intravitreous bevacizumab ( 1.25 mg , three loading injections at six week intervals followed by further treatment if required at six week intervals ) or st and ard treatment available at the start of the trial ( photodynamic treatment with verteporfin for predominantly classic type neovascular age related macular degeneration , or intravitreal pegaptanib or sham treatment for occult or minimally classic type neovascular age related macular degeneration ) . Main outcome measures Primary outcome : proportion of patients gaining ≥15 letters of visual acuity at one year ( 54 weeks ) . Secondary outcomes : proportion of patients with stable vision and mean change in visual acuity . Results Of the 131 patients enrolled in the trial , five patients did not complete the study because of adverse events , loss to follow-up , or death . In the bevacizumab group , 21 ( 32 % ) patients gained 15 or more letters from baseline visual acuity compared with two ( 3 % ) in the st and ard care group ( P<0.001 ) ; the estimated adjusted odds ratio was 18.1 ( 95 % confidence interval 3.6 to 91.2 ) and the number needed to treat was 4 ( 3 to 6 ) . In addition , the proportion of patients who lost fewer than 15 letters of visual acuity from baseline was significantly greater among those receiving bevacizumab treatment ( 91 % ( 59 ) v 67 % ( 44 ) in st and ard care group ; P<0.001 ) . Mean visual acuity increased by 7.0 letters in the bevacizumab group with a median of seven injections compared with a decrease of 9.4 letters in the st and ard care group ( P<0.001 ) , and the initial improvement at week 18 ( plus 6.6 letters ) was sustained to week 54 . Among 65 patients treated with bevacizumab , there were no cases of endophthalmitis or serious uveitis related to the intervention . All end points with respect to visual acuity in the study eye at 54 weeks favoured bevacizumab treatment over st and ard care . Conclusions Bevacizumab 1.25 mg intavitreous injections given as part of a six weekly variable retreatment regimen is superior to st and ard care ( pegaptanib sodium , verteporfin , sham ) , with low rates of serious ocular adverse events . Treatment improved visual acuity on average at 54 weeks . Trial registration number Current controlled trials IS RCT Introduction Wet age-related macular degeneration ( AMD ) is a chronic eye condition that causes severe deterioration of vision and even blindness . Current wet AMD treatment in the UK involves the vascular endothelial growth factor inhibitors ranibizumab and aflibercept . Patients with wet AMD require frequent and long-term monitoring for treatment to be effective , contributing to a substantial re source burden at wet AMD centers . The European license for ranibizumab was recently up date d with an individualized ‘ treat and extend ’ ( T&E ) regimen , comprising a structured monitoring and treatment protocol . This study evaluated the cost-effectiveness of ranibizumab T&E versus aflibercept within a UK setting . Methods An individual patient-level simulation model was developed utilizing treatment effects from a network meta- analysis of r and omized controlled trials . The model was conducted from a UK National Health Service ( NHS ) perspective over a lifetime horizon and the base case utilized probabilistic sensitivity analysis to assess uncertainty in the model . Additional scenario analyses were conducted to assess the impact of changes to the model inputs . Results Ranibizumab T&E was found to be more effective and less costly than aflibercept , providing , on average , an additional 1.058 quality -adjusted life years ( QALYs ) and a cost-saving of £ 19,604 over a lifetime horizon . At list price , ranibizumab T&E was found to be cost-effective versus aflibercept in 100 % of simulations at a willingness-to-pay threshold of £ 20,000 per QALY . The robustness of the results was tested in several scenario analyses ; ranibizumab T&E was found to be more effective , and less costly , than aflibercept in the vast majority of cases . Conclusion This evaluation suggests that treating patients with ranibizumab according to the T&E regimen could be a better use of NHS re sources than aflibercept , and could , therefore , be considered as a first-line regimen for patients with wet AMD in the UK . Funding Novartis Pharmaceuticals UK Limited Background Age-related macular degeneration ( AMD ) is a blinding disease placing considerable burden on society due to blindness-associated costs . Intravitreal anti — vascular endothelial growth factors ( anti- Output:

Comparing ranibizumab and aflibercept , either treatment can be more cost-effective depending on the assumptions used for drug prices and treatment frequencies . As such , they may negatively influence overall patient outcomes and societal costs .

MS2_1shot144

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Background : Dengue is highly endemic in Chennai city , South India , in spite of continuous vector control efforts . This intervention study was aim ed at establishing the efficacy as well as the favouring and limiting factors relating to a community-based environmental intervention package to control the dengue vector Aedes aegypti . Methods : A cluster r and omized controlled trial was design ed to measure the outcome of a new vector control package and process analysis ; different data collection tools were used to determine the performance . Ten r and omly selected intervention clusters ( neighbourhoods with 100 houses each ) were paired with ten control clusters on the basis of ecological/entomological indices and sociological parameters collected during baseline studies . In the intervention clusters , Aedes control was carried out using a community-based environmental management approach like provision of water container covers through community actors , clean-up campaigns , and dissemination of dengue information through schoolchildren . The main outcome measure was reduction in pupal indices ( pupae per person index ) , used as a proxy measure of adult vectors , in the intervention clusters compared to the control clusters . Results : At baseline , almost half the respondents did not know that dengue is serious but preventable , or that it is transmitted by mosquitoes . The stakeholder analysis showed that dengue vector control is carried out by vertically structured programmes of national , state , and local administrative bodies through fogging and larval control with temephos , without any involvement of community-based organizations , and that vector control efforts were conducted in an isolated and irregular way . The most productive container types for Aedes pupae were cement tanks , drums , and discarded containers . All ten intervention clusters with a total of 1000 houses and 4639 inhabitants received the intervention while the ten control clusters with a total of 1000 houses and 4439 inhabitants received only the routine government services and some of the information education and communication project material s. The follow-up studies showed that there was a substantial increase in dengue underst and ing in the intervention group with only minor knowledge changes in the control group . Community involvement and the partnership among stakeholders ( particularly women ’s self-help groups ) worked well . After 10 months of intervention , the pupae per person index was significantly reduced to 0·004 pupae per person from 1·075 ( P = 0·020 ) in the intervention clusters compared to control clusters . There were also significant reductions in the Stegomyia indices : the house index was reduced to 4·2 % , the container index to 1·05 % , and the Breteau index to 4·3 from the baseline values of 19·6 , 8·91 , and 30·8 in the intervention arm . Conclusion : A community-based approach together with other stakeholders that promoted interventions to prevent dengue vector breeding led to a substantial reduction in dengue vector density Background Sh and ong Province experienced a declining malaria trend of local-acquired transmission , but the increasing imported malaria remains a challenge . Therefore , underst and ing the epidemiological characteristics of malaria and the control and elimination strategy and interventions is needed for better planning to achieve the overall elimination goal in Sh and ong Province . Methods A retrospective study was conducted and all individual cases from a web-based reporting system were review ed and analysed to explore malaria-endemic characteristics in Sh and ong from 2005 to 2015 . Annual malaria incidence reported in 2005–2015 were geo-coded and matched to the county-level . Spatial cluster analysis was performed to evaluate any identified spatial disease clusters for statistical significance . The space – time cluster was detected with high rates through the retrospective space – time analysis scanning using the discrete Poisson model . Results The overall malaria incidence decreased to a low level during 2005–2015 . In total , 1564 confirmed malaria cases were reported , 27.1 % of which ( n = 424 ) were indigenous cases . Most of the indigenous case ( n = 339 , 80.0 % ) occurred from June to October . However , the number and scale of imported cases have been increased but no significant difference was observed during months . Sh and ong is endemic for both Plasmodium vivax ( n = 730 ) and Plasmodium falciparum ( n = 674 ) . The disease is mainly distributed in Southern ( n = 710 ) and Eastern region ( n = 424 ) of Sh and ong , such as Jinning ( n = 214 [ 13.7 % ] ) , Weihai ( n = 151 [ 9.7 % ] ) , and Yantai ( n = 107 [ 6.8 % ] ) . Furthermore , the spatial cluster analysis of malaria cases from 2005 to 2015 indicated that the diseased was not r and omly distributed . For indigenous cases , a total of 15 and 2 high-risk counties were determined from 2005 to 2009 ( control phase ) and from 2010 to 2015 ( elimination phase ) , respectively . For imported cases , a total of 26 and 29 high-risk counties were determined from 2005 to 2009 ( control phase ) and from 2010 to 2015 ( elimination phase ) , respectively . The method of spatial scan statistics identified different 13 significant spatial clusters between 2005 and 2015 . The space – time clustering analysis determined that the most likely cluster included 14 and 19 counties for indigenous and imported , respectively . Conclusions In order to cope with the requirements of malaria elimination phase , the surveillance system should be strengthened particularity on the frequent migration regions as well as the effective multisectoral cooperation and coordination mechanisms . Specific response packages should be tailored among different types of cities and capacity building should also be improved mainly focus on the emergence response and case management . Fund guarantees for scientific research should be maintained both during the elimination and post-elimination phase to consoli date the achievements of malaria elimination Background Integrated vector management strategies depend on local eco-bio-social conditions , community participation , political will and inter-sectorial partnership . Previously identified risk factors for persistent Triatoma dimidiata infestation include the presence of rodents and chickens , tiled roofs , dirt floors , partial wall plastering and dog density . Methods A community-based intervention was developed and implemented based on cyclical stakeholder and situational analyses . Intervention implementation and evaluation combined participatory action research and cluster r and omized pre-test post-test experimental design s. The intervention included modified insecticide application , education regarding Chagas disease and risk factors , and participatory rodent control . Results At final evaluation there was no significant difference in post-test triatomine infestation between intervention and control , keeping pre-test rodent and triatomine infestations constant . Knowledge levels regarding Chagas disease and prevention practice s including rodent control , chicken management and health service access increased significantly only in intervention communities . The odds of nymph infection and rat infestation were 8.3 and 1.9-fold higher in control compared to intervention communities , respectively . Conclusion Vector control measures without reservoir control are insufficient to reduce transmission risk in areas with persistent triatomine infestation . This integrated vector management program can complement house improvement initiatives by prioritizing households with risk factors such as tiled roofs . Requirement for active participation and multi-sectorial coordination poses implementation challenges Objective To assess the effectiveness of an integrated community based environmental management strategy to control Aedes aegypti , the vector of dengue , compared with a routine strategy . Design Cluster r and omised trial . Setting Guantanamo , Cuba . Participants 32 circumscriptions ( around 2000 inhabitants each ) . Interventions The circumscriptions were r and omly allocated to control clusters ( n=16 ) comprising routine Aedes control programme ( entomological surveillance , source reduction , selective adulticiding , and health education ) and to intervention clusters ( n=16 ) comprising the routine Aedes control programme combined with a community based environmental management approach . Main outcome measures The primary outcome was levels of Aedes infestation : house index ( number of houses positive for at least one container with immature stages of Ae aegypti per 100 inspected houses ) , Breteau index ( number of containers positive for immature stages of Ae aegypti per 100 inspected houses ) , and the pupae per inhabitant statistic ( number of Ae aegypti pupae per inhabitant ) . Results All clusters were subjected to the intended intervention ; all completed the study protocol up to February 2006 and all were included in the analysis . At baseline the Aedes infestation levels were comparable between intervention and control clusters : house index 0.25 % v 0.20 % , pupae per inhabitant 0.44 × 10−3 v 0.29 × 10−3 . At the end of the intervention these indices were significantly lower in the intervention clusters : rate ratio for house indices 0.49 ( 95 % confidence interval 0.27 to 0.88 ) and rate ratio for pupae per inhabitant 0.27 ( 0.09 to 0.76 ) . Conclusion A community based environmental management embedded in a routine control programme was effective at reducing levels of Aedes infestation . Trial registration Current Controlled Trials IS RCT N88405796 Abstract Background and Objectives : Dengue is an important public health problem in Yogyakarta city , Indonesia . The aim of this study was to build an innovative community-centered dengue-ecosystem management intervention in the city and to assess the process and results . Methods : For describing the baseline situation , entomological surveys and household surveys were carried out in six r and omly selected neighborhoods in Yogyakarta city , documents were analyzed and different stakeholders involved in dengue control and environmental management were interviewed . Then a community-centered dengue-ecosystem management intervention was built up in two of the neighborhoods ( Demangan and Giwangan ) whereas two neighborhoods served as controls with no intervention ( Tahunan and Bener ) . Six months after the intervention follow up surveys ( household interviews and entomological ) were conducted as well as focus group discussion s and key informant interviews . FIindings : The intervention results included : better community knowledge , attitude and practice s in dengue prevention ; increased household and community participation ; improved partnership including a variety of stakeholders with prospect s for sustainability ; vector control efforts refocused on environmental and health issues ; increased community ownership of dengue vector management including broader community development activities such as solid waste management and recycling . Conclusion : The community-centred approach needs a lot of effort at the beginning but has better prospect s for sustainability than the vertical “ top-down ” approach Background Long-lasting insecticide-treated bed nets ( LLITN ) have demonstrated a significant effect in reducing malaria-related morbidity and mortality . However , barriers on the utilization of LLITN have hampered the desired outcomes . The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia . Methods A cluster r and omized trial was done in 22 ( 11 intervention and 11 control ) villages in south-west Ethiopia . The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system . The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline , six and 12 months of the project period . Cases of malaria and anaemia were treated based on the national protocol . The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect . Eight Focus group discussion s were conducted to complement the quantitative findings . Results A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410 , 2037 and 2612 under-five children at baseline , six and 12 months of the project period respectively . During the high transmission/epidemic season , children in the intervention arm were less likely to have malaria as compared to children in the control arm ( OR = 0.42 ; 95%CI : 0.32 , 0.57 ) . Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods . Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high ( OR = 0.84 ; 95%CI : 0.71 , 0.99 ) ) and low ( OR = 0.73 ; 95%CI : 0.60 , 0.89 ) transmission seasons . Conclusion Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children . The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : Abstract Introduction : Waste management through community mobilization to reduce breeding places at household level could be an effective and sustainable dengue vector control strategy in areas where vector breeding takes place in small discarded water containers . The objective of this study was to assess the validity of this assumption . Methods : An intervention study was conducted from February 2009 to February 2010 in the populous Gampaha District of Sri Lanka . Eight neighborhoods ( clusters ) with roughly 200 houses each were selected r and omly from high and low dengue endemic areas ; 4 of them were allocated to the intervention arm ( 2 in the high and 2 in the low endemicity areas ) and in the same way 4 clusters to the control arm . A baseline household survey was conducted and entomological and sociological surveys were carried out simultaneously at baseline , at 3 months , at 9 months and at 15 months after the start of the intervention . The intervention programme in the treatment clusters consisted of building partnerships of local stakeholders , waste management at household level , the promotion of composting biodegradable household waste , raising awareness on the importance of solid waste management in dengue control and improving garbage collection with the assistance of local government authorities . Results : The intervention and control clusters were very similar and there were no significant differences in pupal and larval indices of Aedes mosquitoes . The establishment of partnerships Output:

This review shows the importance of inter-sectoral collaboration to reduce VBDs or vector densities . However , very few studies measured how much inter-sectoral collaboration contributes to the impact .

MS2_1shot145

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIMS Mipomersen , an apolipoprotein ( apo ) B synthesis inhibitor , has been shown to produce potent reductions in apoB and LDL-cholesterol levels in animal models as well as healthy human volunteers . A r and omized , double-blind , placebo-controlled , dose-escalation study was design ed to evaluate the efficacy and safety of mipomersen monotherapy with or without dose loading in subjects with mild-to-moderate hyperlipidaemia . METHODS AND RESULTS Fifty subjects with LDL-cholesterol levels between 119 and 266 mg/dL were enrolled into five cohorts at a 4:1 r and omization ratio of active to placebo . Two 13-week dose regimens were evaluated at doses ranging from 50 to 400 mg/week . Mipomersen produced dose-dependent reductions in all apoB containing lipoproteins . In the 200 and 300 mg/week dose cohorts , mean reductions from baseline in LDL cholesterol were -45 ± 10 % ( P= 0.000 ) and -61 ± 8 % ( P= 0.000 ) , corresponding to a -46 ± 11 % ( P= 0.000 ) and -61 ± 7 % ( P= 0.000 ) decrease in apoB levels . Triglyceride levels were also lowered with median reductions up to 53 % ( P= 0.021 ) . The most common adverse events were injection site reactions . Seven of 40 subjects ( 18 % ) showed consecutive transaminase elevations > 3 × upper limit of normal . Five of these subjects received 400 mg/week , four of whom had apoB levels below the limit of detection . As a consequence , the 400 mg/week cohort was discontinued . CONCLUSIONS Mipomersen administered as monotherapy in subjects with mild-to-moderate hyperlipidaemia produced potent reductions in all apoB-containing lipoproteins . Higher doses were associated with hepatic transaminase increases BACKGROUND Homozygous familial hypercholesterolaemia is a genetic disorder characterised by substantially raised LDL cholesterol , reduced LDL receptor function , xanthomas , and cardiovascular disease before age 20 years . Conventional therapy is with statins , ezetimibe , and apheresis . We aim ed to assess the long-term safety and efficacy of the proprotein convertase subtilisin/kexin type 9 ( PCSK9 ) inhibitor evolocumab in a subset of patients with homozygous familial hypercholesterolaemia enrolled in an open-label , non-r and omised phase 3 trial . METHODS In this interim subset analysis of the TAUSSIG study , which was undertaken at 35 sites in 17 countries , we included patients aged 12 years or older with homozygous familial hypercholesterolaemia who were on stable LDL cholesterol-lowering therapy for at least 4 weeks ; all patients received evolocumab 420 mg subcutaneously monthly , or if on apheresis every 2 weeks . Dosing could be increased to every 2 weeks after 12 weeks in patients not on apheresis . The primary outcome of the TAUSSIG study was treatment-emergent adverse events ; secondary outcomes were the effects of evolocumab on LDL cholesterol and other lipids . We analysed patients on an intention-to-treat basis , and all statistical comparisons were done post hoc in this interim analysis . The TAUSSIG study is registered with Clinical Trials.gov , number NCT01624142 , and is ongoing . FINDINGS 106 patients were included in this analysis , 34 receiving apheresis at study entry and 14 younger than 18 years . The first patient was enrolled on June 28 , 2012 , and the cutoff date for the analysis was Aug 13 , 2015 ; mean follow-up was 1·7 years ( SD 0·63 ) . After 12 weeks , mean LDL cholesterol decreased from baseline by 20·6 % ( SD 24·4 ; mean absolute decrease 1·50 mmol/L [ SD 1·92 ] ) ; these reductions were maintained at week 48 . 47 of 72 patients not on apheresis at study entry increased evolocumab dosing to every 2 weeks , with an additional mean reduction in LDL cholesterol of 8·3 % ( SD 13·0 ; mean absolute decrease 0·77 mmol/L [ SD 1·38 ] ; p=0·0001 ) . In a post-hoc analysis , mean reductions in LDL cholesterol in patients on apheresis were significant at week 12 ( p=0·0012 ) and week 48 ( p=0·0032 ) , and did not differ from reductions achieved in patients not on apheresis ( p=0·38 at week 12 and p=0·09 at week 48 ) . We noted a small reduction ( median -7·7 % [ IQR -21·6 to 6·8 ] ) in lipoprotein(a ) at week 12 ( p=0·0015 ) , with some additional reduction at week 48 ( -11·9 % [ -28·0 to 0·0 ] ; p<0·0001 ) . HDL cholesterol was increased by a mean of 7·6 % ( SD 18·1 ) at week 12 ( p<0·0001 ) and 7·6 % ( SD 20·6 ) at week 48 ( p=0·0007 ) . Evolocumab was well tolerated ; 82 ( 77 % ) patients reported treatment-emergent adverse events , which were mostly minor . The most common were nasopharyngitis ( 14 patients [ 13 % ] ) , influenza ( 13 [ 12 % ] ) , headache ( 11 [ 10 % ] ) , and upper respiratory tract infection ( 11 [ 10 % ] ) . Serious adverse events occurred in 18 ( 17 % ) patients , with the most common being cardiovascular events ( four patients [ 4 % ] ) . There were no deaths and four positively adjudicated cardiovascular events , one ( 3 % ) among patients on apheresis and three ( 4 % ) among patients who did not receive apheresis . INTERPRETATION Our interim results suggest that evolocumab is an effective additional option to reduce LDL cholesterol in patients with homozygous familial hypercholesterolaemia , with or without apheresis . FUNDING Amgen BACKGROUND Patients with homozygous familial hypercholesterolaemia respond inadequately to existing drugs . We aim ed to assess the efficacy and safety of the microsomal triglyceride transfer protein inhibitor lomitapide in adults with this disease . METHODS We did a single-arm , open-label , phase 3 study of lomitapide for treatment of patients with homozygous familial hypercholesterolemia . Current lipid lowering therapy was maintained from 6 weeks before baseline through to at least week 26 . Lomitapide dose was escalated on the basis of safety and tolerability from 5 mg to a maximum of 60 mg a day . The primary endpoint was mean percent change in levels of LDL cholesterol from baseline to week 26 , after which patients remained on lomitapide through to week 78 for safety assessment . Percent change from baseline to week 26 was assessed with a mixed linear model . FINDINGS 29 men and women with homozygous familial hypercholesterolaemia , aged 18 years or older , were recruited from 11 centres in four countries ( USA , Canada , South Africa , and Italy ) . 23 of 29 enrolled patients completed both the efficacy phase ( 26 weeks ) and the full study ( 78 weeks ) . The median dose of lomitapide was 40 mg a day . LDL cholesterol was reduced by 50 % ( 95 % CI -62 to -39 ) from baseline ( mean 8·7 mmol/L [ SD 2·9 ] ) to week 26 ( 4·3 mmol/L [ 2·5 ] ; p<0·0001 ) . Levels of LDL cholesterol were lower than 2·6 mmol/L in eight patients at 26 weeks . Concentrations of LDL cholesterol remained reduced by 44 % ( 95 % CI -57 to -31 ; p<0·0001 ) at week 56 and 38 % ( -52 to -24 ; p<0·0001 ) at week 78 . Gastrointestinal symptoms were the most common adverse event . Four patients had aminotransaminase levels of more than five times the upper limit of normal , which resolved after dose reduction or temporary interruption of lomitapide . No patient permanently discontinued treatment because of liver abnormalities . INTERPRETATION Our study suggests that treatment with lomitapide could be a valuable drug in the management of homozygous familial hypercholesterolaemia . FUNDING FDA Office of the Orphan Product Development , Aegerion Pharmaceuticals OBJECTIVES The aim of this study was to evaluate the efficacy and safety of mipomersen in hypercholesterolemic subjects taking stable statin therapy . BACKGROUND Mipomersen is an apolipoprotein ( apo ) B synthesis inhibitor that has demonstrated significant reductions in apo B and low-density lipoprotein ( LDL ) cholesterol in Phase 1 clinical trials in healthy volunteers . METHODS A r and omized , placebo-controlled , dose-escalation Phase 2 study was design ed to evaluate the effects of mipomersen in hypercholesterolemic subjects taking stable statin therapy . Seventy-four subjects were enrolled sequentially into 1 of 6 dose cohorts at a 4:1 ( active/placebo ) ratio . Subjects received 7 doses of 30 to 400 mg over 5 weeks in the first 5 cohorts and 15 doses of 200 mg over 13 weeks in the sixth cohort . Pre-specified end points included percentage change from baseline in apo B and LDL cholesterol . Safety was assessed with laboratory test results and by the incidence and severity of adverse events . RESULTS The apo B and LDL cholesterol were reduced by 19 % to 54 % and 21 % to 52 % , respectively , at doses of 100 mg/week mipomersen and higher in the 5-week treatment cohorts . Efficacy seemed to increase upon treatment for 13 weeks at a dose of 200 mg/week . Injection site reactions ( mild to moderate erythema [ 90 % ] ) and hepatic transaminase increases ( 17 % ) were the most common adverse events , leading to discontinuation in 2 subjects and 1 subject , respectively . In the 13-week treatment cohort , 5 of 10 subjects ( 50 % ) had elevations > or=3x the upper limit of normal , 4 of which persisted on 2 consecutive occasions . CONCLUSIONS Mipomersen might hold promise for treatment of patients not reaching target LDL cholesterol levels on stable statin therapy . Further studies are needed to address the mechanisms and clinical relevance of transaminase changes after mipomersen administration . ( Dose-Escalating Safety Study in Subjects on Stable Statin Therapy ; NCT00231569 ) Background Routine apolipoprotein ( apo ) measurements for cardiovascular disease ( CVD ) are restricted to apoA-I and apoB. Here , the authors measured an unprecedented range of apolipoproteins in a prospect i ve , population -based study and relate their plasma levels to risk of CVD . Objectives This study sought to measure apolipoproteins directly by mass spectrometry and compare their associations with incident CVD and to obtain a system-level underst and ing of the correlations of apolipoproteins with the plasma lipidome and proteome . Methods Associations of 13 apolipoproteins , 135 lipid species , and 211 other plasma proteins with incident CVD ( 91 events ) , defined as stroke , myocardial infa rct ion , or sudden cardiac death , were assessed prospect ively over a 10-year period in the Bruneck Study ( N = 688 ) using multiple-reaction monitoring mass spectrometry . Changes in apolipoprotein and lipid levels following treatment with volanesorsen , a second-generation antisense drug targeting apoC-III , were determined in 2 human intervention trials , one of which was r and omized . Results The apolipoproteins most significantly associated with incident CVD were apoC-II ( hazard ratio per 1 SD [ HR/SD ] : 1.40 ; 95 % confidence interval [ CI ] : 1.17 to 1.67 ) , apoC-III ( HR/SD : 1.38 ; 95 % CI : 1.17 to 1.63 ) , and apoE ( HR/SD : 1.31 ; 95 % CI : 1.13 to 1.52 ) . Associations were independent of high-density lipoprotein ( HDL ) and non-HDL cholesterol , and extended to stroke and myocardial infa rct ion . Lipidomic and proteomic profiles implicated these 3 very-low-density lipoprotein (VLDL)-associated apolipoproteins in de novo lipogenesis , glucose metabolism , complement activation , blood coagulation , and inflammation . Notably , Output:

As a matter of fact , mipomersen therapy is more likely discontinued and associated with increased risk of injection-site reactions , hepatic steatosis , hepatic enzyme elevation , and flu-like symptoms

MS2_1shot146

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To evaluate the effects of canagliflozin , a sodium-glucose cotransporter 2 inhibitor , in type 2 diabetes mellitus inadequately controlled with metformin monotherapy . RESEARCH DESIGN AND METHODS This was a double-blind , placebo-controlled , parallel-group , multicenter , dose-ranging study in 451 subjects r and omized to canagliflozin 50 , 100 , 200 , or 300 mg once daily ( QD ) or 300 mg twice daily ( BID ) , sitagliptin 100 mg QD , or placebo . Primary end point was change in A1C from baseline through week 12 . Secondary end points included change in fasting plasma glucose ( FPG ) , body weight , and overnight urinary glucose-to-creatinine ratio . Safety and tolerability were also assessed . RESULTS Canagliflozin was associated with significant reductions in A1C from baseline ( 7.6–8.0 % ) to week 12 : −0.79 , −0.76 , −0.70 , −0.92 , and −0.95 % for canagliflozin 50 , 100 , 200 , 300 mg QD and 300 mg BID , respectively , versus −0.22 % for placebo ( all P < 0.001 ) and −0.74 % for sitagliptin . FPG was reduced by −16 to −27 mg/dL , and body weight was reduced by −2.3 to −3.4 % , with significant increases in urinary glucose-to-creatinine ratio . Adverse events were transient , mild to moderate , and balanced across arms except for a non – dose-dependent increase in symptomatic genital infections with canagliflozin ( 3–8 % ) versus placebo and sitagliptin ( 2 % ) . Urinary tract infections were reported without dose dependency in 3–9 % of canagliflozin , 6 % of placebo , and 2 % of sitagliptin arms . Overall incidence of hypoglycemia was low . CONCLUSIONS Canagliflozin added onto metformin significantly improved glycemic control in type 2 diabetes and was associated with low incidence of hypoglycemia and significant weight loss . The safety/tolerability profile of canagliflozin was favorable except for increased frequency of genital infections in females Aims We examined the efficacy , safety and tolerability of canagliflozin , a sodium glucose co-transporter 2 inhibitor , in Japanese patients with type 2 diabetes ( T2DM ) undergoing diet and exercise therapy . Methods Patients aged 20–80 years with T2DM diagnosed ≥3 months previously , and HbA1c of 6.9–9.9 % were r and omized to 50 , 100 , 200 or 300 mg canagliflozin or placebo once daily for 12 weeks . The primary and secondary endpoints were changes in HbA1c , fasting plasma glucose ( FPG ) , urinary glucose/creatinine and postpr and ial glycaemic parameters following a meal test . The safety assessment s included adverse events ( AEs ) and clinical laboratory tests . Results Overall , 383 patients were r and omized to receive either placebo ( n = 75 ) , or 50 mg ( n = 82 ) , 100 mg ( n = 74 ) , 200 mg ( n = 77 ) or 300 mg canagliflozin ( n = 75 ) . At week 12 , significant reductions in HbA1c were observed in all canagliflozin groups relative to placebo ( −0.61 , –0.80 , –0.79 and −0.88 % for 50 , 100 , 200 and 300 mg , respectively , versus + 0.11 % for placebo ; all , p < 0.01 ) . FPG and postpr and ial glycaemic parameters improved significantly in the canagliflozin groups . Body weight was significantly decreased by canagliflozin . No deaths or drug-related serious AEs were reported . There was no dose-dependent increase in the incidence of AEs in the canagliflozin groups . The incidence of hypoglycaemia was low ; episodes were not severe or dose dependent . Canagliflozin did not affect serum creatinine levels or the urinary albumin/creatinine ratio . Conclusions Treatment with canagliflozin for 12 weeks significantly improved glycaemic control and reduced body weight in Japanese patients with T2DM . Canagliflozin was well tolerated Background Canagliflozin is a sodium glucose co-transporter 2 inhibitor developed for the treatment of patients with type 2 diabetes mellitus ( T2DM ) . The efficacy and safety of canagliflozin were evaluated in patients with T2DM < 65 and ≥65 years of age . Methods Pooled data from 4 r and omised , placebo-controlled , 26-week , Phase 3 studies ( N = 2,313 ) evaluating canagliflozin 100 and 300 mg were analysed by age : < 65 years ( n = 1,868 ; mean age , 52.8 years ) or ≥65 years ( n = 445 ; mean age , 69.3 years ) . Efficacy evaluations included change from baseline in glycaemic parameters and systolic blood pressure ( BP ) , and percent change from baseline in body weight . Assessment of safety/tolerability included adverse event ( AE ) reports , incidence of documented hypoglycaemia , and percent change from baseline in fasting plasma lipids . Results Canagliflozin 100 and 300 mg reduced HbA1c and fasting plasma glucose relative to placebo in patients < 65 and ≥65 years of age . Both canagliflozin doses reduced body weight and systolic BP relative to placebo in patients < 65 and ≥65 years of age . Incidence of overall AEs was similar across all treatment groups in patients < 65 and ≥65 years of age . Incidences of serious AEs and AE-related discontinuations were similar across all treatment groups in patients < 65 years of age and higher with canagliflozin 100 mg than other groups in patients ≥65 years of age . As in patients < 65 years of age , incidences of genital mycotic infections and osmotic diuresis-related AEs were higher with canagliflozin relative to placebo in those ≥65 years of age . Incidences of urinary tract infections ( UTIs ) , renal-related AEs , AEs related to volume depletion , and documented hypoglycaemia episodes were similar across all treatment groups in patients ≥65 years of age ; no notable trends were observed with canagliflozin 100 and 300 mg relative to placebo in these AEs among patients < 65 years of age . Changes in lipid parameters with canagliflozin were similar in both age subsets . Conclusions Canagliflozin improved glycaemic control , body weight , and systolic BP , and was generally well tolerated in older patients with T2DM.Trial registration Clinical Trials.gov , NCT01081834 ; NCT01106677 ; NCT01106625 ; NCT01106690 Aims /hypothesisThe aim of this work was to evaluate the efficacy and safety of canagliflozin vs placebo and sitagliptin in patients with type 2 diabetes who were being treated with background metformin . Methods This r and omised , double-blind , four-arm , parallel-group , Phase 3 study was conducted at 169 centres in 22 countries between April 2010 and August 2012 . Participants ( N = 1,284 ) with type 2 diabetes aged ≥18 and ≤80 years who had inadequate glycaemic control ( HbA1c ≥7.0 % [ 53 mmol/mol ] and ≤10.5 % [ 91 mmol/mol ] ) on metformin therapy received canagliflozin 100 mg or 300 mg , sitagliptin 100 mg , or placebo ( n = 368 , 367 , 366 , 183 , respectively ) for a 26 week , placebo- and active-controlled period followed by a 26 week , active-controlled period ( placebo group switched to sitagliptin [ placebo/sitagliptin ] ) and were included in the modified intent-to-treat analysis set . R and omisation was performed using a computer-generated schedule ; participants , study centres and the sponsor were blinded to group assignment . The primary endpoint was change from baseline in HbA1c at week 26 ; secondary endpoints included changes in HbA1c ( week 52 ) and fasting plasma glucose ( FPG ) , body weight , and systolic blood pressure ( BP ; weeks 26 and 52 ) . Adverse events ( AEs ) were recorded throughout the study . Results At week 26 , canagliflozin 100 mg and 300 mg reduced HbA1c vs placebo ( −0.79 % , –0.94 % , –0.17 % , respectively ; p < 0.001 ) . At week 52 , canagliflozin 100 mg and 300 mg demonstrated non-inferiority , and canagliflozin 300 mg demonstrated statistical superiority , to sitagliptin in lowering HbA1c ( −0.73 % , –0.88%,–0.73 % , respectively ) ; differences ( 95 % CI ) vs sitagliptin were 0 % ( −0.12 , 0.12 ) and −0.15 % ( −0.27 , –0.03 ) , respectively . Canagliflozin 100 mg and 300 mg reduced body weight vs placebo ( week 26 : –3.7 % , –4.2 % , –1.2 % , respectively ; p < 0.001 ) and sitagliptin ( week 52 : –3.8 % , –4.2 % , –1.3 % , respectively ; p < 0.001 ) . Both canagliflozin doses reduced FPG and systolic BP vs placebo ( week 26 ) and sitagliptin ( week 52 ) ( p < 0.001 ) . Overall AE and AE-related discontinuation rates were generally similar across groups , but higher with canagliflozin 100 mg . Genital mycotic infection and osmotic diuresis-related AE rates were higher with canagliflozin ; few led to discontinuations . Hypoglycaemia incidence was higher with canagliflozin . Conclusions /interpretationCanagliflozin improved glycaemia and reduced body weight vs placebo ( week 26 ) and sitagliptin ( week 52 ) and was generally well tolerated in patients with type 2 diabetes on metformin . Clinical trial registry Clinical Trials.gov NCT01106677 Funding This study was supported by Janssen Research & Development , LLC Aim The efficacy and safety of canagliflozin , a sodium glucose co-transporter 2 inhibitor , was evaluated in patients with type 2 diabetes mellitus ( T2DM ) inadequately controlled with metformin and pioglitazone . Methods In this r and omized , double-blind , phase 3 study , patients ( N = 342 ) received canagliflozin 100 or 300 mg during a 26-week , placebo-controlled , core period and a 26-week , active-controlled extension in which placebo-treated patients were switched to sitagliptin 100 mg . Efficacy comparisons for canagliflozin versus placebo at week 26 are reported , with no comparisons versus sitagliptin at week 52 ( sitagliptin used to maintain double-blind and control for safety ) . Safety data are reported for canagliflozin and placebo/sitagliptin . Results Canagliflozin 100 and 300 mg significantly lowered haemoglobin A1c ( HbA1c ) compared with placebo at week 26 ( −0.89 % , −1.03 % and −0.26 % ; p < 0.001 ) ; reductions with canagliflozin 100 and 300 mg were maintained at week 52 ( −0.92 % and −1.03 % ) . Relative to placebo , both canagliflozin doses significantly reduced body weight ( −2.5 and −3.5 kg ) , fasting plasma glucose and systolic blood pressure ( BP ) at week 26 ( p < 0.05 for all ) , with reductions maintained at week 52 . Overall adverse event ( AE ) incidence over 52 weeks was 69.9 , 76.3 and 76.5 % with canagliflozin 100 and 300 mg and placebo/sitagliptin ; AE-related discontinuation and serious AE rates were low . Incidences of genital mycotic infections and AEs related to osmotic diuresis and volume depletion were higher with canagliflozin than placebo/sitagliptin . Conclusion Canagliflozin Output:

Conclusion 300 mg canagliflozin was not associated with significantly higher adverse events compared to 100 mg canagliflozin in those patients who were treated for T2DM .

MS2_1shot147

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE Individuals with osteoarthritis can experience difficulty walking and poor strength , possibly leading to falls and fractures . Exercise has been found to increase strength and bone mineral density . The purpose of this study was to determine the effects of 6 months of t'ai chi on knee muscle strength , bone mineral density , and fear of falling in older women with osteoarthritis . METHODS Eighty-two ( 82 ) women with osteoarthritis , recruited from outpatient clinics and community health centers , were r and omly assigned to either a t'ai chi group and took part in a t'ai chi program , or a control group . Of these , 30 subjects ( mean age = 63 years ) in the t'ai chi group and 35 ( mean age = 61 years ) in the control group completed post-test measures at 6 months . RESULTS After the 6-month study period , subjects in the t'ai chi program had significantly greater knee extensor endurance ( pre- to post-test mean increase = 36.4 W/kg , versus 1.1 W/kg for the controls ) , and significantly greater bone mineral density in the neck of the proximal femur ( mean change = 0.09 , versus -0.10 for the controls ) , Ward 's triangle ( mean change = 0.04 , versus -0.04 for the controls ) , and trochanter ( mean change = 0.07 , versus -0.05 for the controls ) than the controls . However , knee extensor and flexor strength did not differ significantly between the groups . The fear of falling during daily activities reduced significantly more in the t'ai chi group ( mean change = -2.40 , versus 0.66 for the controls ) . CONCLUSIONS T'ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis , and decreased their fear of falling during daily activities . Further study with long-term follow-up is needed to substantiate the role of t'ai chi exercise in the prevention of fall and its related fracture PURPOSE Tai Chi exercise , an ancient Chinese martial art , has drawn more and more attention for its health benefits . The purpose of the study was to identify the effects of a Sun-style Tai Chi exercise on arthritic symptoms ( joint pain and stiffness ) , motivation for performing health behaviors , and the performance of health behaviors among older women with osteoarthritis . METHODS Total of 72 women with the mean age of 63 years old were recruited from out patients clinic or public health centers according to the inclusion criteria and assigned r and omly to either the Tai Chi exercise group or the control . A Sun-style Tai Chi exercise has been provided three times a week for the first two weeks , and then once a week for another 10 weeks . In 12 weeks of study period , 22 subjects in the Tai Chi exercise group and 21 subjects in the control group completed the posttest measure with the dropout rate of 41 % . Outcome variables included arthritic symptoms measured by K-WOMAC , motivation for health behavior , and health behaviors . RESULTS At the completion of the 12 week Tai Chi exercise , the Tai Chi group perceived significantly less joint pain ( t=-2.19 , p=0.03 ) and stiffness ( t=-2.24 , p=0.03 ) , perceived more health benefits ( t=2.67 , p=0.01 ) , and performed better health behaviors ( t=2.35 , p=0.02 ) , specifically for diet behavior ( t=2.06 , p=0.04 ) and stress management ( t=2.97 , p=0.005 ) . CONCLUSION A Sun-style Tai Chi exercise was found as beneficial for women with osteoarthritis to reduce their perceived arthritic symptoms , improve their perception of health benefits to perform better health behaviors Background Osteoarthritis is the most common reason for pain in older adults , and the individual and economic burden of this disease is immense . The chronic character of osteoarthritis requires a long-term therapeutic treatment . In this regard life-style interventions such as physical exercises that can be carried out by the patient himself are recommended as first line treatment . There is evidence for the short-term benefit of exercise therapy in terms of pain reduction and physical functioning . Nonetheless research agendas highlight the need for multifaceted interventions that incorporate exercise strategies into patient care . Studies should be conducted with appropriate sample sizes and should allow statements on long-term effects as well as cost-utility and safety . These open questions are under the scope of this study . Methods / design This is a controlled study in the context of health services research . The study population consists of n = 1400 subjects with hip or knee osteoarthritis . The intervention group will be recruited from participants of a country-wide health insurance offer for people with hip or knee osteoarthritis . Potential participants for the control group ( ratio 10:1 ( control vs. intervention ) will be filtered out from the insurance data base according to pre-defined matching criteria and asked by letter for their participation . The final statistical twins from the responders ( 1:1 ) will be determined via propensity score matching . The progressive training intervention comprises 8 supervised group sessions , supplemented by home exercises ( 2/week over 11 weeks ) . Exercises include mobilization , strengthening and training of postural control . Primary outcomes are pain and function measured with the WOMAC Index immediately after the intervention period . Among other things , health related quality of life , self-efficacy , cost utility and safety will be evaluated as secondary outcomes . Participants will be followed up 6 , 12 and 24 month after baseline . Discussion Results of this trial will document the effects of clinical as well as economic outcomes in a regular health care setting on the basis of a large sample size . As such , results of this trial might have great impact on future implementations of group- and home-based exercises in hip or knee osteoarthritis . Trail registration German Clinical Trial Register DRKS00009251 . Registered 10 September 2015 Background . This study examined whether simplified Tai Chi resistance training is superior to traditional Tai Chi in slowing bone loss in postmenopausal women . Methods . This prospect i ve trial included 119 postmenopausal women ( age : 52–65 years ) . Subjects were r and omly assigned to participate in a traditional Tai Chi program ( TTC , n = 40 ) , a simplified Tai Chi resistance training program ( TCRT , n = 40 ) , or a blank control group ( routine activity , n = 39 ) . The TTC involved traditional Yang Style Tai Chi . The primary outcome was the change of lumbar bone mass density ( L2–L4 ) at 12 months over the baseline . Femoral neck and Ward 's triangle were also measured using dual-energy X-ray absorptiometry . Results . The L2–L4 density was significantly lower at 12 months in comparison to the baseline in the blank control group . In both the TCRT and TTC groups , the L2–L4 density was comparable to the baseline . There was a trend for less bone loss in the TCRT than in the TTC group . Similar findings were observed with femoral neck and Ward 's triangle . Conclusion . Simplified Tai Chi resistance training could slow bone loss in menopausal women . The results also suggested , but did not confirm , superiority to traditional Tai Chi Background Knee osteoarthritis ( OA ) causes pain and long-term disability with annual healthcare costs exceeding $ 185 billion in the United States . Few medical remedies effectively influence the course of the disease . Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine . We are currently conducting the first comparative effectiveness and cost-effectiveness r and omized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA . This article describes the design and conduct of this trial . Methods / Design A single-center , 52-week , comparative effectiveness r and omized controlled trial of Tai Chi versus a st and ardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston , Massachusetts . The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA ( American College of Rheumatology criteria ) . Participants are r and omly allocated to either 12 weeks of Tai Chi ( 2x/week ) or Physical Therapy ( 2x/week for 6 weeks , followed by 6 weeks of rigorously monitored home exercise ) . The primary outcome measure is pain ( Western Ontario and McMaster Universities WOMAC ) subscale at 12 weeks . Secondary outcomes include WOMAC stkiffness and function domain scores , lower extremity strength and power , functional balance , physical performance tests , psychological and psychosocial functioning , durability effects , health related quality of life , and healthcare utilization at 12 , 24 and 52 weeks . Discussion This study will be the first r and omized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up . We present here a robust and well- design ed r and omized comparative-effectiveness trial that also explores multiple outcomes to eluci date the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs . Results of this study are expected to have important public health implication s for the large and growing population with knee OA.Trial registration Clinical Trials.gov identifier : BACKGROUND The beneficial role of exercise in improving bone mineral density , muscle strength and balance , has been documented predominantly in younger population s. These findings may not apply to elderly population s with limited ability to perform exercises of high intensity . OBJECTIVE To examine the effects of Tai Chi ( TC ) and resistance exercise ( RTE ) on bone mineral density ( BMD ) , muscle strength , balance and flexibility in community living elderly people . DESIGN R and omised controlled trial , using blocked r and omization with stratification by sex . SETTING A community in the New Territories Region of Hong Kong , China . SUBJECTS One hundred eighty subjects ( 90 men , 90 women ) aged 65 - 74 , were recruited through advertisements in community centres . METHODS Subjects were assigned to participate in TC , RTE three times a week , or no intervention ( C ) for 12 months . Measurements were carried out at baseline , 6 and 12 months . Analyses of covariance ( ANCOVA ) adjusted for age , and baseline values of variables that were significantly different between groups : i.e. smoking and flexibility for men ; quadriceps strength for women . RESULTS Compliance was high ( TC 81 % , RTE 76 % ) . In women , both TC and RTE groups had less BMD loss at total hip compared with controls . No effect was observed in men . No difference in either balance , flexibility or the number of falls was observed between either intervention or controls after 12 months . CONCLUSION The beneficial effects of TC or RTE on musculoskeletal health are modest and may not translate into better clinical outcomes Objective : To evaluate the effects of Tai Chi Qigong training on the quality of life and physical function of patients with osteoarthritis of the knee . Design : A preliminary , single-blind , r and omized controlled trial . Setting : General community , performed at Hwaseong City Health Center . Participants : Forty-four elderly subjects ( mean age , 69.1 ± 5.4 years ) with knee osteoarthritis . Intervention : The patients were r and omized ( 2:1 ) to : ( 1 ) an eight-week Tai Chi Qigong training programme or ( 2 ) a waiting list control group . The programme involved eight weeks of group Tai Chi Qigong sessions , with 60 minutes per session twice a week . Main outcome measures : The primary outcome was quality of life measured with the Short Form 36 ( SF-36 ) at baseline and week 8 . Secondary outcomes included the Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) and 6-m walking time . Results : The training group had statistically significant improvements in the quality of life ( changes of SF-36 , Qigong versus control : 21.6 ± 16.8 versus 9.8 ± 13.6 , P<0.05 ) and 6-m walking test ( change in walking time , Qigong versus control : —1.6 ± 1.7 versus —0.2 ± 0.8 s , P<0.01 ) . The WOMAC scores in the training group were markedly improved , although the differences were not statistically significant . Conclusions : Tai Chi Qigong training appears to have beneficial effects in terms of the quality of life and physical functioning of elderly subjects with knee osteoarthritis . However , more rigorous trials are needed to confirm the efficacy of this training for patients with osteoarthritis of the knee Background : Tai chi ( TC ) is proposed as a potential option for the management of osteoarthritis ( OA ) , however , its beneficial effect on patients with knee OA has not been convincing . Objectives : To evaluate the effect of a 24-week TC program on physical functions in older Chinese women with knee OA . Methods : Thirty-five older Chinese women with knee OA were r and omized into TC group ( n = 18 ) and attention control ( wellness education and stretching ) group ( n = 17 ) . Subjects in the TC group practice d the 24-form simplified Yang-style TC 2 to 4 times a week for 24 weeks with frequency gradually increased . Physical function was assessed using the Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) , 6-minute walk distance and stair climb time . Results : Compared with the control group , the participants in TC group had statistically significant improvements in changes of the WOMAC total score ( 6.18 ± 2.13 vs. 1.71 ± 2.73 , P = 0.000 ) , the WOMAC pain sub Output:

The results of meta- analysis revealed that the effects of Tai Chi Chuan were observed for physical components in the body functions and structures domain . The effects favoring Tai Chi Chuan were observed in the physical component in the activities and participation domain . The review revealed that Tai Chi Chuan had beneficial outcomes for patients with knee osteoarthritis . The evidence -based results represented that it had small-to-moderate effects on body functions and structures , activities , and participation of physical component . However , there was insufficient evidence to support that Tai Chi Chuan had beneficial mental effect

MS2_1shot148

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use . Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized . Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Background .The high cost of caring for patients with congestive heart failure ( CHF ) results primarily from frequent hospital readmissions for exacerbations . Home nurse visits after discharge can reduce readmissions , but the intervention costs are high . Objectives .To compare the effectiveness of three hospital discharge care models for reducing CHF-related readmission charges : 1 ) home telecare delivered via a 2-way video-conference device with an integrated electronic stethoscope ; 2 ) nurse telephone calls ; and 3 ) usual outpatient care . Research Design . One-year r and omized trial . Subjects . English-speaking patients 40 years of age and older with a primary hospital admission diagnosis of CHF . Measures .Our primary outcome was CHF-related readmission charges during a 6-month period after r and omization . Secondary outcomes included all-cause readmissions , emergency department ( ED ) visits , and associated charges . Results .Thirty-seven subjects were r and omized : 13 to home telecare , 12 each telephone care and 12 to usual care . Mean CHF-related readmission charges were 86 % lower in the telecare group ( $ 5850 , SD $ 21,094 ) and 84 % lower in the telephone group ( $ 7320 , SD $ 24,440 ) than in the usual care group ( $ 44,479 , SD $ 121,214 ) . However , the between-group difference was not statistically significant . Both intervention groups had significantly fewer CHF-related ED visits ( P = 0.0342 ) and charges ( P = 0.0487 ) than the usual care group . Trends favoring both interventions were noted for all other utilization outcomes . Conclusions .Substantial reductions in hospital readmissions , emergency visits , and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide posthospitalization monitoring . Home telecare may not offer incremental benefit beyond telephone follow-up and is more expensive This study evaluated the impact of telemedicine technology on the provision of neurosurgical health services . We focused on the differences between the use of real time audio-visual teleconferencing and teleradiology versus conventional telephone consultations in the referral of neurosurgical patients from a large district general hospital . All patients requiring emergency neurosurgical consultation were included for r and omization into telephone consultation only ( Mode A ) , teleradiology and telephone consultation ( Mode B ) and video-consultation ( Mode C ) . Measures of effectiveness included diagnostic accuracy and adverse events during the transfer and Glasgow Outcome Score . In a 10-month period , 327 patients were recruited and r and omized into the study : the male/female ratio was 2:1 and the number of patients required to be transferred to the neurosurgical unit was 125 ( 38 % ) . There was a trend towards a more favourable outcome in the video-consultation mode ( 44 % , Mode C ) , versus teleradiology ( 31 % , Mode B ) , versus telephone consultation ( 38 % , Mode A ) . The interim data of this prospect i ve r and omized trial suggests that video-consultation may have a favourable impact on emergency neurosurgical consultations Existing st and ards of the management of the diabetic patients are not efficient enough , and further improvement is needed . The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system design ed and applied for intensive treatment of pregnant type 1 diabetic women . The developed system operates automatically , every night transferring all the data recorded during the day in the patient 's glucometer memory to a central clinical unit . In order to assess the efficiency of the design ed and developed system , a 3-year r and omized prospect i ve clinical trial was conducted , using the study group and the control group , each consisting of 15 pregnant type 1 diabetic women . All patients were treated by the same diabetologist . In the presented analysis , two indices calculated weekly were used for the assessment of glycemic control : MBG represents mean blood glucose level , and the universal J-index is sensitive to the glycemic level and glycemic variations . The most important results from the study concern : ( a ) better glycemic control in the study group in comparison with the control group during the course of treatment , as assessed by the average differences of the MBG and J indices calculated weekly ( n = 24 ) ( deltaMBG = -3.2 + /- 4.3 mg/dL , p = 0.0016 , deltaJ = -1.4 + /- 2.3 , p = 0.0065 ) ; ( b ) much more similar results in glycemic control among members of the study group compared to each other , than among members of the control group compared to each other , as indicated by significantly lower variations of the applied glycemic control indices ( SDMBG : 11.9 vs. 18.7 mg/dL , p = 0.0498 ; SDJ : 6.5 vs. 10.9 , p = 0.0318 ) ; ( c ) the observed tendency of a better glycemic control for patients with a lower level of intelligence ( IQ < 100 ) supported by the telematic system in comparison with all other assessed groups of patients . The last result was not statistically significant ( p > 0.05 ) . This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy . It also allows the diabetologist 's strategy to be much more precise than if it were conducted without telematic support . This telematic system is inexpensive and simple in use OBJECTIVE To test the hypothesis that telemedicine for new patient referrals to neurological out patients is as efficient and acceptable as conventional face to face consultation . METHODS A r and omised controlled trial between two groups : face to face ( FF ) and telemedicine ( TM ) . This study was carried out between a neurological centre and outlying clinics at two distant hospitals linked by identical medium cost commercial interactive video conferencing equipment with ISDN lines transmitting information at 384 kbits/s . The same two neurologists carried out both arms of the study . Of the 168 patients who were suitable for the study , 86 were r and omised into the telemedicine group and 82 into the face to face group . Outcome measures were ( 1 ) consultation process : ( a ) number of investigations ; ( b ) number of drugs prescribed ; ( c ) number of patient review s and ( 2 ) patient satisfaction : ( a ) confidence in consultation ; ( b ) technical aspects of consultation ; ( c ) aspects surrounding confidentiality . Diagnostic categories were also measured to check equivalence between the groups : these were structural neurological , structural non-neurological , non-structural , and uncertain . RESULTS Diagnostic categories were similar ( p>0.5 ) between the two groups . Patients in the telemedicine group had significantly more investigations ( p=0.001 ) . There was no difference in the number of drugs prescribed ( p>0.5 ) . Patients were generally satisfied with both types of consultation process except for concerns about confidentiality and embarrassment in the telemedicine group ( p=0.017 and p=0.005 respectively ) . CONCLUSION Telemedicine for new neurological out patients is possible and feasible but generates more investigations and is less well accepted than face to face examination The dem and for home health care has skyrocketed in recent years . The aging population and the push for more efficient delivery of hospital services have fueled this growing dem and . However , health care financing reforms have constrained the industry 's growth . Home health agencies struggle to deliver high- quality services while staying within the financial limitations imposed by reimbursement changes . Telehomecare is one way to provide cost-effective care in the current environment . Personal computers and video equipment can transmit data over ordinary telephone lines and allow home health providers to monitor patients and provide care at a much lower cost than earlier technologies that required wider b and width telephone lines and more complex equipment . But can telehomecare yield cost-savings for home health agencies ? This article addresses the costs associated with a telehomecare intervention in a large , urban , home health agency . The purpose of the study was two-fold : ( 1 ) to test the effects of telehomecare on clinical outcomes , and ( 2 ) to estimate the financial costs associated with providing telehomecare services . Our results show that , while telehomecare imposes additional expenses for care delivery , it contributes substantial savings without compromising quality . Additionally , we found that the financial benefit increases exponentially as the duration of the patient care episode increases A r and omized controlled trial was conducted to compare the costs of realtime teleneurology with the cost of conventional neurological care . Two district hospitals in Northern Irel and were equipped with videoconferencing units and were connected to the regional neurological centre by ISDN at 384 kbit/s . Of 168 patients r and omized to the study , 141 kept their appointments ( 76 male , 65 female ) . Sixty-five patients were r and omized to a conventional consultation while 76 were r and omized to a teleconsultation . The average age was 44 years of those seen conventionally and 42 years of those seen by telemedicine . The groups had similar diagnoses . The telemedicine group required more investigations and review s than the conventional group . The average cost of the conventional consultation was £ 49 compared with £ 72 for the teleconsultation . Realtime teleneurology was not as cost-effective as conventional care Since 1997 , more than 2,700 home care agencies have closed due to changes in reimbursement . With the implementation of a prospect i ve payment system , there is concern -- not only regarding the survival of the remaining home care agencies , but also whether adequate care can be provided to the patient . Chronic wound care is both prevalent and costly in home care . Factors contributing to cost include inconsistency of wound assessment and documentation and low usage of advanced wound products . These factors lead to lengthened healing time , more frequent visits by practitioners , and low healing rates . Involving a wound specialist can improve patient outcomes while decreasing cost . The authors examined the utilization of telemedicine in situations where wound specialists consulted with the home health nurse in the patient 's home regarding care of chronic wounds . During the two-way video visit , the wound specialist assessed the patient and the wounds and made recommendations for treatment . The wound specialist also collected outcome data during the visits . This data was then compared with like data collected as a baseline prior to the telemedicine intervention . Results revealed improved healing rates , decreased healing time , decreased number of home health visits , and a decreased number of hospitalizations related to wound complications . Telemedicine was deemed a viable option for delivering quality , cost-effective care to chronic wound patients in the home care setting OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised Output:

For a number of other applications , reports of clinical or economic benefits essentially confirmed previous findings .

MS2_1shot149

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Overweight and obesity is a significant health concern during pregnancy . Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity . Methods We conducted a r and omised controlled trial , in which pregnant women with a body mass index ≥25 kg/m2 , and singleton gestation between 10 + 0 to 20 + 0 weeks were recruited and r and omised to Lifestyle Advice ( involving a comprehensive dietary and lifestyle intervention over their pregnancy ) or St and ard Care . Within the intervention group , we conducted a nested r and omised trial in which a subgroup of women were further r and omised to receive access to supervised group walking sessions in addition to the st and ard information presented during the intervention contacts ( the Walking group ) or st and ard information only . The outcome measures were maternal dietary intake , ( including food groups , macronutrient and micronutrient intake , diet quality ( using the Healthy Eating Index ; HEI ) , dietary glycaemic load , and glycaemic index ) and maternal physical activity . Women completed the Harvard Semi-Structured Food Frequency Question naire , and the Short Question naire to Assess Health-enhancing Physical Activity ( SQUASH ) , at trial entry , 28 and 36 weeks ’ gestational age , and 4 months postpartum . Analyses were performed on an intention-to-treat basis , using linear mixed effects models with adjustment for the stratification variables . Results Women r and omised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day , as well as increased consumption of fibre , and reduced percentage energy intake from saturated fats ( P < 0.05 for all ) . Maternal HEI was significantly improved at both 28 ( 73.35 ± 6.62 versus 71.86 ± 7.01 ; adjusted difference in means 1.58 ; 95 % CI 0.89 to 2.27 ; P < 0.0001 ) and 36 ( 72.95 ± 6.82 versus 71.17 ± 7.69 ; adjusted difference in means 1.77 ; 95 % CI 1.01 to 2.53 ; P < 0.0001 ) weeks . There were no differences in dietary glycaemic index or glycaemic load . Women r and omised to Lifestyle Advice also demonstrated greater total physical activity ( adjusted difference in means 359.76 metabolic equivalent task units ( MET ) minutes/week ; 95 % CI 74.87 to 644.65 ; P = 0.01 ) compared with women receiving St and ard Care . The supervised walking group was poorly utilised . Conclusions For women who are overweight or obese , antenatal lifestyle advice improves maternal diet and physical activity during pregnancy . Please see related articles : http://www.biomed central .com/1741 - 7015/12/163 and http://www.biomed central .com/1741 - 7015/12/201.Trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 Background Obesity is a significant global health problem , with the proportion of women entering pregnancy with a body mass index greater than or equal to 25 kg/m2 approaching 50 % . Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant , however there is more limited information available regarding effective interventions to improve health outcomes .The aims of this r and omised controlled trial are to assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese women during pregnancy to limit gestational weight gain is effective in improving maternal , fetal and infant health outcomes . Methods / Design Design : Multicentred r and omised , controlled trial . Inclusion Criteria : Women with a singleton , live gestation between 10 + 0 - 20 + 0 weeks who are obese or overweight ( defined as body mass index greater than or equal to 25 kg/m2 ) , at the first antenatal visit . Trial Entry & R and omisation : Eligible , consenting women will be r and omised between 10 + 0 and 20 + 0 weeks gestation using a central telephone r and omisation service , and r and omisation schedule prepared by non- clinical research staff with balanced variable blocks . Stratification will be according to maternal BMI at trial entry , parity , and centre where planned to give birth . Treatment Schedules : Women r and omised to the Dietary and Lifestyle Advice Group will receive a series of inputs from research assistants and research dietician to limit gestational weight gain , and will include a combination of dietary , exercise and behavioural strategies . Women r and omised to the St and ard Care Group will continue to receive their pregnancy care according to local hospital guidelines , which does not currently include routine provision of dietary , lifestyle and behavioural advice . Outcome assessors will be blinded to the allocated treatment group . Primary Study Outcome : infant large for gestational age ( defined as infant birth weight ≥ 90th centile for gestational age ) . Sample Size : 2,180 women to detect a 30 % reduction in large for gestational age infants from 14.40 % ( p = 0.05 , 80 % power , two-tailed ) . Discussion This is a protocol for a r and omised trial . The findings will contribute to the development of evidence based clinical practice guidelines .Trial Registration Australian and New Zeal and Clinical Trials Registry BACKGROUND Women diagnosed with gestational diabetes mellitus ( GDM ) are at substantially increased risk of developing type 2 diabetes and obesity , currently at epidemic rates in the United States . GDM , therefore , identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder . It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes . To date , however , primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder . METHODS The aims of this study are to investigate the effects of a motivationally targeted , individually tailored 12-week physical activity intervention on ( 1 ) development of GDM , ( 2 ) serum biomarkers associated with insulin resistance , and ( 3 ) the adoption and maintenance of exercise during pregnancy . Women at high risk of GDM are recruited in early pregnancy and r and omized to either an individually tailored exercise intervention or a comparison health and wellness intervention . RESULTS The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle . CONCLUSIONS The intervention takes into account the specific social , cultural , economic , and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic background BACKGROUND Yoga may be well suited for depressed and anxious pregnant women , given reported benefits of meditation and physical activity and pregnant women 's preference for nonpharmacological treatments . METHODS We r and omly assigned 46 pregnant women with symptoms of depression and anxiety to an 8-week yoga intervention or treatment-as-usual ( TAU ) in order to examine feasibility and preliminary outcomes . RESULTS Yoga was associated with high levels of credibility and satisfaction as an intervention for depression and anxiety during pregnancy . Participants in both conditions reported significant improvement in symptoms of depression and anxiety over time ; and yoga was associated with significantly greater reduction in negative affect as compared to TAU ( β = -0.53 , SE = 0.20 , p = .011 ) . CONCLUSION Prenatal yoga was found to be a feasible and acceptable intervention and was associated with reductions in symptoms of anxiety and depression ; however , prenatal yoga only significantly outperformed TAU on reduction of negative affect Background Many women try to stop smoking in pregnancy but fail . One difficulty is that there is insufficient evidence that medications for smoking cessation are effective and safe in pregnancy and thus many women prefer to avoid these . Physical activity ( PA ) interventions may assist cessation ; however , trials examining these interventions have been too small to detect or exclude plausible beneficial effects . The London Exercise And Pregnant smokers ( LEAP ) trial is investigating whether a PA intervention is effective and cost-effective when used for smoking cessation by pregnant women , and will be the largest study of its kind to date . Methods / design The LEAP study is a pragmatic , multi-center , two-arm , r and omized , controlled trial that will target pregnant women who smoke at least one cigarette a day ( and at least five cigarettes a day before pregnancy ) , and are between 10 and 24 weeks pregnant . Eligible patients are individually r and omized to either usual care ( that is , behavioral support for smoking cessation ) or usual care plus a intervention ( entailing supervised exercise on a treadmill plus PA consultations ) . The primary outcome of the trial is self-reported and biochemically vali date d continuous abstinence from smoking between a specified quit date and the end of pregnancy . The secondary outcomes , measured at 1 and 4 weeks after the quit date , and at the end of pregnancy and 6 months after childbirth , are PA levels , depression , self-confidence , and cigarette withdrawal symptoms . Smoking status will also be self-reported at 6 months after childbirth . In addition , perinatal measures will be collected , including antenatal complications , duration of labor , mode of delivery , and birth and placental weight . Outcomes will be analyzed on an intention-to-treat basis , and logistic regression models used to compare treatment effects on the primary outcome . Discussion This trial will assess whether a PA intervention is effective when used for smoking cessation during pregnancy . Trial registration IS RCT Background Physical activity ( PA ) interventions design ed to prevent prenatal complications have focused on increasing moderate PA yielding conflicting results . Minimal attention has focused on the evaluation of sleep , sedentary behavior ( SB ) , light activity or total daily PA during pregnancy . The purpose of this prospect i ve , longitudinal study was to 1 ) objective ly quantify and compare habitual PA and SB during the 2nd and 3rd trimester ; and 2 ) evaluate differences in activity patterns for women meeting prenatal PA guidelines versus those that did not . Methods Forty-six participants wore 2 PA monitors ( SenseWear ® Mini and activPAL ™ ) during week 18 and week 35 of pregnancy . We compared differences in sleep duration , postural allocation , daily steps , and PA between the 2nd and 3rd trimester and for women who met and did not meet PA guidelines . Results During the 2nd trimester , 30 % of the women ’s day ( 24-hours ) was total sleep ; 52 % SB ; 13 % light ; 3 % moderate ; and 0 % vigorous PA . Light ( P = 0.05 ) , vigorous ( P = 0.02 ) , and moderate-vigorous PA ( MET-minutes ; P = 0.02 ) , decreased with a trend in increased SB ( P = 0.07 ) . Activity of other intensities and sleep duration did not significantly change . Only 39 % and 37 % of participants slept between 7–9 hours/night at week 18 and 35 , respectively . Forty-six percent ( n = 21 ) and 28 % ( n = 13 ) of participants met prenatal PA guidelines during the 2nd and 3rd trimester , respectively . At week 18 , no differences in total sleep , SB , or light PA existed for women who met PA guidelines versus those who did not ; total PA was significantly greater for women who met guidelines . At week 35 , women that met PA guidelines had significantly less SB ( P < 0.005 ) than women who did not . Conclusions This study demonstrates that pregnant women spend the majority of their day in SB . Significant reductions in total activity across pregnancy may be attributed , in part to shifts in light PA and increased SB . Based on the lifestyle of our sample , regardless of meeting PA guidelines in mid-pregnancy , no significant difference exists in time spent in SB , however meeting PA recommendations in late pregnancy may reduce SB . Future interventions should target reducing SB by increasing light and moderate PA beyond volitional exercise INTRODUCTION Walking may be a strategy for increasing moderate-intensity physical activity ( MPA ) during pregnancy . PURPOSE This study aim ed to promote MPA among overweight and obese pregnant women , via walking , and to evaluate the effect of the intervention on maternal and birth outcomes . METHODS Thirty-seven overweight or obese pregnant women were r and omly assigned to a walking intervention or control group . Anthropometric and objective PA ( StepWatch ™ Activity Monitor ) data were collected for four 1-wk periods : weeks 10 - 14 ( V1 ) , weeks 17 - 19 ( V2 ) , weeks 27 - 29 ( V3 ) , and weeks 34 - 36 ( V4 ) of gestation . Participants provided information about maternal and birth outcomes . A cadence of ≥ 80 steps per minute was defined as MPA , and " meaningful walking " was defined as moderate walking in ≥ 8-min bouts . ANOVA was used to determine the differences in walking amount and meaningful walks , the Kolmogorov-Smirnov test was used for walking intensity distribution analysis , and Fisher 's exact test was used for maternal and infant outcomes analyses . Pearson correlation was used to examine Output:

This review highlights the under-reporting of issues of context ual factors in studies of physical activity during pregnancy . TWEETABLE ABSTRACT The systematic review highlights the under-reporting of context ual factors in studies of physical activity during pregnancy

MS2_1shot150

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objectives Describe proportions of individuals with patellofemoral pain ( PFP ) with an unfavourable recovery over 12 months ; identify clinical predictors of poor recovery at 3 and 12 months ; and determine baseline values of predictors that identify those with poor 12-month prognosis . Methods An observational analysis utilised data from 310 individuals with PFP enrolled in two r and omised clinical trials . Thirteen baseline variables ( participant , PFP , study characteristics ) were investigated for their prognostic ability . Pain , function and global recovery were measured at 3 and 12 months . Multivariate backward stepwise regression analyses ( treatment-adjusted , p<0.10 ) were performed for each follow-up measure . Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months . Results 55 % and 40 % of participants had an unfavourable recovery at 3 and 12 months , respectively . Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity ( β 11.36 to 24.94 ) , Anterior Knee Pain ( AKP ) Scale ( −4.44 to −11.33 ) and global recovery ( OR : 2.32 to 6.11 ) . Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures ( p<0.05 ) . Baseline duration > 2 months and AKP Scale score < 70/100 were associated with unfavourable 12-month recovery . Conclusions A substantial number of individuals with PFP have an unfavourable recovery over 12 months , irrespective of intervention . Knee pain duration > 2 months is the most consistent prognostic indicator , followed by AKP Scale score < 70 . Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP , and promote early intervention to maximise prognosis . Trial registration Australian study : Australian Clinical Trials Registry ( ACTRN012605000463673 ) , Clinical Trials.gov ( NCT00118521 ) ; Dutch study : International St and ard R and omised Controlled Trial Number Register ( IS RCT N83938749 A prospect i ve study of 390 infantry recruits revealed that the medial tibial intercondylar distance and that the isometric strength of the quadriceps , tested at 85 degrees of flexion of the knee , had a statistically significant correlation with the incidence of patellofemoral pain caused by overactivity . Increased medial tibial intercondylar distance and increased strength of the quadriceps were therefore deemed to be risk factors for this syndrome Background Patellofemoral pain syndrome is one of the most common chronic knee injuries ; however , little research has been done to determine the risk factors for this injury . Hypothesis Altered lower extremity kinematics and kinetics , decreased strength , and altered postural measurements will be risk factors . Study Design Cohort study ( prognosis ) ; Level of evidence , 2 . Methods A total of 1597 participants were enrolled in this investigation and prospect ively followed from the date of their enrollment ( July 2005 , July 2006 , or July 2007 ) through January 2008 , a maximum of 2.5 years of follow-up . Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy . Baseline data collection included 3-dimensional motion analysis during a jump-l and ing task , 6 lower extremity isometric strength tests , and postural alignment measurements ( navicular drop and Q angle ) . Results Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle , decreased vertical ground-reaction force , and increased hip internal rotation angle during the jump-l and ing task . Additionally , decreased quadriceps and hamstring strength , increased hip external rotator strength , and increased navicular drop were risk factors for the development of patellofemoral pain syndrome . Conclusion Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified in this investigation . To decrease the incidence of this chronic injury , the risk factors for patellofemoral pain syndrome need to be targeted in injury prevention programs . Clinical Relevance Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome Objective : To prospect ively determine gait-related risk factors for patellofemoral pain . Design : A prospect i ve cohort study . Setting : Male and female recruits of the Belgian Royal Military Academy during a 6-week basic military training period . Participants : Eighty-four officer cadets ( 65 men , 19 women ) , who entered the Military Academy and were without a history of any knee or lower-leg complaints , participated in the study . Interventions : Before the start of the 6-week basic military training period , plantar pressure measurements during walking were performed . During the basic military training period , patellofemoral complaints were diagnosed and registered by a sports medicine physician . Main Outcome Measurements : Plantar pressure measurements during walking were performed using a footscan pressure plate ( RsScan International ) . Results : During the 6-week training period , 36 subjects developed patellofemoral pain ( 25 male and 11 female ) . Logistic regression analysis revealed that subjects who developed patellofemoral pain had a significantly more laterally directed pressure distribution at initial contact of the foot , a significantly shorter time to maximal pressure on the fourth metatarsal , and a significantly slower maximal velocity of the change in lateromedial direction of the center of pressure during the forefoot contact phase . Conclusions : Our findings suggest that the feet of the persons who developed anterior knee pain have a heel strike in a less pronated position and roll over more on the lateral side compared with the control group . The results of this study can be considered valuable in identifying persons at risk for patellofemoral pain Background Inappropriate control of the vastus medialis oblique and vastus lateralis muscles by the central nervous system can contribute to maltracking of the patella . Hypothesis The activation timing and amplitude of the vastus medialis oblique and vastus lateralis muscles will be different between normal subjects and patients with patellofemoral pain . Study Design Controlled laboratory study . Methods Subjects with patellofemoral pain and asymptomatic control subjects performed maximum voluntary knee extension contractions initiated from a flexed and an extended position . The activation timing and amplitude of the vastus lateralis and vastus medialis oblique muscles were quantified from the recorded electromyographic signals . Results There were no between-group differences in activation timing . The activation amplitude of the vastus medialis oblique and vastus lateralis muscles of the patellofemoral pain subjects was altered to the greatest extent during eccentric contractions and differed significantly from that of control subjects . Conclusions The activation amplitudes of the vastus medialis oblique and vastus lateralis muscles of subjects with patellofemoral pain are consistent with a laterally tracking patella during eccentric contractions . Clinical Relevance The findings suggest the clinical importance of determining whether altered activation patterns are sensitive to rehabilitation , and , if so , if subjective reports of knee joint pain and function parallel changes in the activation patterns as a result of rehabilitation PURPOSE There is emerging evidence that foot orthoses are effective in the management of patellofemoral pain syndrome ( PFPS ) . However , the identification of those most likely to benefit from foot orthoses has not been adequately explored . The aim of this study was to develop a preliminary clinical prediction rule to help identify individuals with PFPS who are most likely to benefit from foot orthoses . METHODS A total of 60 individuals with PFPS were issued with noncustomized prefabricated foot orthoses containing built-in arch supports and 4 ° rear foot varus wedging . Patient-reported level of improvement was documented at 12 wk . Potential baseline predictor variables of interest included patient demographics , pain characteristics , footwear motion control properties , foot and ankle characteristics , and functional performance measures . RESULTS Fourteen ( 25 % ) participants reported marked improvement at 12 wk . The number of participants with marked improvement increased to 78 % if three of the following four criteria were met : footwear motion control properties score of < 5.0 ( indicative of less supportive footwear ) , usual pain < 22.0 mm , ankle dorsiflexion range of motion ( knee flexed ) < 41 ° , and reduced single-leg squat pain when wearing the orthoses . CONCLUSIONS Individuals with PFPS who wear less supportive footwear , report lower levels of pain , exhibit less ankle dorsiflexion range of motion , and report an immediate reduction in pain with foot orthoses when performing a single-leg squat are more likely to benefit from foot orthoses Objective Patellar malalignment is a major cause of patellofemoral pain syndrome ( PFPS ) , but the relationship between clinical symptoms and changes in patellar position and knee muscle strength has not been confirmed . This study examined the effect of weight training on hip and knee muscle strength , patellofemoral joint contact area , and patellar tilt on subjects with and without PFPS , hoping to develop an optimal rehabilitation protocol for subjects with PFPS . Design The study uses a prospect i ve independent group comparison . Fifteen subjects with and without PFPS were assessed for knee strength , patellofemoral joint contact area , and patellar tilt angle using magnetic resonance imaging . The subjects with PFPS were also examined and given a numeric pain rating score and a Kujala patellofemoral score . The subjects performed lower-limb weight training 3 times/wk for 8 wks , and the outcomes were assessed both before and after training . Results Subjects with PFPS have increased their patellofemoral joint contact area after weight training ( P < 0.001 ) . No statistical significant change was found on the patellar tilt angle . The isometric and isokinetic knee strength in subjects with and without PFPS have increased after weight training ( P value increased from 0.007 to 0.05 ) . Both numeric pain rating and Kujala patellofemoral score in the PFPS group improved after training ( P < 0.001 ) . Conclusions Weight-training exercise increased knee muscle strength and the patellofemoral joint contact area , which could reduce mechanical stress in the joint , improving pain and function in subjects with PFPS Objective : To determine prospect ively gait-related intrinsic risk factors for patellofemoral pain ( PFP ) in a population of novice recreational runners . Design : Prospect i ve cohort study . Participants : 102 novice recreational runners ( 89 women ) with no history of knee or lower leg complaints . Interventions : The st and ing foot posture of the subjects was examined and plantar pressure measurements during running were collected . The subjects then participated in a 10-week “ start to run ” programme . During this period all sports injuries were registered by a sports medicine physician . Main outcome measurements : The relationship between the st and ing foot posture and PFP was investigated and gait-related intrinsic risk factors for PFP were determined . Results : The 17 runners who developed PFP exerted a significantly higher vertical peak force underneath the lateral heel and metatarsals 2 and 3 . Logistic regression analysis showed that a significantly higher vertical peak force underneath the second metatarsal and shorter time to the vertical peak force underneath the lateral heel were predictors for PFP . No significant evidence was found for an association between an excessively pronated or supinated foot posture and the development of PFP . Conclusions : The findings suggest that an excessive impact shock during heel strike and at the propulsion phase of running may contribute to an increased risk of developing PFP . The hypothesis that persons at risk for PFP show an altered static foot posture in comparison with non-afflicted persons is not supported by the results of this study Background : The prevalence of adolescent knee pain is 33 % , and patellofemoral pain ( PFP ) is the most common diagnosis with a nontraumatic onset . The 2-year prognosis of adolescent PFP compared with other types of knee pain is unknown . Purpose : To investigate the 2-year prognosis of knee pain among adolescents with and without a diagnosis of PFP . Study Design : Cohort study ; Level of evidence , 2 . Methods : In 2011 , a cohort of 2200 adolescents aged 15 to 19 years answered an online question naire on musculoskeletal pain . Of these , 504 reported knee pain , and 153 of these were clinical ly diagnosed with PFP . After 2 years , the 504 adolescents , as well as 252 r and omly selected adolescents who did not report knee pain in 2011 , were contacted again . Primary outcome at follow-up was the proportion of adolescents with knee pain during the last week prior to follow-up . Results : Overall , 55.9 % ( 95 % CI , 50.8%-60.9 % ) of those reporting knee pain at baseline also reported pain 2 years later . Adolescents diagnosed with PFP had a 1.26 ( 95 % CI , 1.05 - 1.50 ) higher relative risk ( RR ) of knee pain at follow-up compared with other types of knee pain . Adolescents with PFP were significantly more likely to reduce or stop sports participation compared with adolescents with other types of knee pain . Of those without knee pain at baseline , 12.8 % ( 95 % CI , 8.4%-17.2 % ) reported knee pain at follow-up in 2013 . Adolescents with knee pain at baseline had a 4.51 ( 95 % CI , 3.15 - 6.45 ) higher RR of knee pain at follow-up compared with adolescents without knee pain at baseline . Conclusion : Knee pain during adolescence , and PFP in particular , is in most cases present after 2 years and thus may not be self-limiting . Output:

No significant link between BMI and intervention outcomes in adults with PFP was identified . Conclusions Higher BMI is present in PFP and PFOA , but not in adolescents with PFP .

MS2_1shot151

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Neratinib , an irreversible tyrosine-kinase inhibitor of HER1 , HER2 , and HER4 , has clinical activity in patients with HER2-positive metastatic breast cancer . We aim ed to investigate the efficacy and safety of 12 months of neratinib after trastuzumab-based adjuvant therapy in patients with early-stage HER2-positive breast cancer . METHODS We did this multicentre , r and omised , double-blind , placebo-controlled , phase 3 trial at 495 centres in Europe , Asia , Australia , New Zeal and , and North and South America . Eligible women ( aged ≥18 years , or ≥20 years in Japan ) had stage 1 - 3 HER2-positive breast cancer and had completed neoadjuvant and adjuvant trastuzumab therapy up to 2 years before r and omisation . Inclusion criteria were amended on Feb 25 , 2010 , to include patients with stage 2 - 3 HER2-positive breast cancer who had completed trastuzumab therapy up to 1 year previously . Patients were r and omly assigned ( 1:1 ) to receive oral neratinib 240 mg per day or matching placebo . The r and omisation sequence was generated with permuted blocks stratified by hormone receptor status ( hormone receptor-positive [ oestrogen or progesterone receptor-positive or both ] vs hormone receptor-negative [ oestrogen and progesterone receptor-negative ] ) , nodal status ( 0 , 1 - 3 , or ≥4 ) , and trastuzumab adjuvant regimen ( sequentially vs concurrently with chemotherapy ) , then implemented central ly via an interactive voice and web-response system . Patients , investigators , and trial sponsors were masked to treatment allocation . The primary outcome was invasive disease-free survival , as defined in the original protocol , at 2 years after r and omisation . Analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00878709 . FINDINGS Between July 9 , 2009 , and Oct 24 , 2011 , we r and omly assigned 2840 women to receive neratinib ( n=1420 ) or placebo ( n=1420 ) . Median follow-up time was 24 months ( IQR 20 - 25 ) in the neratinib group and 24 months ( 22 - 25 ) in the placebo group . At 2 year follow-up , 70 invasive disease-free survival events had occurred in patients in the neratinib group versus 109 events in those in the placebo group ( stratified hazard ratio 0·67 , 95 % CI 0·50 - 0·91 ; p=0·0091 ) . The 2-year invasive disease-free survival rate was 93·9 % ( 95 % CI 92·4 - 95·2 ) in the neratinib group and 91·6 % ( 90·0 - 93·0 ) in the placebo group . The most common grade 3 - 4 adverse events in patients in the neratinib group were diarrhoea ( grade 3 , n=561 [ 40 % ] and grade 4 , n=1 [ < 1 % ] vs grade 3 , n=23 [ 2 % ] in the placebo group ) , vomiting ( grade 3 , n=47 [ 3 % ] vs n=5 [ < 1 % ] ) , and nausea ( grade 3 , n=26 [ 2 % ] vs n=2 [ < 1 % ] ) . QT prolongation occurred in 49 ( 3 % ) patients given neratinib and 93 ( 7 % ) patients given placebo , and decreases in left ventricular ejection fraction ( ≥ grade 2 ) in 19 ( 1 % ) and 15 ( 1 % ) patients , respectively . We recorded serious adverse events in 103 ( 7 % ) patients in the neratinib group and 85 ( 6 % ) patients in the placebo group . Seven ( < 1 % ) deaths ( four patients in the neratinib group and three patients in the placebo group ) unrelated to disease progression occurred after study drug discontinuation . The causes of death in the neratinib group were unknown ( n=2 ) , a second primary brain tumour ( n=1 ) , and acute myeloid leukaemia ( n=1 ) , and in the placebo group were a brain haemorrhage ( n=1 ) , myocardial infa rct ion ( n=1 ) , and gastric cancer ( n=1 ) . None of the deaths were attributed to study treatment in either group . INTERPRETATION Neratinib for 12 months significantly improved 2-year invasive disease-free survival when given after chemotherapy and trastuzumab-based adjuvant therapy to women with HER2-positive breast cancer . Longer follow-up is needed to ensure that the improvement in breast cancer outcome is maintained . FUNDING Wyeth , Pfizer , Puma Biotechnology Dual epidermal growth factor receptor ( EGFR ) and HER2 targeting with the tyrosine kinase inhibitor lapatinib is approved for treating advanced HER2-positive breast cancer and can prevent estrogen receptor (ER)-negative mammary tumors in HER2 transgenic mouse models . Ki-67 labeling index ( LI ) has prognostic and predictive value and can be used to screen drugs ' therapeutic and preventive potential in a clinical model of short-term presurgical therapy of breast cancer . We conducted a r and omized , placebo-controlled trial of lapatinib ( 1500 mg/d ) administered orally for three weeks between biopsy and surgery in 60 women with HER-2–positive breast cancer to assess lapatinib biomarker ( including the primary endpoint , Ki-67 LI ) and clinical activity in invasive breast cancer , adjacent ductal intraepithelial neoplasia ( DIN , which comprises ductal carcinoma in situ and atypical ductal hyperplasia ) , and distant ductal hyperplasia without atypia ( DH ) . Ki-67 LI increased progressively in association with disease stage , increasing in the placebo arm , for example , by medians of 3 % in DH to 20 % in DIN to 30 % in invasive cancer . Ki-67 LI in cancer tissue decreased by a mean ( ±SD ) of 9.3 % ( ±34.2 ) in the lapatinib arm and increased by 15.1 % ( ±30.9 ) in the placebo arm ( P = 0.008 ) . Compared with placebo , lapatinib reduced Ki-67 significantly more in ER-negative tumors ( by 34.8 % ; P = 0.01 ) but not significantly more in ER-positive tumors ( by 12.3 % ; P = 0.2 ) and reduced Ki-67 more ( nonsignificantly ) in cytosol PTEN-overexpressing tumors ( P = 0.057 ) . The prevalence of DIN in post-treatment surgical specimens of both arms was similar ( 70%–76 % ) , with a median Ki-67 of 15 % ( range , 5%–35 % ) on lapatinib versus 20 % ( 5%–60 % ) on placebo ( P = 0.067 ) . The prevalence of DH also was similar in both arms ( > 90 % ) , with a median Ki-67 of 1 % ( 1%–7 % ) on lapatinib versus 3 % ( 1%–5 % ) on placebo ( P = 0.006 ) . Other results of lapatinib versus placebo , respectively , were as follows : Median tumor diameter at surgery of 18 mm ( 11 mm–57 mm ) versus 24 mm ( 10 mm–37 mm ; P = 0.009 ) ; partial response of 13.6 % versus 3.7 % , stable disease of 59.1 % versus 40.7 % , and progression of 27.3 % versus 55.6 % ( P-trend = 0.035 ) . In conclusion , short-term lapatinib decreased cell proliferation in DIN , DH , and invasive HER-2–positive ( especially ER-negative ) breast cancer , thus providing the rationale for further clinical development of lapatinib for breast cancer prevention in high-risk patients , including those with HER-2–positive DIN . Cancer Prev Res ; 4(8 ) ; 1181–9 . © 2011 AACR On May 5 , 2003 , gefitinib ( Iressa ; ZD1839 ) 250-mg tablets ( AstraZeneca Inc. ) received accelerated approval by the United States Food and Drug Administration as monotherapy for patients with locally advanced or metastatic non-small cell lung cancer after failure of both platinum-based and docetaxel chemotherapies . Information provided in this summary includes chemistry manufacturing and controls , clinical pharmacology , and clinical trial efficacy and safety results . Gefitinib is an anilinoquinazoline compound with the chemical name 4-quinazolinamine , N-(3-chloro-4-flurophenyl)-7-methoxy-6-[3-(4-morpholinyl)propoxy ] . It has the molecular formula C22H24ClFN4O3 . Gefitinib is often referred to as a “ specific ” or “ selective ” inhibitor of epidermal growth factor receptor . Studies demonstrate , however , that gefitinib inhibits the activity of other intracellular transmembrane tyrosine-specific protein kinases at concentrations similar to those at which it inhibits the epidermal growth factor signal . Maximum plasma concentrations result ing from clinical ly relevant doses are 0.5–1 μm or more , well within the IC50 values of several tyrosine kinases . No clinical studies have been performed that demonstrate a correlation between epidermal growth factor receptor expression and response to gefitinib . Gefitinib is 60 % available after oral administration and is widely distributed throughout the body . Gefitinib is extensively metabolized in the liver by cytochrome P450 3A4 enzyme . Over a 10-day period , approximately 86 % of an orally administered radioactive dose is recovered in the feces , with < 4 % of the dose in the urine . After daily oral administration , steady-state plasma levels are reached in 10 days and are 2-fold higher than those achieved after single doses . Gefitinib effectiveness was demonstrated in a r and omized , double-blind , Phase II , multicenter trial comparing two oral doses of gefitinib ( 250 versus 500 mg/day ) . A total of 216 patients were enrolled . The 142 patients who were refractory to or intolerant of a platinum and docetaxel comprised the evaluable population for the efficacy analysis . A partial tumor response occurred in 14 % ( 9 of 66 ) of patients receiving 250 mg/day gefitinib and in 8 % ( 6 of 76 ) of patients receiving 500 mg/day gefitinib . The overall objective response rate ( RR ) for both doses combined was 10.6 % ( 15 of 142 patients ; 95 % confidence interval , 6.0–16.8 % ) . Responses were more frequent in females and in nonsmokers . The median duration of response was 7.0 months ( range , 4.6–18.6 + months ) . Other su bmi tted data included the results of two large trials conducted in chemotherapy-naive , stage III and IV non-small cell lung cancer patients . Patients were r and omized to receive gefitinib ( 250 or 500 mg daily ) or placebo , in combination with either gemcitabine plus cisplatin ( n = 1093 ) or carboplatin plus paclitaxel ( n = 1037 ) . Results from this study showed no benefit ( RR , time to progression , or survival ) from adding gefitinib to chemotherapy . Consequently , gefinitib is only recommended for use as monotherapy . Common adverse events associated with gefitinib treatment included diarrhea , rash , acne , dry skin , nausea , and vomiting . Interstitial lung disease has been observed in patients receiving gefitinib . Worldwide , the incidence of interstitial lung disease was about 1 % ( 2 % in the Japanese post-marketing experience and about 0.3 % in a United States exp and ed access program ) . Approximately one-third of the cases have been fatal . Gefitinib was approved under accelerated approval regulations on the basis of a surrogate end point , RR . No controlled gefitinib trials , to date , demonstrate a clinical benefit , such as improvement in disease-related symptoms or increased survival . Accelerated approval regulations require the sponsor to conduct additional studies to verify that gefitinib therapy produces such benefit Background : Lapatinib is a dual inhibitor of epidermal growth factor receptor ( EGFR ) and human EGFR-2 ( HER-2 ) tyrosine kinases . This study investigated the pharmacodynamic and clinical effects of lapatinib in patients with locally advanced squamous cell carcinoma of the head and neck ( SCCHN ) . Methods : In total , 107 therapy-naive patients with locally advanced SCCHN were r and omised ( 2 : 1 ) to receive lapatinib or placebo for 2–6 weeks before chemoradiation therapy ( CRT ) . Endpoints included apoptosis and proliferation rates , clinical response , and toxicity . Results : Versus placebo , lapatinib monotherapy did not significantly increase apoptosis detected by terminal deoxyn Output:

On subgroup analysis , the RR of high- grade fatigue varies significantly according to drug type , cancer type , treatment line , and treatment duration . The available data suggested that the use of EGFR-TKIs is associated with a significantly increased risk of fatigue in cancer patients

MS2_1shot152

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The use of antracycline ( ANT ) in breast cancer has been associated with adverse cardiac events . Two-dimensional ( 2D ) strain imaging ( SI ) can provide a more sensitive measure of altered left ventricular ( LV ) systolic function . We aim ed to evaluate the preventive effect of carvedilol administration assessed by SI in a patient with breast cancer treated with ANT . METHODS Patients receiving ANT were r and omly assigned to the carvedilol- or placebo-receiving group . Each received an echocardiographic examination with conventional 2D echocardiography , pulsed tissue Doppler , and 2D SI prior to and 6 months post ANT treatment . RESULTS During the 6-month follow-up period there were no patient deaths or interrupted chemotherapy treatments due to doxorubicin-induced cardiotoxicity . Both left ventricular ejection fraction ( LVEF ) and fractional shortening ( FS ) were within normal limits for all patients before and after ANT therapy . EF , FS and LV dimensions were measured using M-mode echocardiography and found to be similar in both groups before and after ANT therapy . The mean EF , FS , and LV echocardiograph baseline and control dimensions were similar in both groups after 6 months . Though baseline SI parameters were similar between the groups , there was a significant decrease in LV basal septal and basal lateral peak systolic strain in the control group compared to the carvedilol group . CONCLUSIONS These results indicate that carvedilol has a protective effect against the cardiotoxicity induced by ANT Abstract Aims Contemporary adjuvant treatment for early breast cancer is associated with improved survival but at the cost of increased risk of cardiotoxicity and cardiac dysfunction . We tested the hypothesis that concomitant therapy with the angiotensin receptor blocker c and esartan or the β-blocker metoprolol will alleviate the decline in left ventricular ejection fraction ( LVEF ) associated with adjuvant , anthracycline-containing regimens with or without trastuzumab and radiation . Methods and results In a 2 × 2 factorial , r and omized , placebo-controlled , double-blind trial , we assigned 130 adult women with early breast cancer and no serious co-morbidity to the angiotensin receptor blocker c and esartan cilexetil , the β-blocker metoprolol succinate , or matching placebos in parallel with adjuvant anticancer therapy . The primary outcome measure was change in LVEF by cardiac magnetic resonance imaging . A priori , a change of 5 percentage points was considered clinical ly important . There was no interaction between c and esartan and metoprolol treatments ( P = 0.530 ) . The overall decline in LVEF was 2.6 ( 95 % CI 1.5 , 3.8 ) percentage points in the placebo group and 0.8 ( 95 % CI −0.4 , 1.9 ) in the c and esartan group in the intention-to-treat analysis ( P-value for between-group difference : 0.026 ) . No effect of metoprolol on the overall decline in LVEF was observed . Conclusion In patients treated for early breast cancer with adjuvant anthracycline-containing regimens with or without trastuzumab and radiation , concomitant treatment with c and esartan provides protection against early decline in global left ventricular function BACKGROUND We aim ed to evaluate the effect of prophylactic nebivolol use on prevention of antracycline-induced cardiotoxicity in breast cancer patients . METHODS In this small , prospect i ve , double-blind study , we r and omly assigned 45 consecutive patients with breast cancer and planned chemotheraphy to receive nebivolol 5 mg daily ( n=27 ) or placebo ( n=18 ) . Echocardiographic measurements and N-terminal pro-brain natriuretic peptide ( NT-pro-BNP ) levels were obtained at baseline and at 6-month of chemotherapy . RESULTS Both studied groups had comparable echocardiographic variables and NT-pro-BNP levels at baseline . At 6-month , the left ventricular ( LV ) end-systolic and end-diastolic diameters increased in the placebo group ( LVESD : 29.7 ± 3.4 to 33.4 ± 4.5 mm ; LVEDD : 47.2 ± 3.8 to 52.0 ± 4.6 mm , p=0.01 for both ) but remained unchanged in the nebivolol group ( LVESD : 30.4 ± 3.5 to 31.0 ± 3.6 mm , p=0.20 ; LVEDD : 47.0 ± 4.4 to 47.1 ± 4.0 mm , p=0.93 ) . The placebo group also had lower LVEF than the nebivolol group ( 57.5 ± 5.6 % vs. 63.8 ± 3.9 % , p=0.01 ) at 6-month . NT-pro-BNP level remained static in the nebivolol group ( 147 ± 57 to 152 ± 69 pmol/l , p=0.77 ) while it increased in the placebo group ( 144 ± 66 to 204 ± 73 pmol/l , p=0.01 ) . CONCLUSIONS Prophylactic use of nebivolol treatment may protect the myocardium against antracycline-induced cardiotoxicity in breast cancer patients Background & objectives : Adriamycin though considered as an effective anticancer drug , leads to irreversible cardiomyopathy ( CMP ) and congestive heart failure ( CHF ) . The aim of this study was to determine the protective effect of carvedilol in adriamycin (ADR)-induced cardiomyopathy ( CMP ) in cancer patients . Methods : Patients with lymphoreticular malignancy in whom ADR therapy was planned were r and omized into two groups : carvedilol and control . Twenty seven patients each were enrolled in carvedilol and control groups . In the carvedilol group , 12.5 mg once daily oral carvedilol was given during six months . The patients were evaluated by echocardiography before and after chemotherapy . Left ventricular ejection fraction ( EF ) and systolic and diastolic diameters were calculated . Results : At six months of follow up , six patients in the carvedilol group and five in the control group had died . The mean EF ( 63.19 vs. 63.88 % ) and fraction shortening ( FS ) ( 34 vs. 34.6 ) of the carvedilol group were similar at follow up , but in the control group , the mean EF ( 67.27 vs. 60.82 % , P=0.003 ) and FS ( 38.48 vs. 34.6 , P<0.05 ) at control echocardiography were significantly lower . In carvedilol group , both systolic and diastolic diameters were not changed , but in control group , systolic diameters were significantly increased compared with basal measures ( left ventricular end systolic diameter = 28.26±5.50 mm vs. 31.25± 6.50 mm ; P < 0.05 ) . Interpretation & conclusions : Prophylactic use of carvedilol in patients receiving anthracycline protected systolic functions of the left ventricle . Carvedilol can be a potential drug which can ameliorate ADR-induced CMP OBJECTIVES The aim of this study was to determine the protective effect of carvedilol in anthracycline (ANT)-induced cardiomyopathy ( CMP ) . BACKGROUND Despite its broad effectiveness , ANT therapy is associated with ANT-induced CMP . Recent animal studies and experimental observations showed that carvedilol prevented development of CMP due to chemotherapeutics . However , there is no placebo-controlled clinical trial concerning prophylactic carvedilol use in preventing ANT-induced CMP . METHODS Patients in whom ANT therapy was planned were r and omized to administration of carvedilol or placebo . We enrolled 25 patients in carvedilol and control groups . In the carvedilol group , 12.5 mg once-daily oral carvedilol was given during 6 months . The patients were evaluated with echocardiography before and after chemotherapy . Left ventricular ejection fraction ( EF ) and systolic and diastolic diameters were calculated . RESULTS At the end of 6 months of follow-up , 1 patient in the carvedilol group and 4 in the control group had died . Control EF was below 50 % in 1 patient in the carvedilol group and in 5 in the control group . The mean EF of the carvedilol group was similar at baseline and control echocardiography ( 70.5 vs. 69.7 , respectively ; p = 0.3 ) , but in the control group the mean EF at control echocardiography was significantly lower ( 68.9 vs. 52.3 ; p < 0.001 ) . Both systolic and diastolic diameters were significantly increased compared with basal measures in the control group . In Doppler study , whereas E velocities in the carvedilol group decreased , E velocities and E/A ratios were significantly reduced in the control group . CONCLUSIONS Prophylactic use of carvedilol in patients receiving ANT may protect both systolic and diastolic functions of the left ventricle PURPOSE To up date a clinical practice guideline on the use of chemotherapy and radiation therapy protectants for patients with cancer . METHODS An up date committee review ed literature published since the last guideline up date in 2002 . RESULTS Thirty-nine reports met the inclusion criteria : palifermin and dexrazoxane , three reports ( two studies ) each ; amifostine , 33 reports ( 31 studies ) ; and mesna , no published r and omized trials identified since 2002 . RECOMMENDATIONS Dexrazoxane is not recommended for routine use in breast cancer ( BC ) in adjuvant setting , or metastatic setting with initial doxorubicin-based chemotherapy . Consider use with metastatic BC and other malignancies , for patients who have received more than 300 mg/m(2 ) doxorubicin who may benefit from continued doxorubicin-containing therapy . Cardiac monitoring should continue in patients receiving doxorubicin . Amifostine may be considered for prevention of cisplatin-associated nephrotoxicity , reduction of grade 3 to 4 neutropenia ( alternative strategies are reasonable ) , and to decrease acute and late xerostomia with fractionated radiation therapy alone for head and neck cancer . It is not recommended for protection against thrombocytopenia , prevention of platinum-associated neurotoxicity or ototoxicity or paclitaxel-associated neuropathy , prevention of radiation therapy-associated mucositis in head and neck cancer , or prevention of esophagitis during concurrent chemoradiotherapy for non-small-cell lung cancer . Palifermin is recommended to decrease severe mucositis in autologous stem-cell transplantation ( SCT ) for hematologic malignancies with total-body irradiation ( TBI ) conditioning regimens , and considered for patients undergoing myeloablative allogeneic SCT with TBI-based conditioning regimens . Data are insufficient to recommend use in the non-SCT setting Objective : The aim of this study is to evaluate the preventive effects of carvedilol on doxorubicin-induced cardiotoxicity . Methods : In this trial , 70 female patients with breast cancer who were c and i date s to receive doxorubicin were enrolled , from which 30 were selected r and omly to receive carvedilol 6.25 mg daily during chemotherapy , with the rest receiving placebo as the control group . Both groups were evaluated 1 week before and 1 week after chemotherapy by measuring the left ventricular ejection fraction and strain/strain rate . Results : Data analysis showed that the case group presented no significant reduction in strain and strain-rate parameters after intervention , while there was a significant reduction in these parameters in the control group ( all p values < 0.001 ) . Also , the mean differences of strain parameters in the case group were significantly less than in the control group in all evaluated heart walls ( basal septal strain , p = 0.005 , basal lateral strain , p = 0.001 , basal inferior strain , p < 0.001 , and basal anterior strain , p < 0.001 ) ; the same was true for the strain-rate parameters ( the p values for basal septal , basal lateral , basal inferior and basal anterior strain rate were 0.037 , 0.037 , 0.002 and < 0.001 , respectively ) . Conclusion : This study shows that carvedilol can prevent doxorubicin-induced cardiotoxicity . Whether this prophylaxis should be considered as the preferred method needs further investigation OBJECTIVE To evaluate left ventricular ( LV ) systolic function by means of echocardiography in patients with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane . METHODS The study analyzed 55 patients with osteosarcoma , with or without metastasis , undergoing a six-cycle chemotherapy regimen of doxorubicin , who were divided into two groups according to dexrazoxane use . Group I : Thirty-seven patients who did not receive dexrazoxane ( 28 males , average age 15.4 years ) . Group II : Eighteen patients who did receive dex Output:

Carvedilol and nebivolol , but not metoprolol , had positive results regarding cardioprotection .

MS2_1shot153

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES : Inadequate follow-up of abnormal fecal occult blood test ( FOBT ) results occurs in several types of practice setting s. Our institution implemented multifaceted quality improvement ( QI ) activities in 2004–2005 to improve follow-up of FOBT-positive results . Activities addressed precolonoscopy referral processes and system-level factors such as electronic communication , provider education , and feedback . We evaluated their effects on timeliness and appropriateness of positive-FOBT follow-up and identified factors that affect colonoscopy performance . METHODS : Retrospective electronic medical record review was used to determine outcomes before and after QI activities in a multispecialty ambulatory clinic of a tertiary care Veterans Affairs facility and its affiliated satellite clinics . From 1869 FOBT-positive cases , 800 were r and omly selected from time periods before and after QI activities . Two review ers used a pretested st and ardized data collection form to determine whether colonoscopy was appropriate or indicated based on predetermined criteria and if so , the timeliness of colonoscopy referral and performance before and after QI activities . RESULTS : In cases where a colonoscopy was indicated , the proportion of patients who received a timely colonoscopy referral and performance were significantly higher post-implementation ( 60.5 % vs. 31.7 % , P<0.0001 and 11.4 % vs. 3.4 % , P=0.0005 ) . A significant decrease also result ed in median times to referral and performance ( 6 vs. 19 days , P<0.0001 and 96.5 vs. 190 days , P<0.0001 ) and in the proportion of positive-FOBT test results that had received no follow-up by the time of chart review ( 24.3 % vs. 35.9 % , P=0.0045 ) . Significant predictors of absence of the performance of an indicated colonoscopy included performance of a non-colonoscopy procedure such as barium enema or flexible sigmoidoscopy ( OR=16.9 ; 95 % CI , 1.9–145.1 ) , patient non-adherence ( OR=33.9 ; 95 % CI , 17.3–66.6 ) , not providing an appropriate provisional diagnosis on the consultation ( OR=17.9 ; 95 % CI , 11.3–28.1 ) , and gastroenterology service not rescheduling colonoscopies after an initial cancellation ( OR=11.0 ; 95 % CI , 5.1–23.7 ) . CONCLUSIONS : Multifaceted QI activities improved rates of timely colonoscopy referral and performance in an electronic medical record system . However , colonoscopy was not indicated in over one third of patients with positive FOBTs , raising concerns about current screening practice s and the appropriate denominator used for performance measurement st and ards related to colon cancer screening Background The Basque Colorectal Cancer Screening Programme has both high participation rate and high compliance rate of colonoscopy after a positive faecal occult blood test ( FIT ) . Although , colorectal cancer ( CRC ) screening with biannual ( FIT ) has shown to reduce CRC mortality , the ultimate effectiveness of the screening programmes depends on the accuracy of FIT and post-FIT colonoscopy , and thus , harms related to false results might not be underestimated . Current CRC screening programmes use a single faecal haemoglobin concentration ( f-Hb ) cut-off for colonoscopy referral for both sexes and all ages . We aim ed to determine optimum f-Hb cut-offs by sex and age without compromising neoplasia detection and interval cancer proportion . Methods Prospect i ve cohort study using a single- sample faecal immunochemical test ( FIT ) on 444,582 invited average-risk subjects aged 50–69 years . A result was considered positive at ≥20 μg Hb/g faeces . Outcome measures were analysed by sex and age for a wide range of f-Hb cut-offs . Results We analysed 17,387 positive participants in the programme who underwent colonoscopy . Participation rate was 66.5 % . Men had a positivity rate for f-Hb of 8.3 % and women 4.8 % ( p < 0.0001 ) . The detection rate for advanced neoplasia ( cancer plus advanced adenoma ) was 44.0‰ for men and 15.9‰ for women ( p < 0.0001 ) . The number of colonoscopies required decreased in both sexes and all age groups through increasing the f-Hb cut-off . However , the loss in CRC detection increased by up to 28.1 % in men and 22.9 % in women . CRC missed were generally at early stages ( Stage I-II : from 70.2 % in men to 66.3 % in women ) . Conclusions This study provides detailed outcomes in men and women of different ages at a range of f-Hb cut-offs . We found differences in positivity rates , neoplasia detection rate , number needed to screen , and interval cancers in men and women and in younger and older groups . However , there are factors other than sex and age to consider when consideration is given to setting the f-Hb cut-off Objective Colorectal cancer screening programmes are implemented worldwide ; many are based on faecal immunochemical testing ( FIT ) . The aim of this study was to evaluate two frequently used FITs on participation , usability , positivity rate and diagnostic yield in population -based FIT screening . Design Comparison of two FITs was performed in a fourth round population -based FIT-screening cohort . R and omly selected individuals aged 50–74 were invited for FIT screening and were r and omly allocated to receive an OC -Sensor ( Eiken , Japan ) or faecal occult blood (FOB)-Gold ( Sentinel , Italy ) test ( March – December 2014 ) . A cut-off of 10 µg haemoglobin (Hb)/g faeces ( ie , 50 ng Hb/mL buffer for OC-Sensor and 59 ng Hb for FOB-Gold ) was used for both FITs . Results In total , 19 291 eligible invitees were included ( median age 61 , IQR 57–67 ; 48 % males ) : 9669 invitees received OC-Sensor and 9622 FOB-Gold ; both tests were returned by 63 % of invitees ( p=0.96 ) . Tests were non-analysable in 0.7 % of participants using OC-Sensor vs 2.0 % using FOB-Gold ( p<0.001 ) . Positivity rate was 7.9 % for OC-Sensor , and 6.5 % for FOB-Gold ( p=0.002 ) . There was no significant difference in diagnostic yield of advanced neoplasia ( 1.4 % for OC-Sensor vs 1.2 % for FOB-Gold ; p=0.15 ) or positive predictive value ( PPV ; 31 % vs 32 % ; p=0.80 ) . When comparing both tests at the same positivity rate instead of cut-off , they yielded similar PPV and detection rates . Conclusions The OC-Sensor and FOB-Gold were equally acceptable to a screening population . However , FOB-Gold was prone to more non-analysable tests . Comparison between FIT br and s is usually done at the same Hb stool concentration . Our findings imply that for a fair comparison on diagnostic yield between FIT 's positivity rate rather than Hb concentration should be used . Trial registration number NTR5385 ; Results IMPORTANCE Although some countries have implemented widespread colonoscopy screening , most European countries have not introduced it because of uncertainty regarding participation rates , procedure-related pain and discomfort , endoscopist performance , and effectiveness . To our knowledge , no r and omized trials on colonoscopy screening currently exist . OBJECTIVE To investigate participation rate , adenoma yield , performance , and adverse events of population -based colonoscopy screening in several European countries . DESIGN , SETTING , AND POPULATION A population -based r and omized clinical trial was conducted among 94 959 men and women aged 55 to 64 years of average risk for colon cancer in Pol and , Norway , the Netherl and s , and Sweden from June 8 , 2009 , to June 23 , 2014 . INTERVENTIONS Colonoscopy screening or no screening . MAIN OUTCOMES AND MEASURES Participation in colonoscopy screening , cancer and adenoma yield , and participant experience . Study outcomes were compared by country and endoscopist . RESULTS Of 31 420 eligible participants r and omized to the colonoscopy group , 12 574 ( 40.0 % ) underwent screening . Participation rates were 60.7 % in Norway ( 5354 of 8816 ) , 39.8 % in Sweden ( 486 of 1222 ) , 33.0 % in Pol and ( 6004 of 18 188 ) , and 22.9 % in the Netherl and s ( 730 of 3194 ) ( P < .001 ) . The cecum intubation rate was 97.2 % ( 12 217 of 12 574 ) , with 9726 participants ( 77.4 % ) not receiving sedation . Of the 12 574 participants undergoing colonoscopy screening , we observed 1 perforation ( 0.01 % ) , 2 postpolypectomy serosal burns ( 0.02 % ) , and 18 cases of bleeding owing to polypectomy ( 0.14 % ) . Sixty-two individuals ( 0.5 % ) were diagnosed with colorectal cancer and 3861 ( 30.7 % ) had adenomas , of which 1304 ( 10.4 % ) were high-risk adenomas . Detection rates were similar in the proximal and distal colon . Performance differed significantly between endoscopists ; recommended benchmarks for cecal intubation ( 95 % ) and adenoma detection ( 25 % ) were not met by 6 ( 17.1 % ) and 10 of 35 endoscopists ( 28.6 % ) , respectively . Moderate or severe abdominal pain after colonoscopy was reported by 601 of 3611 participants ( 16.7 % ) examined with st and ard air insufflation vs 214 of 5144 participants ( 4.2 % ) examined with carbon dioxide ( CO2 ) insufflation ( P < .001 ) . CONCLUSIONS AND RELEVANCE Colonoscopy screening entails high detection rates in the proximal and distal colon . Participation rates and endoscopist performance vary significantly . Postprocedure abdominal pain is common with st and ard air insufflation and can be significantly reduced by using CO2 . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00883792 Immunochemical fecal occult blood test ( FIT ) is a new colorectal cancer ( CRC ) screening method already recommended by the American screening guidelines . We aim ed to test the feasibility of FIT as compared to guaiac fecal occult blood test ( G‐FOBT ) in a large urban population of Tel Aviv . Average‐risk persons , aged 50–75 years , were offered FIT or G‐FOBT after r and omization according to the socioeconomic status of their clinics . Participants with positive tests underwent colonoscopy . Participants were followed through the Cancer Registry 2 years after the study . Hemoccult SENSA ™ and OC‐MICRO ™ ( three sample s , 70 ng/ml threshold ) were used . FIT was offered to 4,657 persons ( Group A ) and G‐FOBT to 7,880 persons ( Group B ) . Participation rate was 25.9 % and 28.8 % in Group A and B , respectively ( p < 0.001 ) . Positivity rate in Group A and B was 12.7 % and 3.9 % , respectively ( p < 0.001 ) . Cancer found in six ( 0.49 % ) and eight ( 0.35 % ) patients of Group A and B , respectively ( NS ) . Cancer registry follow‐up found missed cancer in five ( 0.22 % ) cases of Group B and none in Group A ( NS ) . The sensitivity , specificity , negative and positive predictive value for cancer in Group A and B were 100 % , 85.9 % , 100 % , 3.9 % and 61.5 % , 96.4 % , 99.8 % , 9.1 % , respectively . There was increased detection of advanced adenomatous polyp ( AAP ) by FIT , irrespective of age , gender , and socioeconomic status ( Per Protocol : odds ratio 2.69 , 95 % confidence interval 1.6–4.5 ; Intention to Screen : odds ratio 3.16 , 95 % confidence interval 1.8–5.4 ) . FIT is feasible in urban , average‐risk population , which significantly improved performance for detection of AAP and CRC , despite reduced participation Background Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction . This study evaluates the effectiveness of two ongoing interventions design ed to improve colonoscopy uptake after a positive fecal occult blood test ( FOBT ) result within Ontario ’s population -wide ColonCancerCheck program . The first was a revision of mailed FOBT lab results to physicians to explicitly define a positive FOBT and to recommend colonos Output:

Discussion Compliance with diagnostic evaluation after a positive FOBT is still suboptimal .

MS2_1shot154

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE This study investigated the effect of commuter cycling on cardiorespiratory fitness in men and women . Secondary outcomes included body fat and blood pressure measurements . METHODS In February 2009 , 48 volunteers from the Isl and of Funen , Denmark were r and omly assigned to either " no change in lifestyle " or to " minimum 20 minutes of daily commuter cycling during 8 weeks " . Maximal oxygen uptake was assessed directly during a progressive cycle-ergometer-test , sum of skinfolds was used as an estimate of body fat , and blood pressure was measured using a Dinamap monitor . Measurements were obtained at baseline and at the conclusion of the 8-week intervention program . RESULTS Six cyclists dropped out . After 8 weeks VO(2)max ( mL O(2 ) min(-1 ) ) and cardiorespiratory fitness ( mL O(2 ) kg(-1 ) min(-1 ) ) were significantly improved in the cycling group when compared to the control group . Delta change in VO(2)max between groups equaled 206 mL O(2 ) min(-1 ) ( p=0.005 ) and delta change in cardiorespiratory fitness equaled 2.6 mL O(2 ) kg(-1 ) min(-1 ) ( p=0.003 ) . Body fatness changed more noticeable ( p=0.026 ) in the cyclists ( -12.3±7.3 mm ) than in the controls ( -0.2±7.1 mm ) . CONCLUSIONS VO(2)max and cardiorespiratory fitness were significantly improved and body fat reduced as a result of people engaging in 8 weeks of commuter cycling Background The purpose of this study was to examine the impact of combined cardiorespiratory fitness and waist-to-height ratio in the form of a fit-fat index on incident diabetes risk . Additionally , the independent predictive performance of cardiorespiratory fitness , waist-to-height ratio , and body mass index also were estimated and compared . Methods This was a prospect i ve cohort study of 10,381 men who had a normal electrocardiogram and no history of major chronic disease at baseline from 1979 to 2005 . R and om survival forest models and traditional Cox proportional hazards models were used to predict diabetes at 5- , 10- , and 15-year incidence horizons . Results Overall , 4.8 % of the participants developed diabetes . Receiver operating characteristic curve analyses for incidence risk demonstrated good discrimination using r and om survival forest models across fitness and fatness measures ; Cox models were poor to fair . The differences between fitness and fatness measures across horizons were clinical ly negligible . Smoothed r and om survival forest estimates demonstrated the impact of each fitness and fatness measure on incident diabetes was intuitive and grade d. Conclusions Although fitness and fatness measures showed a similar discriminative ability in predicting incident diabetes , unique to the study was the ability of the fit-fat index to demonstrate a better indication of incident risk when compared to fitness or fatness alone . A single index combining cardiorespiratory fitness and waist-to-height ratio may be more useful because it can indicate improvements in either or both of the measures AIMS We examined the association of grip strength with incident type 2 diabetes mellitus ( T2DM ) in healthy subjects initially aged 50 to 75years after a follow-up of 5.5years and 10.7years . METHODS This was a prospect i ve , population -based study derived from the CoLaus ( Cohorte Lausannoise ) study including 2318 participants ( aged 60.2y ; 1354 women ) free from T2DM at baseline . Grip strength was assessed using a h and held dynamometer . The effect of grip strength on the incidence of T2DM was analyzed by logistic regression . RESULTS After a follow-up of 5.5years , 190 ( 8.2 % ) T2DM cases were identified . In bivariate analysis , participants who developed T2DM had a higher absolute grip strength ( 35.3±10.6 versus 33.2±10.7 kg , P=0.013 ) . Analysis between grip strength expressed in 5 kg increment and incident TD2 M showed a negative association when adjusted for age and sex [ ORs ( 95 % CI ) : 0.88 ( 0.79 , 0.98 ) ] , or for age , sex and body mass index ( BMI ) [ ORs ( 95 % CI ) : 0.87 ( 0.78 , 097 ) ] . After a follow-up of 10.7years , 131 supplemental ( 7.3 % ) T2DM cases were identified , but there was no association between grip strength and incident T2DM in bivariate and multivariable analysis , potentially due to a lack of statistical power . CONCLUSIONS In non elderly healthy adults , the risk of incident T2DM is overall not associated with grip strength over a maximum follow-up of 10.7years . Future studies are warranted to better assess the association between grip strength and incident T2DM in bigger and even younger cohorts A major problem in review ing the published results of different epidemiologic studies of the relation between a quantitative variable and the risk of disease is that the results are presented in many different ways . The purpose of this paper is to exemplify methods by which results expressed either as risks ( or rates ) according to quantlle groups of the quantitative variable or as results derived from a logistic regression analysis can be reexpressed in a uniform manner , as a mean difference in the quantitative variable between the cases of disease and the other subjects in the study . An important assumption of the methods is that the quantitative variable has an approximately normal distribution , and a way of investigating the appropriateness of this assumption is given . The methods can be applied to both prospect i ve and case-control studies and are exemplified by a number of studies of serum albumin concentrations and mortality . In some applications , these methods can be used as a precursor to formal meta- analysis , for example , when differential control of potential confounding factors is not a problem . At the least , the methods can be useful either in quantitatively review ing published studies before undertaking new research or in putting the results of a new study into the context of previously published ones Background : Aerobic exercise is recommended for weight management but energy balance is often less negative than predicted from exercise energy expenditure ( ExEE ) . Objective : To examine effects of active commuting and leisure-time exercise on fat loss in women and men with overweight and obesity . Methods : We r and omized 130 younger , physically inactive women and men with overweight and obesity ( body mass index : 25–35 kg m−2 ) to 6 months of habitual lifestyle ( control ; CON , n=18 ) , active commuting ( BIKE , n=35 ) or leisure-time exercise of moderate ( MOD , 50 % VO2peak reserve , n=39 ) or vigorous intensity ( VIG , 70 % VO2peak reserve , n=38 ) . The primary outcome was change in fat mass measured by dual-energy X-ray absorptiometry , which was analyzed intention-to-treat . Accumulated energy balance was calculated based on changes in body composition , and ExEE was calculated based on heart rate monitoring during exercise . Results : Testing at 3 and 6 months was completed by 95 and 90 participants , respectively . Fat mass was reduced after 3 and 6 months in BIKE ( 3 months : −3.6 ( −5.5 ; −1.7 ) kg ( mean ( 95 % CI ) ) ; 6 months : −4.2 ( −6.6 ; −1.9 ) kg ; both : P<0.001 ) , MOD ( 3 months : −2.2 ( −3.9 ; −0.4 ) kg ; 6 months : −2.6 ( −4.8 ; −0.5 ) kg , both : P<0.02 ) and VIG ( 3 months : −3.4 ( −5.2 ; −1.7 ) kg ; 6 months : −4.5 ( −6.6 ; −2.3 ) kg ; both : P<0.001 ) compared with CON . Furthermore , fat loss was greater in VIG compared with MOD ( 6 months : −1.8 ( −3.6 ; −0.1 ) kg , P=0.043 ) . Based on the ExEE and the accumulated energy balance MOD compensated for the ExEE ( 77 ( 48 ; 106 ) % ) but not BIKE ( 38 ( −18 ; 95 ) % ) and VIG ( 21 ( −14 ; 55 ) % ) . Conclusions : A meaningful fat loss was obtained by 6 months of active commuting and leisure-time exercise , but fat loss was greater with vigorous compared with moderate intensity exercise . Active commuting is an alternative to leisure-time exercise in the management of overweight and obesity . The trial was registered at clinical trials.gov as NCT01962259 ( main trial ) and NCT01973686 ( energy metabolism sub- study ) Observational studies have reported an association of h and grip strength with risk of cardiovascular disease . However , residual confounding and reverse causation may have influenced these findings . A Mendelian r and omization ( MR ) study was conducted to examine whether h and grip is causally associated with cardiovascular disease . Two single nucleotide polymorphisms ( SNPs ) , rs3121278 and rs752045 , were used as the genetic instruments for h and grip . The effect of each SNP on coronary artery disease/myocardial infa rct ion ( CAD/MI ) was weighted by its effect on h and grip strength , and estimates were pooled to provide a summary measure for the effect of increased h and grip on risk of CAD/MI . MR analysis showed that higher grip strength reduces risk for CAD/MI , with 1-kilogram increase in genetically determined h and grip reduced odds of CAD by 6 % ( odds ratio ( OR ) = 0.94 , 95 % confidence interval ( CI ) 0.91–0.99 , P = 0.01 ) , and reduced odds of MI by 7 % ( OR = 0.93 , 95 % CI 0.89–0.98 , P = 0.003 ) . No association of grip strength with type 2 diabetes , body mass index , LDL- and HDL-cholesterol , triglycerides and fasting glucose was found . The inverse causal relationship between h and grip and the risk of CAD or MI suggests that promoting physical activity and resistance training to improve muscle strength may be important for cardiovascular health BACKGROUND Limited data are available on the relationship between muscular and performance fitness ( MPF ) and the incidence of type 2 diabetes . METHODS A cohort of 3792 Japanese men completed a medical examination that included MPF and cardiorespiratory fitness tests . MPF index composite score was calculated using Z-scores from vertical jump , sit-ups , side step , and functional reach tests . RESULTS The mean follow-up period was 187 months ( 15.6 years ) . There were 240 patients who developed type 2 diabetes during follow-up . Relative risks and 95 % confidence intervals ( CI ) for incidence of diabetes across baseline quartiles of MPF index composite score were obtained using the Cox proportional hazards model while adjusting for age , BMI , diastolic blood pressure , cigarette smoking , alcohol intake , and family history of diabetes . The relative risks for developing diabetes across quartiles of MPF index composite scores ( lowest to highest ) were 1.0 ( referent ) , 1.15 ( 95 % CI 0.83 - 1.60 ) , 1.10 ( 0.78 - 1.55 ) , and 0.57 ( 0.37 - 0.90 ) ( P for trend = .061 ) . These results were attenuated after adjustment for cardiorespiratory fitness ( P for trend = .125 ) . CONCLUSIONS This prospect i ve study suggests that MPF is a predictor of type 2 diabetes , although its predictive ability was attenuated after adjusting for cardiorespiratory fitness CONTEXT Exercise guidelines for individuals with diabetes include both aerobic and resistance training although few studies have directly examined this exercise combination . OBJECTIVE To examine the benefits of aerobic training alone , resistance training alone , and a combination of both on hemoglobin A(1c ) ( HbA(1c ) ) in individuals with type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in which 262 sedentary men and women in Louisiana with type 2 diabetes and HbA(1c ) levels of 6.5 % or higher were enrolled in the 9-month exercise program between April 2007 and August 2009 . INTERVENTION Forty-one participants were assigned to the nonexercise control group , 73 to resistance training 3 days a week , 72 to aerobic exercise in which they expended 12 kcal/kg per week ; and 76 to combined aerobic and resistance training in which they expended 10 kcal/kg per week and engaged in resistance training twice a week . Main Outcome Change in HbA(1c ) level . Secondary outcomes included measures of anthropometry and fitness . RESULTS The study included 63.0 % women and 47.3 % nonwhite participants who were a mean ( SD ) age of 55.8 years ( 8.7 years ) with a baseline HbA(1c ) level of 7.7 % ( 1.0 % ) . Compared with the control group , the absolute mean change in HbA(1c ) in the combination training exercise group was -0.34 % ( 95 % confidence interval [ CI ] , -0.64 % to -0.03 % ; P = .03 ) . The mean changes in HbA(1 Output:

Conclusions /interpretationRelatively small increments in cardiorespiratory fitness and muscle strength were associated with clinical ly meaningful reductions in type 2 diabetes risk with indication of a linear dose – response relationship for cardiorespiratory fitness .

MS2_1shot155

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES In a long-term r and omised coronary artery bypass grafting ( CABG ) study , the patency rate using a new ' no touch ' ( NT ) vein-graft preparation technique was superior to the conventional ( C ) technique . This cineangiographic and intravascular ultrasound ( IVUS ) sub study examined possible mechanisms . METHODS A total of 45 patients ( 118 grafts ) in the NT group and 46 patients ( 112 grafts ) in the C group had patent grafts at short-term follow-up after 18 months . Thirty-seven patients ( 91 grafts ) in the NT group and 37 patients ( 77 grafts ) in the C group had patent grafts at long-term follow-up after 8.5 years , and were evaluated on a scale from 0 ( normal ) to 2 ( significant stenosis ) by cineangiogram . IVUS was performed in 15 NT grafts and 14 C grafts in the short-term follow-up , and 27 NT grafts and 26 C grafts in the long-term follow-up , in grafts considered normal by the cineangiogram . The grafts were evaluated with respect to lumen volume , intimal thickness , incidence of plaque and plaque components . RESULTS In the short-term follow-up , the cineangiogram showed more normal grafts ( 89.0 % in the NT group compared with 75.0 % in the C group ) , and the number of grafts with stenosis was 11.0 % in the NT group compared with 25.0 % in the C group ( p=0.006 ) . IVUS showed less mean intimal thickness ( 0.43 (0.07)mm vs 0.52 (0.08)mm ; p=0.03 ) , less grafts with considerable intimal hyperplasia ( ≥ 0.9 mm ; 20 % vs 78.6 % ; p=0.011 ) and fewer patients with considerable hyperplasia ( ≥ 0.9 mm ; 25 % vs 100 % ; p=0.007 ) . In the long-term follow-up , the cineangiogram showed more normal grafts , with 91.2 % in the NT group compared with 83.1 % in the C group ; there were fewer grafts with significant stenosis , with 7.7 % in the NT group compared with 15.6 % in the C group ( p=0.14 ) . IVUS showed fewer grafts containing multiple plaques ( 14.8 % vs 50 % ; p=0.008 ) , less advanced plaque with lipid ( 11.8 % vs 63.9 % ; p=0.0004 ) and less maximal plaque thickness ( 1.04 (0.23)mm vs 1.32 (0.25)mm ; p=0.02 ) in the NT group compared with the C group . CONCLUSION The superior long-term patency rate using the NT vein-graft technique at CABG could be explained by a significantly slower progression of atherosclerosis OBJECTIVE Neointimal hyperplasia secondary to vascular smooth muscle cell ( VSMC ) activation limits the long-term patency of saphenous vein grafts ( SVGs ) . We compared markers of vascular injury and VSMC activation in SVGs harvested using the pedicled ' no-touch ' ( NT ) vs the conventional ( CON ) technique . METHODS Patients undergoing coronary artery bypass surgery were enrolled in the PATENT SVG trial ( clinical trials.gov NCT01488084 ) . Patients were r and omly allocated to have SVGs harvested with the NT technique from one leg and the CON method from the other . SVG segments underwent morphometry , histological and electron microscopy assessment s and transcript measurements of VSMC activation and differentiation markers . Leg wound functional recovery and harvest site complications were assessed using a quality -of-life question naire . RESULTS A total of 17 patients ( 65.3 ± 7.3 years ) were enrolled . SVGs harvested using the NT vs CON technique exhibited preserved intimal , medial and adventitial architecture . CON harvest was associated with greater medial Kruppel-like factor 4 transcript levels ( 0.26 ± 0.05 vs 0.11 ± 0.02 , P < 0.05 ) . CON sample s had significantly lower medial serum response factor ( 0.53 ± 0.11 vs 1.44 ± 0.50 , P < 0.05 ) and myocardin ( 0.59 ± 0.08 vs 1.33 ± 0.33 , P < 0.05 ) transcript levels . MicroRNA-145 , an inhibitor of VSMC activation and differentiation , was higher in the NT vs CON sample s ( 1.84 ± 1.03 vs 0.50 ± 0.19 , P < 0.05 ) . Leg assessment scores were worse in the NT legs at 3 months , but similar to CON scores at 12 months . CONCLUSIONS SVGs harvested using the ' NT ' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting . Functional leg recovery was similar in both groups at 12 months . Larger studies are required to corroborate these findings BACKGROUND The use of bilateral internal thoracic ( mammary ) arteries for coronary-artery bypass grafting ( CABG ) may improve long-term outcomes as compared with the use of a single internal-thoracic-artery plus vein grafts . METHODS We r and omly assigned patients scheduled for CABG to undergo single or bilateral internal-thoracic-artery grafting in 28 cardiac surgical centers in seven countries . The primary outcome was death from any cause at 10 years . The composite of death from any cause , myocardial infa rct ion , or stroke was a secondary outcome . Interim analyses were prespecified at 5 years of follow-up . RESULTS A total of 3102 patients were enrolled ; 1554 were r and omly assigned to undergo single internal-thoracic-artery grafting ( the single-graft group ) and 1548 to undergo bilateral internal-thoracic-artery grafting ( the bilateral-graft group ) . At 5 years of follow-up , the rate of death was 8.7 % in the bilateral-graft group and 8.4 % in the single-graft group ( hazard ratio , 1.04 ; 95 % confidence interval [ CI ] , 0.81 to 1.32 ; P=0.77 ) , and the rate of the composite of death from any cause , myocardial infa rct ion , or stroke was 12.2 % and 12.7 % , respectively ( hazard ratio , 0.96 ; 95 % CI , 0.79 to 1.17 ; P=0.69 ) . The rate of sternal wound complication was 3.5 % in the bilateral-graft group versus 1.9 % in the single-graft group ( P=0.005 ) , and the rate of sternal reconstruction was 1.9 % versus 0.6 % ( P=0.002 ) . CONCLUSIONS Among patients undergoing CABG , there was no significant difference between those receiving single internal-thoracic-artery grafts and those receiving bilateral internal-thoracic-artery grafts with regard to mortality or the rates of cardiovascular events at 5 years of follow-up . There were more sternal wound complications with bilateral internal-thoracic-artery grafting than with single internal-thoracic-artery grafting . Ten-year follow-up is ongoing . ( Funded by the British Heart Foundation and others ; ART Current Controlled Trials number , IS RCT N46552265 . ) BACKGROUND The use of radial‐artery grafts for coronary‐artery bypass grafting ( CABG ) may result in better postoperative outcomes than the use of saphenous‐vein grafts . However , r and omized , controlled trials comparing radial‐artery grafts and saphenous‐vein grafts have been individually underpowered to detect differences in clinical outcomes . We performed a patient‐level combined analysis of r and omized , controlled trials to compare radial‐artery grafts and saphenous‐vein grafts for CABG . METHODS Six trials were identified . The primary outcome was a composite of death , myocardial infa rct ion , or repeat revascularization . The secondary outcome was graft patency on follow‐up angiography . Mixed‐effects Cox regression models were used to estimate the treatment effect on the outcomes . RESULTS A total of 1036 patients were included in the analysis ( 534 patients with radial‐artery grafts and 502 patients with saphenous‐vein grafts ) . After a mean ( ±SD ) follow‐up time of 60±30 months , the incidence of adverse cardiac events was significantly lower in association with radial‐artery grafts than with saphenous‐vein grafts ( hazard ratio , 0.67 ; 95 % confidence interval [ CI ] , 0.49 to 0.90 ; P=0.01 ) . At follow‐up angiography ( mean follow‐up , 50±30 months ) , the use of radial‐artery grafts was also associated with a significantly lower risk of occlusion ( hazard ratio , 0.44 ; 95 % CI , 0.28 to 0.70 ; P<0.001 ) . As compared with the use of saphenous‐vein grafts , the use of radial‐artery grafts was associated with a nominally lower incidence of myocardial infa rct ion ( hazard ratio , 0.72 ; 95 % CI , 0.53 to 0.99 ; P=0.04 ) and a lower incidence of repeat revascularization ( hazard ratio , 0.50 ; 95 % CI , 0.40 to 0.63 ; P<0.001 ) but not a lower incidence of death from any cause ( hazard ratio , 0.90 ; 95 % CI , 0.59 to 1.41 ; P=0.68 ) . CONCLUSIONS As compared with the use of saphenous‐vein grafts , the use of radial‐artery grafts for CABG result ed in a lower rate of adverse cardiac events and a higher rate of patency at 5 years of follow‐up . ( Funded by Weill Cornell Medicine and others . OBJECTIVE Conventional harvesting of the saphenous vein in coronary artery bypass surgery produces vessel damage that contributes to graft failure . A novel " no touch " technique provides high short- and long-term patency rates . METHOD This r and omized longitudinal trial compares graft patency of two patient groups undergoing coronary artery bypass surgery . Conventional : 52 patients had their veins stripped , distended , and stored in saline solution . No-touch : 52 patients had veins removed with surrounding tissue , not distended , and stored in heparinized blood . Angiographic assessment was performed at mean time 18 months after the operation in 46 patients in the conventional group and 45 patients in the no-touch group and repeated at mean time 8.5 years in 37 patients from both groups . RESULTS The distribution of the grafts to the recipient coronary arteries regarding their size and quality was similar in both groups . The angiographic assessment at 18 months postoperatively showed 89 % conventional versus 95 % no-touch grafts were patent . Repeated angiography at 8.5 years showed a patency rate for the conventional group of 76 % and 90 % for the no-touch group ( P = .01 ) . The multivariate analysis showed that the most important surgical factors for graft patency were the technique of harvesting ( odds ratio= 3.7 , P = .007 ) for the no-touch versus the conventional technique and the vein quality before implantation ( odds ratio = 3.2 , P = .007 ) for veins that were of good quality . By comparison the patency of the thoracic artery grafts was 90 % . CONCLUSION Harvesting the saphenous vein with surrounding tissue provides high short- and long-term patency rates comparable to the left internal thoracic artery BACKGROUND In the past decade , the radial artery has frequently been used for coronary bypass surgery despite concern regarding the possibility of graft spasm . Graft patency is a key predictor of long-term survival . We therefore sought to determine the relative patency rate of radial-artery and saphenous-vein grafts in a r and omized trial in which we controlled for bias in the selection of patients and vessels . METHODS We enrolled 561 patients at 13 centers . The left internal thoracic artery was used to bypass the anterior circulation . The radial-artery graft was r and omly assigned to bypass the major vessel in either the inferior ( right coronary ) territory or the lateral ( circumflex ) territory , with the saphenous-vein graft used for the opposing territory ( control ) . The primary end point was graft occlusion , determined by angiography 8 to 12 months postoperatively . RESULTS Angiography was performed at one year in 440 patients : 8.2 percent of radial-artery grafts and 13.6 percent of saphenous-vein grafts were completely occluded ( P=0.009 ) . Diffuse narrowing of the graft ( Output:

Conclusions The NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased . The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting .

MS2_1shot156

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Introduction Low-dose hydrocortisone treatment is widely accepted therapy for the treatment of vasopressor-dependent septic shock . The question of whether corticosteroids should be given to septic shock patients by continuous or by bolus infusion is still unanswered . Hydrocortisone induces hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach . Methods In this prospect i ve r and omized study , we compared the blood glucose profiles , insulin requirements , amount of nursing workload needed , and shock reversal in 48 septic shock patients who received hydrocortisone treatment either by bolus or by continuous infusion with equivalent dose ( 200 mg/day ) . Duration of hydrocortisone treatment was five days . Results The mean blood glucose levels were similar in the two groups , but the number of hyperglycemic episodes was significantly higher in those patients who received bolus therapy ( 15.7 ± 8.5 versus 10.5 ± 8.6 episodes per patient , p = 0.039 ) . Also , more changes in insulin infusion rate were needed to maintain strict normoglycemia in the bolus group ( 4.7 ± 2.2 versus 3.4 ± 1.9 adjustments per patient per day , p = 0.038 ) . Hypoglycemic episodes were rare in both groups . No difference was seen in shock reversal . ConclusionS trict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion . This approach also reduces nursing workload needed to maintain tight blood glucose control . Trial Registration Number IS RCT CONTEXT AND OBJECTIVE Sepsis and septic shock are very common conditions among critically ill patients that lead to multiple organ dysfunction syndrome ( MODS ) and death . Our purpose was to investigate the efficacy of early administration of dexamethasone for patients with septic shock , with the aim of halting the progression towards MODS and death . DESIGN AND SETTING Prospect i ve , r and omized , double-blind , single-center study , developed in a surgical intensive care unit at Hospital das Clínicas , Faculdade de Medicina da Universidade de São Paulo . METHODS The study involved 29 patients with septic shock . All eligible patients were prospect ively r and omized to receive either a dose of 0.2 mg/kg of dexamethasone ( group D ) or placebo ( group P ) , given three times at intervals of 36 hours . The patients were monitored over a seven-day period by means of the sequential organ failure assessment score . RESULTS Patients treated with dexamethasone did not require vasopressor therapy for as much time over the seven-day period as did the placebo group ( p = 0.043 ) . Seven-day mortality was 67 % in group P ( 10 out of 15 ) and 21 % in group D ( 3 out of 14 ) ( relative risk = 0.31 , 95 % confidence interval 0.11 to 0.88 ) . Dexamethasone enhanced the effects of vasopressor drugs . CONCLUSIONS Early treatment with dexamethasone reduced the seven-day mortality among septic shock patients and showed a trend towards reduction of 28-day mortality There is considerable debate regarding the choice of test for treatment difference in a r and omized clinical trial in the presence of competing risks . This question arose in the study of st and ard and new antiepileptic drugs ( SANAD ) trial comparing new and st and ard antiepileptic drugs . This paper provides simulation results for the log-rank test comparing cause-specific hazard rates and Gray 's test comparing cause-specific cumulative incidence curves . To inform the analysis of the SANAD trial , competing-risks setting s were considered where both events are of interest , events may be negatively correlated , and the degree of correlation may differ in the 2 treatment groups . In setting s where there are effects in opposite directions for the 2 event types , a likely situation for the SANAD trial , Gray 's test has greater power to detect treatment differences than log-rank analysis . For the epilepsy application , conclusions were qualitatively similar for both log-rank and Gray 's tests Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose Context Clinicians rely on systematic review s for current , evidence -based information . Contribution This survival analysis of 100 meta-analyses indexed in ACP Journal Club from 1995 to 2005 found that new evidence that substantively changed conclusions about the effectiveness or harms of therapies arose frequently and within relatively short time periods . The median survival time without substantive new evidence for the meta-analyses was 5.5 years . Significant new evidence was already available for 7 % of the review s at the time of publication and became available for 23 % within 2 years . Implication Clinical ly important evidence that alters conclusions about the effectiveness and harms of treatments can accumulate rapidly . The Editors Systematic review s have become increasingly common in recent years ( 1 ) and are recommended by many as the best sources of evidence to guide both clinical decisions ( 2 ) and health care policy ( 3 ) . For systematic review s to fulfill these roles , their findings must remain relatively stable for at least several years or effective mechanisms must exist for alerting end users to important changes in evidence . Yet , surprisingly little research has assessed the extent to which systematic review s become out of date or the rate at which this occurs ( 47 ) . Some organizations , such as the Cochrane Collaboration , recommend updating systematic review s every 2 years , but few empirical data guide this or other recommendations about updating . We sought to determine how quickly systematic review s meet explicitly defined criteria for changes in evidence of sufficient importance to warrant updating . We also sought to identify predictors of survival time , the time to such important changes in evidence . Survival time might vary depending on many factors , including the type of question posed by the original review ( for example , therapeutic or diagnostic ) , the types of studies included ( for example , r and omized trials or observational studies ) , and whether the systematic review provided quantitative synthesis . To limit such variation , we focused on systematic review s of r and omized , controlled trials that evaluated therapeutic benefit or harm by providing quantitative synthesis ( meta- analysis ) for at least 1 outcome . Methods Study Design and Sample We used a quasi-r and om process ( alphabetical sort order by author ) to select 100 systematic review s that were indexed in ACP Journal Club with an accompanying commentary between January 1995 and December 2005 ( with a search date no later than 31 December 2004 to ensure at least 1 full year for new evidence to appear ) . We chose this sampling frame because ACP Journal Club selects systematic review s that meet explicit quality st and ards and are deemed directly relevant to clinical practice ( 8) . We regarded the sample size of 100 as sufficiently large to achieve suitably narrow confidence intervals and to permit evaluation of up to 5 potential predictors of survival . Eligibility Criteria Eligible review s evaluated the benefit or harm of a specific drug , class of drug , device , or procedure ( invasive procedure or surgery ) and included r and omized or quasi-r and omized , controlled trials . We excluded evaluations of alternative and complementary medicines because the stability of review s of such therapies might differ substantially from review s of conventional therapies . We required that review s provide a point estimate and 95 % confidence interval for at least 1 outcome in the form of a relative risk , odds ratio , or absolute risk difference for binary outcomes and weighted mean differences for continuous outcomes . We excluded meta-analyses of individual-patient data , meta-regressions , and indirect meta-analyses because of the difficulty of determining whether new data would alter previous quantitative results . Two team members independently assessed eligibility , with disagreements resolved by consensus involving a third review er . When more than 1 review on the same topic was identified , only the earliest was included . Search ing For each review , search es for new trials included identifying new systematic review s on the same topic , su bmi tting relevant content terms to the Clinical Queries function in Ovid , applying the Related Articles function in PubMed to the 3 largest and the 3 most recent trials in the original review ( up to 6 trials in total ) , and using Scopus ( www . scopus .com/ scopus /home.url ) to identify new r and omized trials that cited the original review . When these search strategies yielded no eligible new trials , we conducted more comprehensive electronic search es and review ed relevant chapters in such sources as Clinical Evidence and UpTo Date to ensure that we had not missed new trials . Team members who had background s in both medicine and clinical research screened citations retrieved by the preceding methods to identify trials that would have met the inclusion criteria in the original review . Retrieved articles were screened in chronological order to ascertain quantitative or qualitative signals for the need for updating . The review protocol stopped when any criteria for updating were met . Each systematic review was discussed in detail , with the final statussignal for updating was or was not detectedadjudicated by consensus ( Figure 1 ) . Figure 1 . Overall process for determining updating status . ACP Journal Club Signals for the Need to Up date Systematic Review s In design ing criteria for comparing new findings with those in a previous review , we adapted methods used by other investigators to address similar problems with comparing 2 sets of results relating to the same question ( 913 ) , such as r and omized and nonr and omized studies of the same intervention . These investigators identified conflicting findings among different publications using a combination of quantitative thresholds for differences in effect magnitude and qualitative judgments about the language used to describe the results . We have similarly conceptualized quantitative and qualitative signals of potential changes in evidence that are sufficiently important to warrant updating previous systematic review s. Quantitative Signals Quantitative signals consisted of a change in statistical significance or relative change in effect magnitude of at least 50 % . We restricted these changes to those involving 1 of the primary outcomes of the original review or any mortality outcome . We also ignored trivial changes in statistical significance when the original and up date d meta-analytic results both had P values between 0.04 and 0.06so that quantitative signals of changes in evidence would represent robust indicators of the need to up date previous review s. Quantitative signals were detected by combining data from eligible new trials with the previous results using a fixed-effects approach . Use of fixed-effect models allowed pooling of the new trials with the previous meta-analytic result , as opposed to having to obtain original data from all of the included trials in each of 100 systematic review s. Although r and om-effects models are usually preferred to avoid spurious precision in the face of heterogeneity , our goal was to detect potential changes in evidence that would warrant a formal up date , not produce exact estimates of the up date d results . Qualitative Signals Qualitative signals included new information about harm sufficient to affect clinical decision making , important caveats to the original results , emergence of a superior alternate therapy , and important changes in certainty or direction of effect . Qualitative signals were detected by using explicit criteria for comparing the language in the original review with descriptions of findings in new systematic review s that addressed the same topic , pivotal trials , clinical practice guidelines , or recent editions of major textbooks ( for example , UpTo Date ) . Pivotal trials were defined as trials that had a sample size at least 3 times larger than that of the previous largest trial or were published in 1 of the 5 highest-impact general medical journals ( The New Engl and Journal of Medicine , Lancet , Journal of the American Medical Association , Annals of Internal Medicine , and the British Medical Journal ) . We defined 2 levels of importance for qualitative signals : potentially invalidating changes in evidence , which would make one no longer want clinicians or policymakers to base decisions on the original findings ( such as a pivotal trial that characterized treatment effectiveness in terms opposite of those in the original systematic review ) , and major changes in evidence , which would affect clinical decision making in important ways without invalidating the previous results ( such as the identification of patient population s for whom treatment is more or less beneficial ) . Major changes also included differing characterizations of effectiveness that were less extreme than those for potentially invalidating signals but that would still affect clinical decision making ( for example , a change from possibly beneficial to definitely beneficial ) . Of importance , such characterizations as possibly effective , probably effective , and promising , were all categorized as possibly effective . Thus , qualitative signals for changes in evidence captured substantive differences in the characterization of treatment effects , not merely semantic differences . Full definitions for each of the specific Output:

Odds of complications were not increased with corticosteroids . Conclusions Although a null effect for mortality treatment efficacy of low dose corticosteroid therapy in severe sepsis and septic shock was not excluded , there remained a high probability of treatment efficacy , more so with outlier exclusion . Similarly , although a null effect was not excluded , advantageous effects of low dose steroids had a high probability of dependence upon patient underlying risk . Low dose steroid efficacy was not demonstrated in corticotrophin non-responders .

MS2_1shot157

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Given that retention rates for weight-loss trials have not significantly improved in the past 20 years , identifying effective techniques to enhance retention is critical . This paper describes a conceptual and practical advance that may have improved retention in a behavioral weight-loss trial-the novel application of motivational interviewing techniques to diffuse ambivalence during interactive group-based orientation sessions prior to r and omization . These orientation sessions addressed ambivalence about making eating and exercise behavior changes , ambivalence about joining a r and omized controlled trial , and unrealistic weight-loss expectations . During these sessions , overweight and obese men and women learned about the health benefits of modest weight loss as well as trial design , the importance of a control condition , r and om assignment and the impact of dropouts . Participants were then divided into groups of three or four , and asked to generate two pros and two cons of being assigned to a control condition and an active condition . Participants shared their pros and cons with the larger group , while the investigator asked open-ended questions , engaged in reflective listening and avoided taking a ' pro-change ' position . Retention was high , with 96 % of the participants ( N = 162 ) completing 18-month clinic visits Background Research increasingly supports the conclusion that well- design ed programs delivered over the Internet can produce significant weight loss compared to r and omized controlled conditions . Much less is known about four important issues addressed in this study : ( 1 ) which recruitment methods produce higher eHealth participation rates , ( 2 ) which patient characteristics are related to enrollment , ( 3 ) which characteristics are related to level of user engagement in the program , and ( 4 ) which characteristics are related to continued participation in project assessment s. Methods We recruited overweight members of three health maintenance organizations ( HMOs ) to participate in an entirely Internet-mediated weight loss program developed by HealthMedia , Inc. Two different recruitment methods were used : personal letters from prevention directors in each HMO , and general notices in member newsletters . The personal letters were sent to members diagnosed with diabetes or heart disease and , in one HMO , to a general membership sample in a particular geographic location . Data were collected in the context of a 2 × 2 r and omized controlled trial , with participants assigned to receive or not receive a goal setting intervention and a nutrition education intervention in addition to the basic program . Results A total of 2311 members enrolled . Bivariate analyses on aggregate data revealed that personalized mailings produced higher enrollment rates than member newsletters and that members with diabetes or heart disease were more likely to enroll than those without these diagnoses . In addition , males , those over age 60 , smokers , and those estimated to have higher medical expenses were less likely to enroll ( all P < .001 ) . Males and those in the combined intervention were less likely to engage initially , or to continue to be engaged with their Web program , than other participants . In terms of retention , multiple logistic regressions revealed that enrollees under age 60 ( P < .001 ) and those with higher baseline self-efficacy were less likely to participate in the 12-month follow-up ( P = .03 ) , but with these exceptions , those participating were very similar to those not participating in the follow-up . Conclusions A single personalized mailing increases enrollment in Internet-based weight loss . eHealth programs offer great potential for recruiting large numbers of participants , but they may not reach those at highest risk . Patient characteristics related to each of these important factors may be different , and more comprehensive analyses of determinants of enrollment , engagement , and retention in eHealth programs are needed Introduction Diabetes self-management education interventions in community gathering places have been moderately effective , but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes . This paper describes a church-based diabetes self-management education intervention for African Americans , a r and omized controlled trial to evaluate the intervention , and baseline characteristics of study participants . Methods A New DAWN : Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina . Each church recruited congregants with type 2 diabetes and design ated a diabetes advisor , or peer counselor , to be part of the intervention team . Participants were enrolled at each church and r and omized as a unit to either the special intervention or the minimal intervention . The special intervention included one individual counseling visit , twelve group sessions , three postcard messages from the participant 's diabetes care provider , and twelve monthly telephone calls from a diabetes advisor . Baseline data included measures of weight , hemoglobin A1c , blood pressure , physical activity , dietary and diabetes self-care practice s , and psychosocial factors . The study to evaluate the intervention ( from enrollment visit to last follow-up ) began in February 2001 and ended in August 2003 . Results Twenty-four churches ( with 201 total participants ) were r and omized . Sixty-four percent of the participants were women . On average , the participants were aged 59 years and sedentary . They had an average of 12 years of education , had been diagnosed with diabetes for 9 years , had a body mass index of 35 , had a hemoglobin A1c level of 7.8 % , and had a reported dietary intake of 39 % of calories from fat . Conclusion A New DAWN is a culturally sensitive , church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a r and omized controlled trial . The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority population s and help to inform the selection of approaches to improve diabetes care in this population OBJECTIVE To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population . RESEARCH DESIGN AND METHODS Five public clinics in Chicago , Illinois , participated in the study with computer kiosks installed in waiting room areas . Two hundred forty-four subjects with diabetes were r and omized to receive either supplemental computer multimedia use ( intervention ) or st and ard of care only ( control ) . The intervention includes audio/video sequences to communicate information , provide psychological support , and promote diabetes self-management skills without extensive text or complex navigation . HbA(1c ) ( A1C ) , BMI , blood pressure , diabetes knowledge , self-efficacy , self-reported medical care , and perceived susceptibility of complications were evaluated at baseline and 1 year . Computer usage patterns and implementation barriers were also examined . RESULTS Complete 1-year data were available for 183 subjects ( 75 % ) . Overall , there were no significant differences in change in A1C , weight , blood pressure , knowledge , self-efficacy , or self-reported medical care between intervention and control groups . However , there was an increase in perceived susceptibility to diabetes complications in the intervention group . This effect was greatest among subjects with lower health literacy . Within the intervention group , time spent on the computer was greater for subjects with higher health literacy . CONCLUSIONS Access to multimedia lessons result ed in an increase in perceived susceptibility to diabetes complications , particularly in subjects with lower health literacy . Despite measures to improve informational access for individuals with lower health literacy , there was relatively less use of the computer among these participants OBJECTIVE The purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly , ethnically diverse diabetic patients . RESEARCH DESIGN AND METHODS Medicare beneficiaries in underserved areas were participants ( n = 1,665 ) in the Informatics for Diabetes Education and Telemedicine ( IDEATel ) project and r and omized to a telemedicine case management intervention or usual care . The data analyzed include baseline demographics ( age , sex , race/ethnicity , marital status , insulin use , years of education , years of diabetes , and pack-years smoked ) and measures of glycemic control ( HbA(1c ) [ A1C ] ) , comorbidity , diabetes symptom severity , functional disability and depression , and 1-year ( n = 1,578 ) A1C . The association between depression and glycemic control was analyzed cross-sectionally and prospect ively . RESULTS At baseline , there was a significant correlation between depression and A1C and a trend for depression to predict A1C when other factors were controlled . However , in prospect i ve analyses , depression did not predict change in A1C , either in the control or intervention group . CONCLUSIONS In this large sample of elderly diabetic patients , a weak relationship between depression and A1C was found , but depression did not prospect ively predict change in glycemic control . Thus , there is no evidence that depression should be used to exclude patients from interventions . Also , we should evaluate the impact of depression on outcomes other than glycemic control Background : The prevalence of type 2 diabetes and diabetesrelated morbidity and mortality is higher among low-income Hispanics when compared to that of Whites . However , little is known about how to effectively promote self-management in this population . Purpose : The objectives were first to determine the feasibility of conducting a r and omized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects . Methods : Participants for this pilot study were recruited from a community health center , an elder program , and a community-wide data base developed by the community health center , in collaboration with other agencies serving the community , by surveying households in the entire community . Participants were r and omly assigned to an intervention ( n = 15 ) or a control ( n = 10 ) condition . Assessment s were conducted at baseline and at 3 months and 6 months postr and omization . The intervention consisted of 10 group sessions that targeted diabetes knowledge , attitudes , and self-management skills through culturally specific and literacysensitive strategies . The intervention used a cognitivebehavioral theoretical framework . Results : Recruitment rates at the community health center , elder program , and community registry were 48 % , 69 % , and 8 % , respectively . Completion rates for baseline , 3-month , and 6-month assessment s were 100 % , 92 % , and 92 % , respectively . Each intervention participant attended an average of 7.8 out of 10 sessions , and as a group the participants showed high adherence to intervention activities ( 93 % turned in daily logs , and 80 % self-monitored glucose levels at least daily ) . There was an overall Group × Time interaction ( p = .02 ) indicating group differences in glycosylated hemoglobin over time . The estimated glycosylated hemoglobin decrease at 3 months for the intervention group was −0.8 % ( 95 % confidence intervals = −1.1 % , −0.5 % ) compared with the change in the control group ( p = .02 ) . At 6 months , the decrease in the intervention group remained significant , −0.85 % ( 95 % confidence intervals = −1.2 , −0.5 ) , and the decrease was still significantly different from that of the controls ( p = .005 ) . There was a trend toward increased physical activity in the intervention group as compared to that of the control group ( p = .11 ) and some evidence ( nonsignificant ) of an increase in blood glucose self-monitoring in the intervention participants but not the control participants . Adjusting for baseline depressive scores , we oberved a significant difference in depressive symptoms between intervention participants and control participants at the 3-month assessment ( p = .02 ) . Conclusions : Low-income Spanish-speaking Hispanics are receptive to participate in diabetes-related research . This study shows that the pilot-tested diabetes self-management program is promising and warrants the conduct of a r and omized clinical trial PURPOSE The purpose of this study was to examine reasons for nonparticipation and drop out in a diabetes self-management intervention . METHODS A total of 468 recently screen-detected patients , receiving usual care or intensive pharmacological treatment , were invited and r and omized into either a control or intervention condition , consisting of a brief self-management course . A nonresponse survey was conducted , and participants , non participants , and dropouts were compared on sociodemographic variables , diabetes attitudes , and self-care . RESULTS A total of 227 patients consented and were allocated to the control ( n=108 ) or intervention group ( n=119 ) . Two hundred forty-one patients declined participation , 41 dropped out , and 78 completed the intervention . Major reasons for refusal and drop out were hesitancy toward research and practical barriers . Non participants were less educated and reported higher self-management , while participation also varied by treatment and disease duration : intensively treated patients were more likely to participate in their first year , and usual-care patients participated more often 2 to 3 years after diagnosis . Dropouts had a lower education level but did not differ on any other measure . CONCLUSION Participants , non participants , and dropouts did not differ in their attitudes toward diabetes , but the intervention did attract patients with lower self-care . Variations in participation by treatment and disease duration suggest that patients prefer self-management interventions at different times depending on their medical treatment . Finally , education appears to be the most important factor determining participation . Alternative strategies are needed to attract and retain patients with low education Background US Latinos have greater prevalence of type 2 diabetes ( diabetes ) , uncontrolled diabetes and diabetes co-morbidities compared to non-Latino Whites . They also have lower literacy levels and are more likely to live in poverty . Interventions are needed to improve diabetes control among low-income Latinos . Methods and design This r and omized clinical trial tested the efficacy of a culturally- and literacy-tailored diabetes self-management intervention ( Latinos en Control ) on glycemic control among low-income Latinos with diabetes , compared to usual care ( control ) . Participants were recruited from five community health centers ( CHCs ) in Massachusetts . Output:

Franklin GM , Kahn LB , Baxter J , Marshall JA , Hamman RF . Sensory neuropathy in non-insulin-dependent diabetes mellitus : the San Luis Valley Diabetes Study . Gross R , Olfson M , Gameroff MJ . Depression and glycemic control in Hispanic primary care patients with diabetes .

MS2_1shot158

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Although long-term azithromycin decreases exacerbation frequency in bronchiectasis , increased macrolide resistance is concerning . We investigated macrolide resistance determinants in a secondary analysis of a multicenter r and omized controlled trial . Indigenous Australian children living in remote regions and urban New Zeal and Māori and Pacific Isl and er children with bronchiectasis were r and omized to weekly azithromycin ( 30 mg/kg ) or placebo for up to 24 months and followed post-intervention for up to 12 months . Nurses administered and recorded medications given and collected nasopharyngeal swabs 3–6 monthly for culture and antimicrobial susceptibility testing . Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups , while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher . Australian children , compared to New Zeal and children , had higher carriage overall , significantly higher carriage of macrolide-resistant bacteria at baseline ( 16/38 versus 2/40 children ) and during the intervention ( 69/152 versus 22/239 swabs ) , and lower mean adherence to study medication ( 63 % versus 92 % ) . Adherence ≥70 % ( versus < 70 % ) in the Australian azithromycin group was associated with lower carriage of any pathogen [ odds ratio ( OR ) 0.19 , 95 % confidence interval ( CI ) 0.07–0.53 ] and fewer macrolide-resistant pathogens ( OR 0.34 , 95 % CI 0.14–0.81 ) . Post-intervention ( median 6 months ) , macrolide resistance in S. pneumoniae declined significantly in the azithromycin group , from 79 % ( 11/14 ) to 7 % ( 1/14 ) of positive swabs , but S. aureus strains remained 100 % macrolide resistant . Azithromycin treatment , the Australian remote setting , and adherence < 70 % were significant independent determinants of macrolide resistance in children with bronchiectasis . Adherence to treatment may limit macrolide resistance by suppressing carriage BACKGROUND AND OBJECTIVE We evaluated the efficacy of a 12-week oral treatment with azithromycin in adult patients with bronchiectasis . The objectives were to demonstrate that this treatment reduces sputum volume , improves quality of life and to assess the lengths of effects after cessation of therapy . METHODS Seventy-eight patients with bronchiectasis confirmed by high-resolution computed tomography were included in this study . Subjects received oral azithromycin or placebo in a r and omized manner for 12 weeks followed by placebo for another 12 weeks . Sputum volume , St George 's Respiratory Question naire ( SGRQ ) score and spirometry were recorded at baseline , 12 weeks and 24 weeks , respectively . End-point measurements were compared from baseline to the end of each study phase . RESULTS Sixty-eight subjects were included in the analysis . Mean 24-h sputum volume significantly decreased ( P < 0.01 ) during the active treatment phase and remained low during the control phase ( P < 0.01 ) . The mean SGRQ total score with azithromycin decreased ( i.e. improved health status ) from baseline by more than the 4 points at the end of 12 and 24 weeks . Lung functions remained stable during oral azithromycin therapy and the subsequent control phase . CONCLUSIONS Twelve weeks administration of azithromycin in bronchiectasis produces significant reductions in mean sputum volume , health status and stabilization of lung function values . Sputum volume reduction and the improvement of quality of life were sustained for 12 weeks after cessation of azithromycin . ( Clinical trials.gov number NCT02107274 ) IMPORTANCE Macrolide antibiotics have been shown beneficial in cystic fibrosis ( CF ) and diffuse panbronchiolitis , and earlier findings also suggest a benefit in non-CF bronchiectasis . OBJECTIVE To determine the efficacy of macrolide maintenance treatment for adults with non-CF bronchiectasis . DESIGN , SETTING , AND PARTICIPANTS The BAT ( Bronchiectasis and Long-term Azithromycin Treatment ) study , a r and omized , double-blind , placebo-controlled trial conducted between April 2008 and September 2010 in 14 hospitals in The Netherl and s among 83 out patients with non-CF bronchiectasis and 3 or more lower respiratory tract infections in the preceding year . INTERVENTIONS Azithromycin ( 250 mg daily ) or placebo for 12 months . MAIN OUTCOME MEASURES Number of infectious exacerbations during 12 months of treatment . Secondary end points included lung function , sputum bacteriology , inflammatory markers , adverse effects , symptom scores , and quality of life . RESULTS Forty-three participants ( 52 % ) received azithromycin and 40 ( 48 % ) received placebo and were included in the modified intention-to-treat analysis . At end of study , the median number of exacerbations in the azithromycin group was 0 ( interquartile range [ IQR ] , 0 - 1 ) , compared with 2 ( IQR , 1 - 3 ) in the placebo group ( P < .001 ) . Thirty-two ( 80 % ) placebo-treated vs 20 ( 46 % ) azithromycin-treated individuals had at least 1 exacerbation ( hazard ratio , 0.29 [ 95 % CI , 0.16 - 0.51 ] ) . In a mixed-model analysis , change in forced expiratory volume in the first second of expiration ( percent of predicted ) over time differed between groups ( F1,78.8 = 4.085 , P = .047 ) , with an increase of 1.03 % per 3 months in the azithromycin group and a decrease of 0.10 % per 3 months in the placebo group . Gastrointestinal adverse effects occurred in 40 % of patients in the azithromycin group and in 5 % in the placebo group ( relative risk , 7.44 [ 95 % CI , 0.97 - 56.88 ] for abdominal pain and 8.36 [ 95 % CI , 1.10 - 63.15 ] for diarrhea ) but without need for discontinuation of study treatment . A macrolide resistance rate of 88 % was noted in azithromycin-treated individuals , compared with 26 % in the placebo group . CONCLUSIONS AND RELEVANCE Among adults with non-CF bronchiectasis , the daily use of azithromycin for 12 months compared with placebo result ed in a lower rate of infectious exacerbations . This could result in better quality of life and might influence survival , although effects on antibiotic resistance need to be considered . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00415350 RATIONALE There are no risk stratification tools for morbidity and mortality in bronchiectasis . Identifying patients at risk of exacerbations , hospital admissions , and mortality is vital for future research . OBJECTIVES This study describes the derivation and validation of the Bronchiectasis Severity Index ( BSI ) . METHODS Derivation of the BSI used data from a prospect i ve cohort study ( Edinburgh , UK , 2008 - 2012 ) enrolling 608 patients . Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up . The score was vali date d in independent cohorts from Dundee , UK ( n = 218 ) ; Leuven , Belgium ( n = 253 ) ; Monza , Italy ( n = 105 ) ; and Newcastle , UK ( n = 126 ) . MEASUREMENTS AND MAIN RESULTS Independent predictors of future hospitalization were prior hospital admissions , Medical Research Council dyspnea score greater than or equal to 4 , FEV1 < 30 % predicted , Pseudomonas aeruginosa colonization , colonization with other pathogenic organisms , and three or more lobes involved on high-resolution computed tomography . Independent predictors of mortality were older age , low FEV1 , lower body mass index , prior hospitalization , and three or more exacerbations in the year before the study . The derived BSI predicted mortality and hospitalization : area under the receiver operator characteristic curve ( AUC ) 0.80 ( 95 % confidence interval , 0.74 - 0.86 ) for mortality and AUC 0.88 ( 95 % confidence interval , 0.84 - 0.91 ) for hospitalization , respectively . There was a clear difference in exacerbation frequency and quality of life using the St. George 's Respiratory Question naire between patients classified as low , intermediate , and high risk by the score ( P < 0.0001 for all comparisons ) . In the validation cohorts , the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88 . CONCLUSIONS The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality , hospitalization , and exacerbations across healthcare systems Background Given the advantages of the r and omised controlled trial ( RCT ) design for the evaluation of therapeutic interventions , it is tempting to assume that the same approach must be the gold st and ard for the evaluation of testing strategies . Such trials present considerable challenges , due to the complex nature of the decision – making process . To interpret how changes in testing strategies create observed effects , trials must pre – specify how test results should inform diagnostic and management decisions and treatment plans Increased airway responsiveness ( AR ) is frequently associated with bronchiectasis . Roxithromycin is a new semisynthetic macrolide antibiotic that also has anti-inflammatory activities . This study was design ed to see whether roxithromycin could favourably alter the degree of AR in patients with bronchiectasis and increased AR . Twenty five children with bronchiectasis , who had an increased AR ( defined as a provocative concentration of methacholine causing a 20 % fall in forced expiratory volume in one second ( FEV1 ) ( PC20 ) < 25 mg x mL(-1 ) evaluated by the dosimeter method ) , were r and omized , double-blind into two parallel groups . Thirteen of the children were treated with roxithromycin ( 4 mg x kg(-1 ) b.i.d . ) for 12 weeks and 12 received placebo . FEV1 , sputum purulence and leucocyte scores were assessed every 3 weeks . To estimate AR , high-dose methacholine challenge tests were performed before and after treatment . On the dose-response curve to methacholine , PD20 and maximal response ( two indices of AR ) were measured . Changes in FEV1 were not observed during the course of the study in both groups . A significant improvement in sputum features was noted after 6 weeks of treatment in the roxithromycin group . After 12 weeks of roxithromycin therapy , the geometric mean ( range of 1 SD ) of provocative cumulative dose producing a 20 % fall in FEV1 ( PD20 ) increased significantly ( p<0.01 ) to 169.2 ( 83.2 - 344.2 ) breath units ( BU ) ( 1 BU denotes one inhalation of 1 mg x mL(-1 ) methacholine ) and the mean+/-SD of maximal response decreased significantly ( p<0.01 ) to 32.5+/-6.8 % , as compared with the initial values ( PD20 87.1 ( 47.3 - 160.4 ) BU ; maximal response 40.9+/-7.4 % ) . No significant changes in either parameter were observed in the placebo group . Our results indicate that roxithromycin may decrease the degree of airway responsiveness in patients with bronchiectasis and increased airway responsiveness . Further study is necessary to determine the mechanism by which roxithromycin reduces airway responsiveness in bronchiectasis and its clinical impact CONTEXT Treatment strategies for cystic fibrosis ( CF ) lung disease include antibiotics , mucolytics , and anti-inflammatory therapies . Increasing evidence suggests that macrolide antibiotics might be beneficial in patients with CF . OBJECTIVE To determine if an association between azithromycin use and pulmonary function exists in patients with CF . DESIGN AND SETTING A multicenter , r and omized , double-blind , placebo-controlled trial conducted from December 15 , 2000 , to May 2 , 2002 , at 23 CF care centers in the United States . PARTICIPANTS Of the 251 screened participants with a diagnosis of CF , 185 ( 74 % ) were r and omized . Eligibility criteria included age 6 years or older , infection with Pseudomonas aeruginosa for 1 or more years , and a forced expiratory volume in 1 second ( FEV1 ) of 30 % or more . Participants were stratified by FEV1 ( > or = 60 % predicted vs < 60 % predicted ) , weight of less than 40 kg vs 40 kg or more , and CF center . INTERVENTION The active group ( n = 87 ) received 250 mg ( weight < 40 kg ) or 500 mg ( weight > or = 40 kg ) of oral azithromycin 3 days a week for 168 days ; placebo group ( n = 98 ) received identically packaged tablets . MA Output:

Long-term macrolide therapy may reduce the frequency of exacerbations and improve quality of life , although supporting evidence is derived mainly from studies of azithromycin , rather than other macrolides , and predominantly among adults rather than children . However , macrolides should be used with caution , as limited data indicate an associated increase in microbial resistance . Macrolides are associated with increased risk of cardiovascular death and other serious adverse events in other population s , and available data can not exclude a similar risk among patients with bronchiectasis

MS2_1shot159

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE : This study aim ed to assess the associations between parity , mode of delivery , and pelvic floor disorders . METHODS : The prevalence of pelvic organ prolapse , stress urinary incontinence , overactive bladder , and anal incontinence was assessed in a r and om sample of women aged 25–84 years by using the vali date d Epidemiology of Prolapse and Incontinence Question naire . Women were categorized as nulliparous , vaginally parous , or only delivered by cesarean . Adjusted odds ratios and 95 % confidence intervals ( CIs ) for each disorder were calculated with logistic regression , controlling for age , body mass index , and parity . RESULTS : In the 4,458 respondents the prevalence of each disorder was as follows : 7 % prolapse , 15 % stress urinary incontinence , 13 % overactive bladder , 25 % anal incontinence , and 37 % for any one or more pelvic floor disorders . There were no significant differences in the prevalence of disorders between the cesarean delivery and nulliparous groups . The adjusted odds of each disorder increased with vaginal parity compared with cesarean delivery : prolapse = 1.82 ( 95 % CI 1.04–3.19 ) , stress urinary incontinence = 1.81 ( 95 % CI 1.25–2.61 ) , overactive bladder = 1.53 ( 95 % CI 1.02–2.29 ) , anal incontinence = 1.72 ( 95 % CI 1.27–2.35 ) , and any one or more pelvic floor disorders = 1.85 ( 95 % CI 1.42–2.41 ) . Number-needed-to-treat analysis revealed that 7 women would have to deliver only by cesarean delivery to prevent one woman from having a pelvic floor disorder . CONCLUSION : The risk of pelvic floor disorders is independently associated with vaginal delivery but not with parity alone . Cesarean delivery has a protective effect , similar to nulliparity , on the development of pelvic floor disorders when compared with vaginal delivery . LEVEL OF EVIDENCE : OBJECTIVES : To investigate whether postpartum fecal incontinence is less common in women who had a cesarean delivery and more common in women who had an operative vaginal birth compared with women who had a spontaneous vaginal birth for their first newborn , and whether postpartum fecal incontinence is more common in women who report intimate-partner violence . METHODS : This was a multicenter , prospect i ve , nulliparous pregnancy cohort ( n=1,507 ) using st and ardized measures to assess frequency and severity of fecal incontinence in pregnancy and at 3 , 6 , 9 , and 12 months postpartum . RESULTS : Approximately 17 % reported fecal incontinence at some point in the first 12 months postpartum , with 12.8 % reporting fecal incontinence beyond the first 3 months postpartum . Fecal incontinence at 4 to12 months postpartum was significantly more common among women who had experienced emotional violence , physical violence , or both in the first 12 months postpartum ( 18.8 % compared with 11.5 % , adjusted odds ratio [ OR ] 1.62 , 95 % confidence interval [ CI ] 1.05–2.50 ) . Compared with spontaneous vaginal birth , cesarean delivery ( 13.1 % compared with 11.3 % , adjusted OR 0.99 , 95 % CI 0.65–1.53 ) , and operative vaginal birth ( 15.0 % compared with 11.3 % , adjusted OR 1.33 , 95 % CI 0.86–2.07 ) did not significantly alter the likelihood of fecal incontinence beyond the first 3 months postpartum . CONCLUSION : Underst and ing causal pathways for postpartum fecal incontinence requires attention to the interplay of pregnancy and birth events and upstream factors such as intimate-partner violence . This has implication s for how clinicians present evidence and discuss risks associated with vaginal birth and cesarean delivery . In this nulliparous cohort , method of birth was not a major determinant of fecal incontinence status beyond 3 months postpartum . LEVEL OF EVIDENCE : Background This study was carried out to identify risk factors associated with urinary incontinence in women three months after giving birth . Methods Urinary incontinence before and during pregnancy was assessed at study enrolment early in the third trimester . Incontinence was re-assessed three months postpartum . Logistic regression analysis was used to assess the role of maternal and obstetric factors in causing postpartum urinary incontinence . This prospect i ve cohort study in 949 pregnant women in Quebec , Canada was nested within a r and omised controlled trial of prenatal perineal massage . Results Postpartum urinary incontinence was increased with prepregnancy incontinence ( adjusted odds ratio [ adj0R ] 6.44 , 95 % CI 4.15 , 9.98 ) , incontinence beginning during pregnancy ( adjOR 1.93 , 95 % CI 1.32 , 2.83 ) , and higher prepregnancy body mass index ( adjOR 1.07/unit of BMI , 95 % CI 1.03,1.11 ) . Caesarean section was highly protective ( adjOR 0.27 , 95 % CI 0.14 , 0.50 ) . While there was a trend towards increasing incontinence with forceps delivery ( adjOR 1.73 , 95 % CI 0.96 , 3.13 ) this was not statistically significant . The weight of the baby , episiotomy , the length of the second stage of labour , and epidural analgesia were not predictive of urinary incontinence . Nor was prenatal perineal massage , the r and omised controlled trial intervention . When the analysis was limited to women having their first vaginal birth , the same risk factors were important , with similar adjusted odds ratios . Conclusions Urinary incontinence during pregnancy is extremely common , affecting over half of pregnant women . Urinary incontinence beginning during pregnancy roughly doubles the likelihood of urinary incontinence at 3 months postpartum , regardless whether delivery is vaginal or by Caesarean section STUDY OBJECTIVE : To investigate the prevalence and lifetime risk factors for urinary incontinence in middle aged women . DESIGN : Nationally representative birth cohort study with prospect i ve data on childhood enuresis , measured adult height and weight , childbearing histories and measures of socioeconomic status up date d at regular contacts , and measures of menopausal status , symptomatology and health care in midlife . SETTING : Engl and , Scotl and and Wales . PARTICIPANTS : General population sample of 1333 women aged 48 years . MAIN RESULTS : Fifty per cent reported symptoms of stress incontinence and 22 % reported symptoms of urge incontinence in the previous year . Eight per cent had severe symptoms . Women who at age 6 years had wet in the day or several nights a week were more likely to suffer severe incontinence and report urge symptoms but occasional bedwetting was not associated with an increased risk in adult life . Those who were older at the birth of their children and who had vaginal deliveries had an excess risk of stress symptoms . Heavier adult body weight was also a risk factor for these symptoms and for severe incontinence . Postmenopausal women were less likely to report stress symptoms . These risk factors remained significant after taking account of the increased reporting of incontinence among women with high levels of general symptomatology and general practitioner visits , and of stress symptoms among better educated women . CONCLUSIONS : Urinary incontinence is a common problem among middle aged women . This is the first prospect i ve study of a general population sample to support the postulated link between childhood enuresis and adult incontinence . Child-bearing has long term adverse effects , particularly for older mothers . Overweight is a common risk factor The purpose of this study was to evaluate pelvic organ support during pregnancy and following delivery . This was a prospect i ve observational study . Pelvic organ prolapse quantification ( POPQ ) examinations were performed during each trimester of pregnancy and in the postpartum . Statistical comparisons of POPQ stage and of the nine measurements comprising the POPQ between the different time intervals were made using Wilcoxon ’s signed rank and the paired t-test . Comparison of POPQ stage by mode of delivery was made using Fisher ’s exact test . One hundred thirty-five nulliparous women underwent 281 pelvic organ support evaluations . During both the third trimester and postpartum , POPQ stage was significantly higher compared to the first trimester ( p<0.001 ) . In the postpartum , POPQ stage was significantly higher in women delivered vaginally compared to women delivered by cesarean ( p=0.02 ) . In nulliparous pregnant women , POPQ stage appears to increase during pregnancy and does not change significantly following delivery . In the postpartum , POPQ stage may be higher in women delivered vaginally compared to women delivered by cesarean OBJECTIVE This study was undertaken to compare maternal outcomes at 2 years postpartum after planned cesarean section and planned vaginal birth for the singleton fetus in breech presentation at term . STUDY DESIGN In selected centers in the Term Breech Trial , mothers completed a structured question naire at 2 or more years postpartum to determine their health in the previous 3 to 6 months . RESULTS A total of 917 of 1159 ( 79.1 % ) mothers from 85 centers completed a follow-up question naire at 2 years postpartum . There were no differences between groups in breast feeding , relationship with child or partner , pain , subsequent pregnancy , incontinence , depression , urinary , menstrual or sexual problems , fatigue , or distressing memories of the birth experience . Planned cesarean section was associated with a higher risk of constipation ( P = .02 ) . CONCLUSION Maternal outcomes at 2 years postpartum are similar after planned cesarean section and planned vaginal birth for the singleton breech fetus at term OBJECTIVE The purpose of this study was to determine the relative effects of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence . STUDY DESIGN This was a prospect i ve , observational multicenter study of women presenting to 6 gynecology clinics . Demographic data collected included : height , weight , gravidity , parity , and number of vaginal deliveries . Patients were diagnosed with incontinence by question naire . St and ard univariate logistic regression analyses ' were performed to determine the contribution of pregnancy , mode of delivery , and BMI on the prevalence of urinary and fecal incontinence . RESULTS One thous and and four women were enrolled over an 18-month period . Two hundred and thirty-seven and 128 subjects had urinary and fecal incontinence , respectively . Odds ratio ( 95 % CI ) calculated for the prevalence of urinary incontinence by pregnancy and mode of delivery were : any term pregnancy vs no term pregnancy was 2.46 ( 1.53 - 3.95 ) , any term pregnancy but no vaginal deliveries ( cesarean section only ) vs no term pregnancy was 1.95 ( 0.99 - 3.80 ) , any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.53 ( 1.57 - 4.07 ) , and any term pregnancy but no vaginal delivery ( cesarean section only ) vs any term pregnancy , and at least 1 vaginal delivery was 1.30 ( 0.77 - 3.95 ) . Odds ratio ( 95 % CI ) calculated for the prevalence of fecal incontinence by pregnancy and mode of delivery were : any term pregnancy vs no term pregnancy was 2.26 ( 1.22 - 4.19 ) , any term pregnancy but no vaginal deliveries ( cesarean section only ) vs no term pregnancy was 1.13 ( 0.43 - 2.96 ) , any term pregnancy and at least 1 vaginal delivery vs no term pregnancy was 2.41 ( 1.30 - 4.49 ) , and any term pregnancy but no vaginal deliveries ( cesarean section only ) vs any term pregnancy , and at least 1 vaginal delivery was 2.15 ( 0.97 - 4.77 ) . BMI and age did not impact these results . CONCLUSION Pregnancy increases the risk of urinary and fecal incontinence . Cesarean section does not decrease the risk of urinary or fecal incontinence compared to pregnancy with a vaginal delivery Objective To evaluate the long term effect of a postpartum pelvic floor muscle training course in prevention and treatment of urinary incontinence We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery . We performed a prospect i ve controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth . All subjects received an identical question naire on lower urinary tract symptoms in late pregnancy , at 3 and 9 months postpartum . Two hundred twenty subjects underwent elective cesarean section , and 215 subjects underwent vag Output:

RESULTS Compared to vaginal delivery , caesarean section appears to protect against urinary incontinence , but the effect decreases after patients reach their fifties . The risk of pelvic organ prolapse increases ( dose-response effect ) with the number of vaginal deliveries compared to caesarean sections . There are few reliable studies on the association between mode of delivery and anal incontinence , but meta-analyses may indicate that caesarean section does not offer protection after the postpartum period . Women with previous anal sphincter rupture during vaginal delivery are a sub-group with an elevated risk of anal incontinence . The degree of severity of pelvic floor dysfunction is frequently unreported in the literature . INTERPRETATION The prevalence of urinary incontinence and pelvic organ prolapse is lower in women who have only delivered by caesarean section than in those who have delivered vaginally . For urinary incontinence this difference appears to level out with increasing age . There is no basis for identifying sub-groups with a high risk of pelvic floor injury , with the exception of women who have previously had an anal sphincter rupture . Caesarean section will have a limited primary preventive effect on pelvic floor dysfunction at a population level

MS2_1shot160

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background This study was design ed to determine the optimal timing of vitamins E and C to prevent oxidative stress induced by a high‐fat evening meal in type 2 diabetes . Methods and Results Eleven subjects were admitted on 4 occasions . Euglycemia was maintained for 24 hours by insulin infusion . Participants were fed a high‐fat test supper equivalent to a McDonald 's Big Mac Meal . Blood was drawn for measurement of C‐reactive protein ( CRP ) , interleukin 6 ( IL‐6 ) , plasminogen activator inhibitor‐1 ( PAI‐1 ) , malonyldialdehyde ( MDA ) , and total radical antioxidant parameter ( TRAP ) before and during the 4 hours after the test meal . Studies were performed in r and om sequence with vitamin E 800 IU and vitamin C 1 g given either before breakfast or before supper in a double‐blind manner on the day of the test meal . Control studies were performed with no vitamins and no test meal administered . There was a significant rise in CRP and PAI‐1 after the test supper ( P<0.05 compared with “ no meal ” ) . Either presupper or prebreakfast vitamins E and C prevented the meal‐induced rise in CRP ( P=0.03 ) , although presupper vitamins were more effective ( P=0.03 compared with prebreakfast vitamins ) . Only prebreakfast vitamins prevented the meal‐induced rise in PAI‐1 ( P=0.006 ) . There were no significant meal‐related changes in the concentrations of IL‐6 , MDA , or TRAP . Conclusions The timing of administration of antioxidant vitamins has variable effects on markers of meal‐induced inflammation and fibrinolysis . This observation may be one reason why cardiovascular disease prevention trials using these vitamins have reported conflicting results . ( Circulation . 2003;108:24‐31 . Objective This study evaluated the possibility of inhibiting protein glycosylation in vivo with vitamin E. Research Design and Methods Two groups of 10 insulin-requiring diabetic patients , matched for duration of disease and metabolic control , received daily vitamin E supplementation of 1200 and 600 mg , respectively , for 2 mo . A third group of 10 diabetic patients , matched for duration of disease and metabolic control , served as the control group and received placebo . Fasting plasma glucose , mean daily plasma glucose , fasting labile HbA1 , and glycosylated proteins were measured in the basal state and after 1 and 2 mo of treatment . In addition , hyperglycemic clamp studies were performed in basal state and after 1 mo of vitamin E administration in all patients . Results Glycemic indices did not show any significant changes during the study , whereas fasting labile HbA , and glycosylated proteins decreased significantly after 1 and 2 mo in patients on vitamin E administration . Stable HbA1 decreased after 2 mo . Mean glycemic incremental area in the hyperglycemic clamp procedure was similar before and after treatment , whereas a significant reduction in mean labile HbA1 incremental area was found after vitamin E supplementation . A significant difference was also found in both fasting and incremental labile HbA1 levels , stable HbA1 , and glycosylated proteins between the two groups of diabetic patients on the two doses of vitamin E ; the diabetic patients who received the higher dose of vitamin E showed the greater reduction . No significant changes in these parameters were observed in diabetic patients on placebo administration . Conclusions These results demonstrate that vitamin E administration may reduce protein glycosylation in diabetic subjects independently of changes in plasma glucose , an effect that may be due to the inhibition of labile glycosylation , the first step of the Maillard reaction . Long-term studies will help establish the usefulness of vitamin E administration for the prevention of diabetic complications BACKGROUND Type 2 diabetes is associated with elevated oxidative stress and declines in antioxidant defense . The disease is also characterized by an imbalance in the ratio of cardiac sympathetic to parasympathetic tone . Antioxidants , vitamin E in particular , may have beneficial effects on the cardiac autonomic nervous system through a decline in oxidative stress . OBJECTIVE We investigated the possible effects of vitamin E on the cardiac autonomic nervous system , as assessed by analysis of heart rate variability , in patients with type 2 diabetes and cardiac autonomic neuropathy . DESIGN In a double-blind r and omized controlled trial , 50 patients with type 2 diabetes were assigned to treatment with vitamin E ( 600 mg/d ) or placebo for 4 mo . RESULTS The anthropometric characteristics of the patients remained unchanged throughout the study . Chronic vitamin E administration was associated with decreases in concentrations of glycated hemoglobin ( P < 0.05 ) , plasma insulin ( P < 0.05 ) , norepinephrine ( P < 0.03 ) , and epinephrine ( P < 0.02 ) ; a lower homeostasis model assessment index ( P < 0.05 ) ; and improved indexes of oxidative stress . Furthermore , vitamin E administration was associated with increases in the R-R interval ( P < 0.05 ) , total power ( P < 0.05 ) , and the high-frequency component of heart rate variability ( HF ; P < 0.05 ) and decreases in the low-frequency component ( LF ; P < 0.05 ) and the ratio of LF to HF ( P < 0.05 ) . Finally , change in the plasma vitamin E concentration was correlated with change in the LF-HF ratio ( r = -0.43 , P < 0.04 ) independently of changes in the homeostasis model assessment index and plasma catecholamines concentrations . CONCLUSIONS Chronic vitamin E administration improves the ratio of cardiac sympathetic to parasympathetic tone in patients with type 2 diabetes . Such an effect might be mediated by a decline in oxidative stress BACKGROUND Most Koreans with type 2 diabetes are insulin deficient and insulin resistant . Continuous subcutaneous insulin infusion ( CSII ) provides a suitable amount of insulin to overcome insulin deficiency and achieve near-normal blood glucose concentrations . Our previous study showed , however , that CSII does not reduce oxidative stress even though it normalizes blood glucose concentrations . OBJECTIVE The purpose of this study was to determine whether CSII plus alpha-tocopherol supplementation for 2 mo would alter oxidative stress in Korean patients with type 2 diabetes . DESIGN Ninety-eight subjects received CSII plus either 200 mg alpha-tocopherol/d ( n = 48 ) or a placebo ( n = 50 ) for 2 mo . The general characteristics ( age , duration of diabetes , body mass index , and blood glucose concentrations ) of the 2 groups were not significantly different . RESULTS Fasting and postpr and ial blood glucose concentrations of all subjects were normalized after CSII . Fasting plasma insulin concentrations did not differ significantly between the 2 groups after CSII . Lipid peroxide concentrations in plasma and red blood cells decreased and alpha-tocopherol concentrations in plasma and red blood cells increased after alpha-tocopherol supplementation . However , these changes were not affected significantly by CSII . Plasma vitamin C concentrations increased significantly after CSII plus alpha-tocopherol supplementation . However , the activities of antioxidant enzymes in red blood cells did not change significantly after CSII plus alpha-tocopherol supplementation . CONCLUSION alpha-Tocopherol supplementation was beneficial in decreasing blood lipid peroxide concentrations without altering antioxidant enzyme activities in Korean patients with type 2 diabetes treated with CSII BACKGROUND Some studies have shown potential benefit of vitamin E on platelet function , but several clinical trials failed to show improved cardiovascular outcome with alpha-tocopherol supplementation . Gamma-tocopherol , a major dietary form of vitamin E , may have protective properties different from those of alpha-tocopherol . OBJECTIVE We compared the effects of supplementation with alpha-tocopherol ( 500 mg ) and a gamma-tocopherol-rich compound ( 500 mg , containing 60 % gamma-tocopherol ) on serum and cellular tocopherol concentrations , urinary tocopherol metabolite excretion , and in vivo platelet activation in subjects with type 2 diabetes . DESIGN Fifty-eight subjects were r and omly assigned to receive either 500 mg alpha-tocopherol/d , 500 mg mixed tocopherols/d , or matching placebo . Serum , erythrocyte , and platelet tocopherol and urinary metabolite concentrations were measured at baseline and after the 6-wk intervention . Soluble CD40 lig and , urinary 11-dehydro-thromboxane B2 , serum thromboxane B2 , soluble P-selectin , and von Willebr and factor were measured as biomarkers of in vivo platelet activation . RESULTS Serum alpha-tocopherol increased with both tocopherol treatments . Serum and cellular gamma-tocopherol increased 4-fold ( P < 0.001 ) in the mixed tocopherol group , whereas red blood cell gamma-tocopherol decreased significantly after alpha-tocopherol supplementation . Excretion of alpha-carboxyethyl-hydroxychroman increased significantly after supplementation with alpha-tocopherol and mixed tocopherols . Excretion of gamma-carboxyethyl-hydroxychroman increased significantly after supplementation with mixed tocopherols and after that with alpha-tocopherol , which may reflect the displacement of gamma-tocopherol by alpha-tocopherol due to incorporation of the latter into lipoproteins in the liver . Neither treatment had any significant effect on markers of platelet activation . CONCLUSIONS Supplementation with alpha-tocopherol decreased red blood cell gamma-tocopherol , whereas mixed tocopherols increased both serum alpha-tocopherol and serum and cellular gamma-tocopherol . Changes in serum tocopherol closely reflect changes in cellular concentrations of tocopherols after supplementation Objective : The present study design ed to assess the effect of Mg+Zn , vitamin C+E , and combination of these micronutrients on blood pressure in type 2 diabetic patients . Material s and Methods : In a r and omized , double-blind , placebo controlled clinical trial , 69 type 2 diabetic patients were r and omly divided into four groups , each group receiving one of the following daily supplement for three months ; group M : 200 mg Mg and 30 mg Zn ( n = 16 ) , group V : 200 mg vitamin C and 150 mg vitamin E ( n = 18 ) , group MV : minerals plus vitamins ( n = 17 ) , group P : placebo ( n = 18 ) . Blood pressure was measured at the beginning and at the end of the trial . Treatment effects were analyzed by general linear modeling . Results : Results indicate that after three months of supplementation levels of systolic , diastolic and mean blood pressure decreased significantly in the MV group by 8 mmHg ( 122 ± 16 vs. 130 ± 19 mmHg ) , 6 mmHg ( 77 ± 9 vs. 83 ± 11 mmHg ) , and 7 mmHg ( 92 ± 9 vs. 99 ± 13 mmHg ) , respectively ( p < 0.05 ) . Also combination of vitamin and mineral supplementation had significantly effects in increasing serum potassium ( p < 0.05 ) and in decreasing serum malondialdehyde ( p < 0.05 ) . There was no significant change in the levels of these parameters in the other three groups . Conclusion : The results of the present study indicated that in type 2 diabetic patients a combination of vitamins and minerals , rather than vitamin C and E or Mg and Zn , might decrease blood pressure Objective — Clinical trials of vitamin E have failed to demonstrate a decrease in cardiovascular events . However , these studies did not address possible benefit to subgroups with increased oxidative stress . Haptoglobin ( Hp ) , a major antioxidant protein , is a determinant of cardiovascular events in patients with Type 2 diabetes mellitus ( DM ) . The Hp gene is polymorphic with 2 common alleles , 1 and 2 . The Hp 2 allelic protein product provides inferior antioxidant protection compared with the Hp 1 allelic product . We sought to test the hypothesis that vitamin E could reduce cardiovascular events in DM individuals with the Hp 2 - 2 genotype , a subgroup that comprises 2 % to 3 % of the general population . Methods and Results —1434 DM individuals ≥55 years of age with the Hp 2 - 2 genotype were r and omized to vitamin E ( 400 U/d ) or placebo . The primary composite outcome was myocardial infa rct ion , stroke , and cardiovascular death . At the first evaluation of events , 18 months after initiating the study , the primary outcome was significantly reduced in individuals receiving vitamin E ( 2.2 % ) compared with placebo ( 4.7 % ; P=0.01 ) and led to early termination of the study . Conclusions —Vitamin E supplementation appears to reduce cardiovascular events in individuals with DM and the Hp 2 - 2 genotype ( Clinical Trials.gov NCT00220831 ) OBJECTIVE The present study was design ed to assess the effect of magnesium plus zinc Output:

Vitamin E supplementation did not improve glycaemic control in the full set of type 2 diabetes patients . WHAT IS NEW AND CONCLUSIONS The evidence suggests no beneficial effect of vitamin E supplementation in improving glycaemic control in unselected patients with type 2 diabetes . However , HbA(₁c ) may decrease with vitamin E supplementation in patients with inadequate glycaemic control or low serum levels of vitamin E. This shows the importance of targeting therapy .

MS2_1shot161

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND AND PURPOSE Leukocytes have been implicated in the development of ischemic atherosclerotic vascular diseases . In a prospect i ve study we investigated whether the plasma concentrations of inflammatory mediators , ie , proteases and cytokines , as markers for systemic leukocyte activation , are increased in patients with acute ischemic cerebrovascular diseases . METHODS Using enzyme-linked immunosorbent assays , we measured the plasma levels of neutrophil gelatinase-associated lipocalin ( NGAL ) , neutrophil proteinase 4 ( NP4 ) , tumor necrosis factor-alpha ( TNF ) , and soluble TNF receptor protein-1 p55 ( sTNFR-1 ) in 120 patients with acute ischemic cerebrovascular insult ( 72 with stroke and 48 with transient ischemic attack [ TIA ] ) and in 35 age- and sex-matched healthy subjects . RESULTS Compared with the control group , plasma NGAL levels were higher in the stroke group ( P < .0001 ) and the TIA group ( P < .01 ) ; plasma NP4 levels were higher in the stroke group ( P < .0001 ) and the TIA group ( P < .01 ) ; and plasma sTNFR-1 levels were higher in the stroke group ( P < .04 ) . There was significant correlation between the plasma levels of fibrinogen and those of both sTNFR-1 ( r = .32 ; P = .005 ) and NGAL ( r = .40 ; P = .0001 ) and between the erythrocyte sedimentation rate and the plasma levels of both sTNFR-1 ( r = .35 ; P = .001 ) and NGAL ( r = .34 ; P = .002 ) . CONCLUSIONS Our study demonstrated that markers for systemic leukocyte activation , ie , plasma levels of cytokines and proteases , were higher in patients with acute ischemic cerebrovascular disease than in healthy control subjects . Activated leukocytes and leukocytic mediators may have an important role in acute cerebrovascular ischemia and its consequences Neutrophil gelatinase‐associated lipocalin ( NGAL ) is a measure of acute kidney injury . Renal dysfunction portends significant risk after discharge from acute heart failure ( AHF ) . Thus , a sensitive marker of renal injury might also help to risk stratify HF patients OBJECTIVES The aim of this study was to test the hypothesis that , without diagnostic changes in serum creatinine , increased neutrophil gelatinase-associated lipocalin ( NGAL ) levels identify patients with sub clinical acute kidney injury ( AKI ) and therefore worse prognosis . BACKGROUND Neutrophil gelatinase-associated lipocalin detects sub clinical AKI hours to days before increases in serum creatinine indicate manifest loss of renal function . METHODS We analyzed pooled data from 2,322 critically ill patients with predominantly cardiorenal syndrome from 10 prospect i ve observational studies of NGAL . We used the terms NGAL(- ) or NGAL(+ ) according to study -specific NGAL cutoff for optimal AKI prediction and the terms sCREA(- ) or sCREA(+ ) according to consensus diagnostic increases in serum creatinine defining AKI . A priori-defined outcomes included need for renal replacement therapy ( primary endpoint ) , hospital mortality , their combination , and duration of stay in intensive care and in-hospital . RESULTS Of study patients , 1,296 ( 55.8 % ) were NGAL(-)/sCREA(- ) , 445 ( 19.2 % ) were NGAL(+)/sCREA(- ) , 107 ( 4.6 % ) were NGAL(-)/sCREA(+ ) , and 474 ( 20.4 % ) were NGAL(+)/sCREA(+ ) . According to the 4 study groups , there was a stepwise increase in subsequent renal replacement therapy initiation-NGAL(-)/sCREA(- ) : 0.0015 % versus NGAL(+)/sCREA(- ) : 2.5 % ( odds ratio : 16.4 , 95 % confidence interval : 3.6 to 76.9 , p < 0.001 ) , NGAL(-)/sCREA(+ ) : 7.5 % , and NGAL(+)/sCREA(+ ) : 8.0 % , respectively , hospital mortality ( 4.8 % , 12.4 % , 8.4 % , 14.7 % , respectively ) and their combination ( 4-group comparisons : all p < 0.001 ) . There was a similar and consistent progressive increase in median number of intensive care and in-hospital days with increasing biomarker positivity : NGAL(-)/sCREA(- ) : 4.2 and 8.8 days ; NGAL(+)/sCREA(- ) : 7.1 and 17.0 days ; NGAL(-)/sCREA(+ ) : 6.5 and 17.8 days ; NGAL(+)/sCREA(+ ) : 9.0 and 21.9 days ; 4-group comparisons : p = 0.003 and p = 0.040 , respectively . Urine and plasma NGAL indicated a similar outcome pattern . CONCLUSIONS In the absence of diagnostic increases in serum creatinine , NGAL detects patients with likely sub clinical AKI who have an increased risk of adverse outcomes . The concept and definition of AKI might need re- assessment BACKGROUND Acute coronary ischemia is usually initiated by rupture of atherosclerotic plaque , leading to intracoronary thrombosis and clinical sequelae . The proximate cause of plaque rupture is unknown . Accordingly , we investigated the potential role of the 92-kD gelatinase member of the matrix metalloproteinase family in acute coronary ischemia . METHODS AND RESULTS Coronary atherectomy specimens from patients with atherosclerosis and an acute ischemic syndrome consistent with recent plaque rupture ( unstable angina ) ( n = 12 ) were immunostained for the presence of 92-kD gelatinase ; the results were compared with those obtained by identical study of atherectomy specimens from patients with atherosclerosis and angina but without acute ischemia ( stable angina ) ( n = 12 ) . Positive immunostaining for 92-kD gelatinase was present in 83 % of specimens from both unstable and stable angina patients . However , intracellular localization of enzyme ( indicating active synthesis ) was documented in 10 of 10 positively stained specimens from patients with unstable angina compared with 3 of 10 positively stained specimens from patients with stable angina . Macrophages and smooth muscle cells were the major sources of 92-kD gelatinase in all specimens examined by immunostaining of adjacent sections . CONCLUSIONS 92-kD gelatinase is commonly expressed in coronary arterial atherosclerotic lesions . Active synthesis of 92-kD gelatinase by macrophages and smooth muscle cells in atherosclerotic lesions may play a pathogenic role in the development of acute coronary ischemia Acute kidney injury ( AKI ) is a frequent complication of cardiac surgery and increases morbidity and mortality . The identification of reliable biomarkers that allow earlier diagnosis of AKI in the postoperative period may increase the success of therapeutic interventions . Here , we conducted a prospect i ve , multicenter cohort study involving 1219 adults undergoing cardiac surgery to evaluate whether early postoperative measures of urine IL-18 , urine neutrophil gelatinase-associated lipocalin ( NGAL ) , or plasma NGAL could identify which patients would develop AKI and other adverse patient outcomes . Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery . After multivariable adjustment , the highest quintiles of urine IL-18 and plasma NGAL associated with 6.8-fold and 5-fold higher odds of AKI , respectively , compared with the lowest quintiles . Elevated urine IL-18 and urine and plasma NGAL levels associated with longer length of hospital stay , longer intensive care unit stay , and higher risk for dialysis or death . The clinical prediction model for AKI had an area under the receiver-operating characteristic curve ( AUC ) of 0.69 . Urine IL-18 and plasma NGAL significantly improved the AUC to 0.76 and 0.75 , respectively . Urine IL-18 and plasma NGAL significantly improved risk prediction over the clinical models alone as measured by net reclassification improvement ( NRI ) and integrated discrimination improvement ( IDI ) . In conclusion , urine IL-18 , urine NGAL , and plasma NGAL associate with subsequent AKI and poor outcomes among adults undergoing cardiac surgery BACKGROUND The identification of patients at risk for worse outcome is still a challenge . We hypothesized that cystatin C , a marker of renal function , and neutrophil gelatinase-associated lipocalin ( NGAL ) , a marker of acute renal injury , would have a role in the prognostic stratification of these patients . METHODS We prospect ively evaluated 121 patients admitted for acute HF . Serum NGAL and cystatin C levels were measured on the first morning after admission . The outcome measures used were the occurrence of death from all causes , and the combined endpoint defined as the first occurrence of either death or hospital admission . Patients were followed for up to 3 months . RESULTS The variables associated with a higher occurrence of death in a univariate approach were older age and higher levels of BNP , cystatin C and NGAL , and those associated with the occurrence of the combined endpoint were older age , Diabetes mellitus , lower GFR , type 1 cardio-renal syndrome , BNP , cystatin C and NGAL . BNP and NGAL remained independent predictors of the occurrence of both all-cause death and the combined endpoint . NGAL levels in the 75th percentile ( > 167.5 ng/mL ) were associated with a 2.7-fold increase in the risk of death and a 2.9-fold increase in the risk of the first occurrence of either death or hospitalization . CONCLUSIONS Serum NGAL , a marker of acute renal injury , is an independent predictor of worse short term prognosis in patients with acute HF . This suggests a role of renal damage , apart from renal function , in the prognosis of these patients Output:

NGAL is highly expressed in the heart , both in failing myocardium and myocarditis , and is also expressed in atherosclerotic plaques . Areas of co-localization of NGAL and matrix metalloproteinase (MMP)-9 exhibited increased MMP-9 proteolytic activity .

MS2_1shot162

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIMS We examined the effects of physical activity with or without dietary restriction for 3 months on regional fat and insulin sensitivity and compared the effect of total energy expenditure from all levels of physical activity with that of physical activity energy expenditure from moderate-to-vigorous exercise in obese women with Type 2 diabetes . METHODS In this r and omized , controlled trial , we assessed change of body weight , abdominal visceral fat area , subcutaneous fat area and insulin sensitivity , expressed as K(ITT ) , and monitored total energy expenditure and physical activity energy expenditure using an accelerometer during a 12-week intervention in four groups : control , diet , exercise and diet plus exercise . RESULTS The mean body mass index was 28.0 + /- 2.7 kg/m(2 ) and the mean duration of diabetes was 8 + /- 6 years . Both the diet and diet plus exercise groups showed significant body weight loss compared with the control group ( P < 0.05 ) . However , the visceral fat area was reduced only in the diet and exercise group ( P = 0.017 ) and the subcutaneous fat area was reduced only in the diet group ( P = 0.009 ) . Mean energy intake was an independent determinant of the change in subcutaneous fat area ( P = 0.020 ) and mean total anergy expenditure was an independent determinant of visceral fat area ( P = 0.002 ) . Insulin sensitivity K(ITT ) was associated with physical activity energy expenditure ( P = 0.006 ) , energy intake ( P = 0.047 ) and the change in fructosamine level ( P = 0.016 ) but not with changes in body weight , subcutaneous fat area , visceral fat area or adipokine level . CONCLUSIONS Exercise had an additive effect to dietary restriction on visceral fat reduction . Visceral fat area was associated with total energy expenditure , but insulin sensitivity was associated with physical activity energy expenditure OBJECTIVE To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness , body composition , and glycemic control . RESEARCH DESIGN AND METHODS Subjects with type 2 diabetes were r and omized to a control ( n = 8) , continuous-walking ( n = 12 ) , or interval-walking group ( n = 12 ) . Training groups were prescribed five sessions per week ( 60 min/session ) and were controlled with an accelerometer and a heart-rate monitor . Continuous walkers performed all training at moderate intensity , whereas interval walkers alternated 3-min repetitions at low and high intensity . Before and after the 4-month intervention , the following variables were measured : VO2max , body composition , and glycemic control ( fasting glucose , HbA1c , oral glucose tolerance test , and continuous glucose monitoring [ CGM ] ) . RESULTS Training adherence was high ( 89 ± 4 % ) , and training energy expenditure and mean intensity were comparable . VO2max increased 16.1 ± 3.7 % in the interval-walking group ( P < 0.05 ) , whereas no changes were observed in the continuous-walking or control group . Body mass and adiposity ( fat mass and visceral fat ) decreased in the interval-walking group only ( P < 0.05 ) . Glycemic control ( elevated mean CGM glucose levels and increased fasting insulin ) worsened in the control group ( P < 0.05 ) , whereas mean ( P = 0.05 ) and maximum ( P < 0.05 ) CGM glucose levels decreased in the interval-walking group . The continuous walkers showed no changes in glycemic control . CONCLUSIONS Free-living walking training is feasible in type 2 diabetic patients . Continuous walking offsets the deterioration in glycemia seen in the control group , and interval walking is superior to energy expenditure – matched continuous walking for improving physical fitness , body composition , and glycemic control OBJECTIVE To assess the effect of yoga on anthropometry , blood pressure , glycemic control , and oxidative stress in type 2 diabetic patients on st and ard care in comparison with st and ard care alone . RESEARCH DESIGN AND METHODS The study involved 123 patients stratified according to groups with microvascular complications , macrovascular complications , and peripheral neuropathy and without complications and assigned to receive either st and ard care or st and ard care along with additional yoga for 3 months . RESULTS In comparison with st and ard care alone , yoga result ed in significant reduction in BMI , glycemic control , and malondialdehyde and increase in glutathione and vitamin C. There were no differences in waist circumference , waist-to-hip ratio , blood pressure , vitamin E , or superoxide dismutase in the yoga group at follow-up . CONCLUSIONS Yoga can be used as an effective therapy in reducing oxidative stress in type 2 diabetes . Yoga in addition to st and ard care helps reduce BMI and improve glycemic control in type 2 diabetic patients Objective : Both Nordic walking and Exercise on Prescription have potential as elements in the management of type 2 diabetes mellitus . These programs are recommended , but their effectiveness has not yet been established . The aim was to evaluate the efficacy of these 2 interventions compared with st and ard information on physical activity . Design : Single-blinded , r and omized , controlled intervention study . Setting : Sixty-eight patients ( 37 men and 31 women ) were r and omized into 3 groups : Nordic walking ( NW ; n = 22 ) , Exercise on Prescription ( EP ; n = 24 ) , and control ( CG ; n = 22 ) . Patients : Patients were recruited from a diabetes outpatient clinic and via newspaper advertisement . Interventions : Consisted of a 4-month intervention period followed by an 8-month follow-up , during which the participants were recommended to train on their own . Main Outcome Measures : HbA1c . Results : There was no difference in HbA1c when comparing the intervention groups relative to the control group : ΔNW = −0.4 % [ 95 % confidence intervals ( CI ) , −0.9 % to 0.1 % ] and ΔEP = −0.2 % ( 95 % CI , −0.6 % to 0.2 % ) after 4 months ; ΔNW = 0.0 % ( 95 % CI , −0.6 % to 0.5 % ) and ΔEP = 0.3 % ( 95 % CI , −0.3 % to 0.9 % ) after 12 months . However , fat mass assessed by dual energy X-ray absorptiometry ( DXA ) decreased significantly in the NW group after 4 months [ −1.0 kg ( 95 % CI , −1.7 to 0.1 ) ] and after 12 months in both NW [ −1.8 kg ( 95 % CI , −3.2 to −0.4 ) ] and EP [ −1.5 kg ( 95 % CI , −2.9 to −0.05 ) ] groups . No significant changes in other variables . Conclusions : Four-month exercise programs at moderate intensity of either Nordic walking or Exercise on Prescription did not significantly improve HbA1c in patients with type 2 diabetes either at the end of the program or at the follow-up AIMS To investigate association between leisure-time physical activity at weekends and the risk of developing Type 2 diabetes mellitus ( DM ) . METHODS Prospect i ve examination of 6,013 Japanese men aged 35 - 60 years who were free of DM , impaired fasting glycaemia , or hypertension at study entry . Type 2 DM was defined by a fasting plasma glucose level > or = 7.0 mmol/l or a 2-h post-load plasma glucose level > or = 11.1 mmol/l . Data on physical activity obtained from question naires consisted of overall leisure-time physical activity weekly and leisure-time physical activity at weekends . RESULTS During the 59,966 person-years follow-up , 444 cases developed Type 2 DM . Regular physical exercise at least once a week was associated with a reduced risk of Type 2 DM . After adjustments for age , body mass index , daily alcohol consumption , smoking habits , blood pressure levels and a parental history of Type 2 DM , men who engaged in regular physical exercise at least once a week had a relative risk of Type 2 DM of 0.75 ( 95 % CI , 0.61 - 0.93 ) compared with men engaging in exercise less often . Even vigorous activity only once a week at weekends was associated with a reduced risk of Type 2 DM . Men who engaged in vigorous activity at least once a week at weekends had a multiple-adjusted relative risk of Type 2 DM of 0.55 ( 95 % CI , 0.35 - 0.88 ) compared with sedentary men . CONCLUSIONS Regular physical exercise at least once a week and vigorous activity even only once a week at weekends are associated with a decreased risk of Type 2 DM Aims /hypothesisStructured exercise is considered a cornerstone in type 2 diabetes treatment . However , adherence to combined resistance and endurance type exercise or medical fitness intervention programmes is generally poor . Group-based brisk walking may represent an attractive alternative , but its long-term efficacy as compared with an individualised approach such as medical fitness intervention programmes is unknown . We compared the clinical benefits of a 12-month exercise intervention programme consisting of either brisk walking or a medical fitness programme in type 2 diabetes patients . Methods We r and omised 92 type 2 diabetes patients ( 60 ± 9 years old ) to either three times a week of 60 min brisk walking ( n = 49 ) or medical fitness programme ( n = 43 ) . Primary outcome was the difference in changes in HbA1c values at 12 months . Secondary outcomes were differences in changes in blood pressure , plasma lipid concentrations , insulin sensitivity , body composition , physical fitness , programme adherence rate and health-related quality of life . Results After 12 months , 18 brisk walking and 19 medical fitness participants were still actively participating . In both programmes , 50 and 25 % of the dropout was attributed to overuse injuries and lack of motivation , respectively . Intention-to-treat analyses showed no important differences between brisk walking and medical fitness programme in primary or secondary outcome variables . Conclusions /interpretationThe prescription of group-based brisk walking represents an equally effective intervention to modulate glycaemic control and cardiovascular risk profile in type 2 diabetes patients when compared with more individualised medical fitness programmes . Future exercise intervention programmes should anticipate the high attrition rate due to overuse injuries and motivation problems The effect of practicing yoga for the management of type II Diabetes was assessed in this systematic review through search ing related electronic data bases and the grey literature to the end of May 2007 using Ovid . All r and omized controlled clinical trials ( RCTs ) comparing yoga practice with other type of intervention or with regular practice or both , were included regardless of language or type of publication . Each study was assessed for quality by two independent review ers . Mean difference was used for summarizing the effect of each study outcomes with 95 % confidence intervals . Pooling of the studies did not take place due to the wide clinical variation between the studies . Publication bias was assessed by statistical methods . Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics . The studies ’ results show improvement in outcomes among patients with diabetes type II . These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant . The results were inconclusive and not significant for the long-term outcomes . No adverse effects were reported in any of the included studies . Short-term benefits for patients with diabetes may be achieved from practicing yoga . Further research is needed in this area . Factors like quality of the trials and other method ological issues should be improved by large r and omized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II . A definitive recommendation for physicians to encourage their patients to practice yoga can not be reached at present OBJECTIVE This study aim ed to vali date the effects of a simplified , gentle form of t'ai chi chuan in patients with type 2 diabetes and who are also obese . DESIGN The study was design ed to be a r and omized controlled trial . SETTING This study was conducted in the department of metabolism and endocrinology at Cheng Ching Hospital , in Taichung , Taiwan . SUBJECTS The study subjects were hospital-based patients with type 2 diabetes and who were also obese ( ages 40 - 70 , with a body-mass index [ BMI ] range of 30 - 35 ) . The patients were r and omly selected and grouped into t'ai chi exercise ( TCE ) and conventional exercise ( CE ) groups . INTERVENTIONS After receiving instruction in t'ai chi , the TCE group and the CE group practice d three times per week , including one practice session lasting up to 1 hour , for 12 weeks . OUTCOME MEASURES Hemoglobin A1C , serum lipid profile , serum malondialdehyde , and C-reactive protein were measured . Physical parameters of body weight and BMI were also measured . Diet and medications of participants were monitored carefully while biochemical and physical conditions were analyzed . RESULTS After 12 weeks , hemoglobin A1C values of the TCE group did not decrease ( 8.9 ± 2.7 % : 8.3 ± 2.2 % ; p = 0.064 ) . BMI ( 33.5 ± 4.8 : 31.3 ± 4.2 ; p = Output:

The results indicated yoga was the most effective in lowering glycated haemoglobin A1c ( HbA1c ) levels . A higher frequency of regular leisure-time physical activities was found to be more effective in reducing HbA1c levels . The results of this review provide evidence of the benefits associated with regular leisure-time physical activities compared with routine care for lowering HbA1c levels in people with type 2 diabetes

MS2_1shot163

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This study compared preoperative administration of acetaminophen or a combination of acetaminophen and ibuprofen versus placebo for potential increased effectiveness of inferior alveolar nerve ( IAN ) block anesthesia . There were 40 patients with irreversible pulpitis r and omly assigned to a drug or placebo group . Thirty minutes after ingestion of medication , an IAN block was administered . A cold test was done 15 minutes after the block , and if the patients had no sensitivity , endodontic therapy was initiated . If the patient had no pain on access , the IAN was recorded as successful . If the patient had sensitivity to cold or to the access procedure , it was recorded as a failure . Overall success was 60 % for all three groups . Success was 71.4 % for the acetaminophen group , 75.9 % for the acetaminophen and ibuprofen group , and 46.2 % for the placebo group . There was no significant difference between the groups ; however , there was a trend toward higher success in the medication groups Objectives : This study was done to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine with that of 2 % lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in m and ibular posterior teeth . Material and Methods : Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics , K.D. Dental College , r and omly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:80,000 epinephrine . After the patient ’s subjective assessment of lip anesthesia , the absence/presence of pulpal anesthesia through electric pulp stimulation was recorded and the absence/presence of pain was recorded through visual analogue scale . Results : The pulpal anesthesia success for articaine ( 76 % ) was slightly more than with lidocaine ( 58 % ) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine ( 88 % ) was slightly more than that of lidocaine ( 82 % ) although the difference between the two solutions was not statistically significant . Conclusions : Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block . Key words : Anesthesia , articaine , lignocaine , pulpitis AIM This r and omized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block ( IANB ) injection for m and ibular first molar teeth with irreversible pulpitis with or without supplementary buccal infiltration and intraligamentary injection . METHODOLOGY Eighty-two patients with asymptomatic irreversible pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in m and ibular first molar teeth with irreversible pulpitis . Each patient recorded their pain score on a Heft-Parker visual analogue scale before commencing treatment , in response to a cold test 15 min after the design ated anaesthetic injection , during access cavity preparation and during root canal instrumentation . No or mild pain at any stage was considered a success . Data were analysed by chi-square test . RESULTS At the final stage of treatment , 69 of the 82 patients were eligible to be included in the study . No significant difference was found between age ( P = 0.569 ) and gender ( P = 0.570 ) amongst the patients in the two groups . The success rate of anaesthesia in the IANB and the combination groups were 22 % and 58 % , respectively . The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection ( P = 0.003 ) . CONCLUSION A combination of anaesthetic techniques can improve the success rate of anaesthesia for m and ibular first molar teeth with irreversible pulpitis AIM To compare the anaesthetic efficacy of inferior alveolar nerve blocks ( IANB ) with 1.8 mL of 2 % lidocaine ( LI ) to a buccal infiltration ( BI ) with 1.8 mL of 4 % articaine ( AR ) , both with 1 : 100 000 epinephrine , in patients with symptomatic irreversible pulpits in a r and omized controlled trial . METHODOLOGY Volunteers presenting at the Emergency Centre ( FOP-UNICAMP ) were r and omly divided into two groups ( 30 for AR and 20 for LI ) . Operator and patient were not blinded . Success was recorded when complete pain-free treatment was achieved after a single injection ( IANB or BI ) or when one supplemental injection was needed for emergency endodontic procedures . Success rate of supplemental injection was evaluated between and within groups using Fisher 's exact test and chi-square test . RESULTS A higher success rate ( P = 0.03/Fisher 's exact test ) was observed with AR ( 40 % ) than with LI ( 10 % ) . No significant difference was found when a single injection plus one supplemental injection was compared between groups ( P = 1.0 ; AR = 70 % ; LI = 80 % ) . However , supplemental injection increased the anaesthetic success rates ( AR , P = 0.04 ; LI , P = 0.0001 ) within groups . CONCLUSIONS Single anaesthesia techniques ( IANB or BI ) were not able to achieve pain-free emergency endodontic treatment . Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate ( consort : registration number - NCT01912755/Fapesp : # 2009/10834 - 4 ) INTRODUCTION Achieving anesthesia in m and ibular molar teeth with irreversible pulpitis is very difficult . The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block ( IANB ) when treating molars with symptomatic irreversible pulpitis . METHODS In a r and omized , double-blind clinical trial , 82 first m and ibular molar teeth with symptomatic irreversible pulpitis r and omly received conventional IANB injection either with 1 ( 1.8 mL ) or 2 cartridges ( 3.6 mL ) of 4 % articaine with 1:100,000 epinephrine . The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale . No or mild pain was considered as successful anesthesia . Data were analyzed by t and chi-square tests . RESULTS Eighty patients were eligible to participate in this study , which showed that 3.6 mL articaine provided a significantly higher success rate ( 77.5 % ) of IANBs compared with 1.8 mL of the same anesthetic solution ( 27.5 % ) although neither group had 100 % successful anesthesia ( P < .001 ) . CONCLUSIONS Increasing the volume of articaine provided a significantly higher success rate of IANBs in m and ibular first molar teeth with symptomatic irreversible pulpitis , but it did not result in 100 % anesthetic success The purpose of the present study was to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine with that of 2 % lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in m and ibular posterior teeth . Forty volunteers , patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo , r and omly received a conventional inferior alveolar nerve block containing 3.6 mL of either 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:100,000 epinephrine . During the subsequent pulpectomy , we recorded the patients ' subjective assessment s of lip anesthesia , the absence/presence of pulpal anesthesia through electric pulp stimulation , and the absence/presence of pain through a verbal analogue scale . All tested patients reported lip anesthesia after the application of either inferior alveolar nerve block . Regarding pulpal anesthesia success as measured with the pulp tester , the lidocaine solution had a higher success rate ( 70 % ) than the articaine solution ( 65 % ) . For patients reporting none or mild pain during pulpectomy , the success rate of the articaine solution ( 65 % ) was higher than that of the lidocaine solution ( 45 % ) . Yet , none of the observed differences between articaine and lidocaine were statistically significant . Apparently , therefore , both local anesthetic solutions had similar effects on the patients with irreversible pulpitis in m and ibular posterior teeth . Neither of the solutions , however , result ed in an effective pain control during irreversible pulpitis treatments INTRODUCTION Profound pulpal anesthesia in posterior m and ibular teeth with irreversible pulpitis usually requires administering an inferior alveolar nerve block ( IANB ) plus other supplemental injections . The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic success rate of buccal infiltration injections of articaine and lidocaine when supplemented with an IANB . METHODS One hundred twenty-five emergency patients who had their first or second m and ibular molar diagnosed with irreversible pulpitis participated in the study and received the IANB by using either 2 % lidocaine with 1:100,000 epinephrine or 4 % articaine with 1:100,000 epinephrine . One hundred two of the patients reported moderate-to-severe pain upon initiation of their endodontic treatment or through filing of their tooth canals and received supplemental buccal infiltration injections by using the same anesthetic that the IANB had been performed . After the block or the supplemental buccal infiltration injections , success was achieved with no or mild pain during instrumentation of the tooth canals . RESULTS The success rate after the administration of the infiltration injections after an incomplete IANB by using lidocaine was 29 % , whereas by using articaine it was 71 % ( P < .001 ) . No statistical differences were detected in the success rates between the 2 anesthetics after the block injections . CONCLUSIONS Supplementing an incomplete articaine IANB with articaine infiltration raises the anesthetic success more effectively compared with lidocaine in m and ibular molars with irreversible pulpitis The purpose of this prospect i ve , r and omized , double-blind , placebo-controlled study was to determine the effect of preoperative oral administration of ibuprofen or dexamethasone on the success rate of inferior alveolar nerve block ( IANB ) in patients with symptomatic irreversible pulpitis . Seventy-eight patients with irreversible pulpitis were r and omly divided into 3 groups ( 26 per group ) and given one of the following at 1 hr prior to performing local anesthesia : a placebo ; 400 mg ibuprofen ; or 4 mg dexamethasone . Each patient recorded their pain level on a visual analog scale before taking the medication or placebo , at 15 min after completion of IANB , and during treatment if pain occurred . The success of the anesthesia was defined as no or mild pain at any stage during the endodontic procedure . The success rate of the IANB was 38.5 , 73.1 , and 80.8 % with the placebo , ibuprofen , and dexamethasone , respectively . Both ibuprofen and dexamethasone were significantly more effective than the placebo . No significant difference was observed , however , between the two experimental medications in terms of effectiveness . The results of the present study suggest that premedication with ibuprofen or dexamethasone increases the success rate of an IANB in patients with symptomatic irreversible pulpitis in the m and ibular molars PURPOSE To evaluate the efficacy of local anesthesia using tramadol hydrochloride ( HCl ) with versus without adrenaline in the extraction of upper molar teeth . PATIENTS AND METHODS This was a double-blinded study that included 100 patients who required extraction of 1 upper molar by the conventional method and were allocated r and omly into 1 of 2 groups : in group A ( n = 50 ) , each patient received an initial dose of drug A ( tramadol HCl 50 mg and adrenalin 0.0225 mg diluted to 1.8 mL by distilled water ) ; in group B ( n = 50 ) , each patient received an initial dose of drug B ( tramadol HCl 50 mg diluted to 1.8 mL by distilled water ) . Degree of pain during tooth extraction , duration of surgery , and total number of cartridges used were recorded intraoperatively . Postoperatively , patients were instructed to record any adverse effects , such as nausea or vomiting , on the first day of the operation . RESULTS There were significant differences in the number of cartridges used and the degree of intraoperative pain . However , there was no significant difference in duration of surgery or side effects . CONCLUSIONS The results of this study suggest that tramadol HCl in combination with adrenaline can be used as an alternative local anesthetic in Output:

It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of m and ibular anesthetic effect in irreversible pulpitis .

MS2_1shot164

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients . This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens . METHODS We r and omly assigned 1645 renal-transplant recipients to receive st and ard-dose cyclosporine , mycophenolate mofetil , and corticosteroids , or daclizumab induction , mycophenolate mofetil , and corticosteroids in combination with low-dose cyclosporine , low-dose tacrolimus , or low-dose sirolimus . The primary end point was the estimated glomerular filtration rate ( GFR ) , as calculated by the Cockcroft-Gault formula , 12 months after transplantation . Secondary end points included acute rejection and allograft survival . RESULTS The mean calculated GFR was higher in patients receiving low-dose tacrolimus ( 65.4 ml per minute ) than in the other three groups ( range , 56.7 to 59.4 ml per minute ) . The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus ( 12.3 % ) than in those receiving st and ard-dose cyclosporine ( 25.8 % ) , low-dose cyclosporine ( 24.0 % ) , or low-dose sirolimus ( 37.2 % ) . Allograft survival differed significantly among the four groups ( P=0.02 ) and was highest in the low-dose tacrolimus group ( 94.2 % ) , followed by the low-dose cyclosporine group ( 93.1 % ) , the st and ard-dose cyclosporine group ( 89.3 % ) , and the low-dose sirolimus group ( 89.3 % ) . Serious adverse events were more common in the low-dose sirolimus group than in the other groups ( 53.2 % vs. a range of 43.4 to 44.3 % ) , although a similar proportion of patients in each group had at least one adverse event during treatment ( 86.3 to 90.5 % ) . CONCLUSIONS A regimen of daclizumab , mycophenolate mofetil , and corticosteroids in combination with low-dose tacrolimus may be advantageous for renal function , allograft survival , and acute rejection rates , as compared with regimens containing daclizumab induction plus either low-dose cyclosporine or low-dose sirolimus or with st and ard-dose cyclosporine without induction . ( Clinical Trials.gov number , NCT00231764 [ Clinical Trials.gov ] . ) OBJECTIVES Basiliximab is used alongside tacrolimus-based immunosuppression for routine induction therapy , even for well-matched living-donor renal transplant recipients . Because tacrolimus is a different drug from cyclosporine , this study examined the utility of tacrolimus-based immunosuppression without basiliximab for well-matched living-donor renal transplant recipients . MATERIAL S AND METHODS This prospect i ve study evaluated 36 patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants without basiliximab induction therapy between April 2012 and March 2015 ( group 1 ) . All transplants were ABO compatible and T-flow negative and were followed until April 2015 . Tacrolimus-based triple therapy was used for maintenance immunosuppression . The control group comprised 72 age- and sex-matched patients who underwent 1 to 3 human leukocyte antigens mismatched living-donor renal transplants with basiliximab induction therapy during the same period ( group 2 ) . RESULTS Two patients in group 1 and 12 patients in group 2 had infection , with cytomegalovirus infection and Pneumocystis pneumonia infection occurring only in group 2 and BK virus and urinary tract infection reported in both groups , with a similar incidence . One patient from group 2 had sepsis . Although the incidence of infection tended to be lower in group 1 than in group 2 ( 5.6 % vs 16.7 % ) , the overall incidence of infection was not significantly different ( P=.135 ) . In addition , there were no significant differences in incidence of acute rejection between groups 1 and 2 ( 2.8 % vs 4.2 % ; P=.699 ) . All patients showed stable renal function after treatment . CONCLUSIONS Tacrolimus-based triple drug maintenance immunosuppression without basiliximab might be an optimal treatment choice for individuals undergoing well-matched living-donor renal transplant Background . Sequential anti-thymocyte globulins (ATG)/cyclosporine immunosuppression has two main advantages : delayed introduction of the nephrotoxic drug cyclosporine and prevention of acute rejection . Basiliximab , a recently developed chimeric monoclonal antibody that selectively depletes the minor sub population of activated T lymphocytes , has been shown to reduce the incidence of acute rejection when used with cyclosporine introduced on day 1 . Methods . This open , r and omized , multicenter study was undertaken to compare the safety and efficacy of ATG versus basiliximab induction therapy ( IT ) with delayed introduction of cyclosporine for microemulsion ( Neoral ) in 105 low immunologic risk renal-transplant patients receiving mycophenolate mofetil and steroids . Results . One-year patient and graft survival rates were 98.1 % and 94.2 % , respectively , in the basiliximab group ( n=52 ) , and 98.1 % and 96.2 % in the ATG group ( n=53 ) . The incidence of biopsy-confirmed acute rejection was comparable ( basiliximab 9.6 % , ATG 9.4 % ) , as were key parameters of renal function , notably serum creatinine levels , time-to-nadir serum creatinine , and the number of patients requiring posttransplantation dialysis ( basiliximab 28.8 % , ATG 30.2 % ) . However , significantly fewer patients in the basiliximab group experienced cytomegalovirus ( CMV ) infection , leukopenia , and thrombocytopenia , and this without any significant difference in any other key safety parameters ( including the incidences of serum sickness , fever , lymphoma , and infections in general ) . Conclusions . Both ATG and basiliximab , when used for IT in a sequential protocol , are equally effective in terms of graft and patient survival as well as at preventing acute rejection . However , basiliximab is associated with a lower incidence of certain key adverse events , namely CMV infection , leukopenia , and thrombocytopenia BACKGROUND Monoclonal antibodies that block the high-affinity interleukin-2 receptor expressed on alloantigen-reactive T lymphocytes may cause selective immunosuppression . Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically to the alpha chain of the interleukin-2 receptor and may thus reduce the risk of rejection after renal transplantation . METHODS We administered daclizumab ( 1.0 mg per kilogram of body weight ) or placebo intravenously before transplantation and once every other week afterward , for a total of five doses , to 260 patients receiving first cadaveric kidney grafts and immunosuppressive therapy with cyclosporine , azathioprine , and prednisone . The patients were followed at regular intervals for 12 months . The primary end point was the incidence of biopsy-confirmed acute rejection within six months after transplantation . RESULTS Of the 126 patients given daclizumab , 28 ( 22 percent ) had biopsy-confirmed episodes of acute rejection , as compared with 47 of the 134 patients ( 35 percent ) who received placebo ( P=0.03 ) . Graft survival at 12 months was 95 percent in the daclizumab-treated patients , as compared with 90 percent in the patients given placebo ( P=0.08 ) . The patients given daclizumab did not have any adverse reactions to the drug , and at six months , there were no significant differences between the two groups with respect to infectious complications or cancers . The serum half-life of daclizumab was 20 days , and its administration result ed in prolonged saturation of interleukin-2alpha receptors on circulating lymphocytes . CONCLUSIONS Daclizumab reduces the frequency of acute rejection in kidney-transplant recipients BACKGROUND Currently available immunosuppressive regimens for cadaver-kidney recipients are far from ideal because acute-rejection episodes occur in about 30 % to 50 % of these patients . In the phase III study described here we assessed the ability of basiliximab , a chimeric interleukin (IL)-2 receptor monoclonal antibody , to prevent acute-rejection episodes in renal allograft recipients . METHODS 380 adult recipients of a primary cadaveric kidney transplant were r and omly allocated , in this double-blind trial , to receive a 20 mg infusion of basiliximab on day 0 ( day of surgery ) and on day 4 , to provide IL-2-receptor suppression for 4 - 6 weeks ( n=193 ) , or to receive placebo ( n=187 ) . Both groups received baseline dual immunosuppressive therapy with cyclosporin and steroids throughout the study . The primary outcome measure was incidence of acute-rejection episodes during the 6 months after transplantation . Safety and tolerability were monitored over the 12 months of the study . FINDINGS 376 patients were eligible for intention-to-treat analysis ( basiliximab , n=190 ; placebo , n=186 ) . No significant differences in patient characteristics were apparent . The incidence of biopsy-confirmed acute rejection 6 months after transplantation was 51 ( 29.8 % ) of 171 in the basiliximab group compared with 73 ( 44.0 % ) of 166 in the placebo group ( 32 % reduction ; 14.2 % difference [ 95 % Kaplan-Meier CIs 3 % to 24 % ] , p=0.012 ) . The incidence of steroid-resistant first rejection episodes that required antibody therapy was significantly lower in the basiliximab group ( 10 % vs 23.1 % , 13.1 % difference [ 5.4 % to 20.8 % ] , p<0.001 ) . At weeks 2 and 4 post-transplantation , the mean daily dose of steroids was significantly higher in the placebo group ( p<0.001 with one-way analysis of variance ) . The incidence of graft loss at 12 months post-transplantation was 23 ( 12.1 % ) of 190 in the basiliximab group and 25 ( 13.4 % ) of 186 in the placebo group ( 1.3 % difference [ -5 % to 9 % ] , p=0.591 ) . The incidence of infection and other adverse events was similar in the two treatment groups . The acute tolerability of basiliximab was excellent , with no evidence of cytokine-release syndrome . 14 deaths ( basiliximab n=9 ; placebo n=5 ; -2.0 % difference [ -6 % to 2 % ] , p=0.293 ) occurred during the 12-month study and a further three deaths ( basiliximab n=1 ; placebo n=2 ) occurred within the 380-day cut-off period . One post-transplantation lymphoproliferative disorder was recorded in each group . INTERPRETATION Prophylaxis with 40 mg basiliximab reduces the incidence of acute rejection episodes significantly , with no clinical ly relevant safety or tolerability concerns There is little experience on the use of monoclonal antibodies that block the high-affinity interleukin-2 receptor ( basiliximab and daclizumab ) in sequential therapy in renal transplants with risk of delayed graft function . This study sougth to test the efficacy and safety of the substitution of anticalcineurins with two doses of basiliximab or daclizumab in the immediate posttransplant period for recipients at risk of delayed renal graft function . Immunosuppression consisted of steroids , mycophenolate mofetil , and two doses of basiliximab ( 20 mg/day ) on days 0 and 4 posttransplant or daclizumab ( 1 mg/kg per day ) on days 0 and 15 posttransplant . Anticalcineurins were not administered until the beginning of graft function . Among 49 recipients ( mean age 63.5 + /- 10.5 years ) , 40 received a kidney from a donor over 60 years of age , three from a non-heart-beating donor , and six from donors with an acute elevation of serum creatinine to 2.4 + /- 0.86 ( 1.7 - 3.7 ) . At a mean follow-up of 14.2 + /- 8.4 months , five patients experienced acute rejection episodes . Only 15 patients Output:

Forest plot analysis for rate of rejection during the follow-up period post-transplant showed no significant difference between the groups . Conclusion IL-2R antibody induction therapy has no significant effect on the rate of rejection or patient or graft survival in st and ard-risk renal transplant recipients on tacrolimus-based maintenance immunotherapy .

MS2_1shot165

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Micro-inflammation is considered an element in the pathogenesis of irritable bowel syndrome ( IBS ) . High-sensitivity C reactive protein ( hs-CRP ) was previously shown to be higher in IBS compared to healthy controls , albeit within the normal range . Since probiotics may suppress micro-inflammation in the gut , we tested if they reduce symptoms and inflammatory markers ( hs-CRP and fecal calprotectin ( FC ) in diarrhea-predominant IBS ( IBS-D ) . The aim of this study was to assess the clinical and laboratory effects of BIO-25 , a multispecies probiotic , in women with IBS-D. METHODS A double-blind , placebo-controlled study . Following a 2-week run-in , eligible women were assigned at r and om to a probiotic capsule or an indistinguishable placebo , twice daily for 8 weeks . IBS symptoms and stool consistency were rated daily by Visual Analogue Scales ( VAS ) and the Bristol Stool Scale ( BSS ) . High-sensitivity C reactive protein was tested at baseline , 4 and 8 weeks . FC was tested at baseline and 8 weeks . KEY RESULTS One hundred and seventy-two IBS-D patients were recruited and 107 eligible patients were allocated to the intervention ( n=54 ) or placebo ( n=53 ) group . All symptoms improved in both groups with no significant difference between them in symptom improvement , hs-CRP or FC levels . CONCLUSIONS & INFERENCES An 8-week treatment with BIO-25 improved symptoms in women with IBS-D , but was not superior to placebo . This rigorously design ed and executed study supports the findings of other studies that did not demonstrate superiority of probiotics over placebo in IBS . High quality clinical studies are necessary to examine the efficacy of other specific probiotics in IBS-D patients since data are still conflicting : No currently available treatment provides consistent relief of irritable bowel syndrome . Colonic sensory and motor function are modulated partly through 5HT3‐receptors AIM To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome ( IBS ) symptoms and quality of life ( QoL ) . METHODS In this r and omized triple-blind trial , adult IBS volunteers who were recruited according to Rome III criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk . IBS Symptom Severity Score ( IBS-SSS ) , which constituted the primary outcome , and secondary outcomes , including individual IBS symptoms , IBS-related QoL question naire , anxiety and depression , defecation frequency , and stool consistency , were assessed at baseline at the end of the 8-wk run-in period , after 4 and 12 wk of intervention , and after a 4-wk washout . RESULTS A total of 340 of 391 r and omized volunteers completed the trial . IBS-SSS improved over 12 wk of treatment in all treatment groups , decreasing by a mean ± SD of 44.0 ± 80.2 , 50.8 ± 82.4 , and 48.3 ± 72.2 in the placebo , active low-dose , and active high-dose groups , respectively . Similarly , secondary outcomes did not differ between treatment groups . However , in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline ( VAS > 35/100 ) , the treatment significantly reduced the sensation of abdominal pain . Pain scores fell by 20.8 ± 22.8 , 29.4 ± 17.9 , and 31.2 ± 21.9 in the placebo , active low-dose , and active high-dose groups , respectively ( P value for placebo vs combined active doses = 0.0460 ) . CONCLUSION NCFM alleviates moderate to severe abdominal pain , consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression Background and Aim . The efficacy of supplementation treatment with two multispecies probiotic formulates on subjects diagnosed with IBS-C and the assessment of their gut microbiota were investigated . Methods . A r and omized , double-blind , three-arm parallel group trial was carried out on 150 IBS-C subjects divided into three groups ( F_1 , F_2 , and F_3 ) . Each group received a daily oral administration of probiotic mixtures ( for 60 days ) F_1 or F_2 or placebo F_3 , respectively . Fecal microbiological analyses were performed by species-specific qPCR to assess the different amount of probiotics . Results . The percentage of responders for each symptom was higher in the probiotic groups when compared to placebo group during the treatment period ( t60 ) and was maintained quite similar during the follow-up period ( t90 ) . Fecal analysis demonstrated that probiotics of the formulations increased during the times of treatment only in fecal DNA from subjects treated with F_1 and F_2 and not with F_3 , and the same level was maintained during the follow-up period . Conclusions . Multispecies probiotic supplementations are effective in IBS-C subjects and induce a different assessment in the composition of intestinal microbiota . This clinical study is registered with the clinical study registration number IS RCT N15032219 BACKGROUND Irritable bowel syndrome ( IBS ) is a common disorder in Iran with challenging treatment . Although trials have suggested that probiotics alleviate the complaints of patients with minimal side effects , they have not been investigated in Iranian adults . METHODS In a r and omized double-blind study , 108 eligible IBS patients ( Rome III Criteria ) aged 20 - 70 years who referred consecutively to a clinical center in Tehran with abdominal bloating from 2010 to 2012 received a combination probiotics or placebo twice daily for 4 weeks . The objective was to evaluate the efficacy and safety of a multi-strain probiotics combination . One week prior to and throughout the treatment , the participants recorded their abdominal symptoms on a daily basis , using visual analogue scale and reported satisfactory relief of general symptoms at the end of each week . Adverse events were evaluated by self-reporting and physical examination . Continuous variables were analyzed by independent t-test and chi-square was used for binomials . RESULTS The baseline characteristics were balanced ( 60 % female , mean age 36.7 ± 11.5 ) . A total of 97 ( 51 intervention , 46 control ) completed the treatment . Intention to treat analysis was done on 108 allocated subjects . 85 % of the probiotic group reported satisfactory relief of general symptoms compared with 47 % in the control group ( P < 0.01 ) . A reduction in abdominal bloating and pain with probiotic was superior to placebo [ -13.0 vs. -3.7 ( P < 0.01 ) , -8.2 vs. -2.1 ( P = 0.02 ) , respectively ] . No severe adverse drug reaction was seen in either group . CONCLUSIONS A 4-week period of treatment with the combination probiotics twice daily was safe , well tolerated , and effective in our patients . Further investigation is recommended for other subgroups of IBS . Trial Registration : I RCT .ir I RCT 2012071010230N1 Background Probiotics have treatment efficacy in irritable bowel syndrome ( IBS ) , but the exact mechanism remains obscure . One hypothesis is the mediation of melatonin levels , leading to changes in IBS symptoms . Aim The purpose of this study was to evaluate the effects of a probiotic , VSL#3 , on symptoms , psychological and sleep parameters , and pain sensitivity in IBS , and relate these parameters to in vivo melatonin levels . Methods Forty-two IBS patients were r and omly assigned to receive VSL#3 or placebo for 6 weeks . Subjects completed bowel and psychological question naires , underwent rectal sensitivity testing and saliva melatonin assays . Results Abdominal pain duration and distension intensity decreased significantly in the probiotic group , along with an increase in rectal distension pain thresholds . A correlation between increase in pain tolerance and improvement in abdominal pain scores ( r = 0.51 , p = 0.02 ) was seen with probiotic . There was an increase in salivary morning melatonin levels in males treated with VSL#3 , which correlated ( r = 0.61 ) with improved satisfaction in bowel habits . When grouped based on baseline diurnal melatonin levels , patients with normal diurnal fluctuations showed an increase in morning melatonin levels with VSL#3 treatment , which significantly correlated with improved satisfaction in bowel habits ( r = 0.68 ) . They also had reduced symptom severity scores and abdominal pain duration when treated with VSL#3 , as well as satisfaction with bowel movements and quality -of-life . Conclusions VSL#3 improved symptoms and increased rectal pain thresholds . Symptom improvement correlated with a rise in morning melatonin , significant in males and subjects with normal circadian rhythm . This suggests that probiotics may act by influencing melatonin production , hence modulating IBS symptoms , in individuals with a normal circadian rhythm BACKGROUND Irritable bowel syndrome ( IBS ) is characterized by heterogeneous pathophysiology and low response to treatment . Up to 60 % of IBS patients suffers from visceral hypersensitivity , which is associated with symptom severity and underlying pathophysiological mechanisms . Recently , positive effects of probiotics in IBS have been reported , but overall the response was modest . We performed a study in IBS patients , characterized by visceral hypersensitivity measured with the rectal barostat , aim ing to assess the effect of 6 weeks of multispecies probiotic mix on visceral pain perception . METHODS We conducted a r and omized , placebo-controlled , double-blind trial in forty Rome III IBS patients with visceral hypersensitivity . Prior to intake , patients kept a 2-week symptom diary and underwent a rectal barostat measurement . When hypersensitivity was confirmed , participation was allowed and patients received a multispecies probiotic with in vitro proven potential beneficial effects on mechanisms contributing to visceral hypersensitivity ( six different probiotic strains ; 10(9 ) cfu/g ) , or a placebo product of one sachet ( 5 g ) per day for 6 weeks . At the end of the intervention period , visceroperception and symptoms were reassessed . KEY RESULTS Thirty-five patients completed the trial . The percentage of patients with visceral hypersensitivity decreased significantly in the probiotic and placebo group ( 76.5 % and 71.4 % , respectively ; N.S. between groups ) . Improvement in pain scores and mean symptom score did not differ between the probiotic and placebo group . CONCLUSIONS & INFERENCES In this placebo-controlled trial in IBS patients with visceral hypersensitivity , no significant effect of a multispecies probiotic on viscerperception was observed . The study has been registered in the US National Library of Medicine ( http://www . clinical trials.gov , NCT00702026 ) Objectives : There has been an increasing interest in the role of fermentable oligo- , di- , and monosaccharides and polyols ( FODMAPs ) in irritable bowel syndrome ( IBS ) . We report results from the first r and omized controlled trial of the low FODMAP diet in US adults with IBS and diarrhea ( IBS-D ) . The objectives were to compare the efficacy of the low FODMAP diet vs. a diet based upon modified National Institute for Health and Care Excellence guidelines ( mNICE ) on overall and individual symptoms in IBS-D patients . Methods : This was a single-center , r and omized-controlled trial of adult patients with IBS-D ( Rome III ) which compared 2 diet interventions . After a 2-week screening period , eligible patients were r and omized to a low FODMAP or mNICE diet for 4 weeks . The primary end point was the proportion of patients reporting adequate relief of IBS-D symptoms ≥50 % of intervention weeks 3–4 . Secondary outcomes included a composite end point which required response in both abdominal pain ( ≥30 % reduction in mean daily pain score compared with baseline ) and stool consistency ( decrease in mean daily Bristol Stool Form of ≥1 compared with baseline ) , abdominal pain and stool consistency responders , and other key individual IBS symptoms assessed using daily question naires . Results : After screening , 92 subjects ( 65 women , median age 42.6 years ) were r and omized . Eighty-four patients completed the study ( 45 low FODMAP , 39 mNICE ) . Baseline demographics , symptom severity , and nutrient intake were similar between groups . Fifty-two percent of the low FODMAP vs. 41 % of the mNICE group reported adequate relief of their IBS-D symptoms ( P=0.31 ) . Though there was no significant difference in the proportion of composite end point responders ( P=0.13 ) , the low FODMAP diet result ed in a higher proportion of abdominal pain responders compared with the mNICE group ( 51 % vs. 23 % , P=0.008 ) . Compared with baseline scores , the low FODMAP diet led to greater reductions in average daily scores of abdominal pain , bloating , consistency , frequency , and urgency than the mNICE diet . Conclusions : In this US trial , 40–50 % of patients reported adequate relief of their IBS-D symptoms with the low FODMAP diet or a diet based on modified NICE guidelines . The low FODMAP diet Output:

Overall , the beneficial effects were more distinct in the trials using multi-strain supplements with an intervention of 8 weeks or more , suggesting that multi-strain probiotics supplemented over a period of time have the potential to improve IBS symptoms

MS2_1shot166

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The relationship between molecular defect and clinical phenotype has been examined in 42 patients with heterozygous familial hypercholesterolaemia ( FH ) and premature coronary heart disease . The defined defects included mutations in the low density lipoprotein (LDL)-receptor gene ( 23/42 ) or the apolipoprotein B Arg3500Gln mutation ( 5/42 ) . Mean LDL-cholesterol was higher , both before and during treatment with simvastatin and bile acid sequestrants , in patients predicted as having a ' severe ' mutation than in those with a ' mild ' mutation ( 8.72 + /- 2.02 mmol/l vs 6.63 + /- 1.8 , P = 0.05 before and 4.51 + /- 0.90 mmol/l vs 3.19 + /- 0.58 , P = 0.05 during treatment ) . Maximum inducible LDL-receptor activity in cultured lymphoblasts was inversely correlated with LDL-cholesterol before ( r2 = 0.499 , P = 0.002 ) and during ( r2 = 0.478 , P = 0.004 ) treatment in patients with a defined mutation in the LDL-receptor gene , but not in the 14 patients with no detectable molecular defect . LDL-cholesterol concentrations before and during treatment were significantly correlated in patients with a defined LDL-receptor gene mutation ( r2 = 0.548 , P = 0.0001 ) , but not in those with no detectable genetic defect . All these correlations were weak , however and there were no differences in the response to treatment in terms of either relative reduction or absolute decrease in LDL-cholesterol concentration between patients with different LDL-receptor defects . We conclude that only part of the variable phenotype of heterozygous FH patients is explained by different LDL-receptor defects and that other factors determine the severity of their hypercholesterolaemia and the onset of coronary disease The relation of peripheral flow-mediated vasodilation and coronary arterial calcium was studied in young patients with heterozygous familial hypercholesterolemia ( FH ) using high-resolution ultrasound and multi-detector computed tomography ( MDCT ) . We found that peripheral flow mediated vasodilation , a precursor of atherosclerosis , is altered in young heterozygous patients with FH . This alteration occurs before coronary arterial or aortic root calcium can be detected by MDCT and is independently related to hypercholesterolemia Output:

The risks of myopathy and clinical adverse events were also similar in both groups . AUTHORS ' CONCLUSIONS Statin treatment is an efficient lipid-lowering therapy in children with familial hypercholesterolemia . It seems to be safe in the short term but long-term safety is unknown .

MS2_1shot167

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Enhanced vascularization appears to be important for follicular selection and maturation in both spontaneous and stimulated IVF cycles . Nitric oxide , formed in vivo from L-arginine , may play a key role in follicular maturation and ovulation . METHODS To evaluate the role of L-arginine supplementation in controlled ovarian hyperstimulation , 37 IVF patients were divided into two groups according to ovarian stimulation protocol s : group I , GnRH agonist plus pure (p)FSH plus oral L-arginine ( n = 18 ) ; and group II , GnRH agonist plus pFSH plus placebo ( n = 19 ) . Hormonal , ultrasonographic and Doppler evaluations were performed , and plasma and follicular fluid nitrite/nitrate concentrations were monitored . RESULTS Thirty-two patients completed the study . In group I ( n = 16 ) , plasma L-arginine concentrations increased from ( basal ) 87 + /- 12 micromol to 279 + /- 31 micromol ( P = 0.002 ) on the day of beta-HCG administration . In this group , pFSH treatment was shorter ( P = 0.039 ) than in group II ( n = 16 ) . The number of the follicles > or = 17 mm was lower ( P = 0.038 ) in group I than group II . The " good quality " embryos were fewer in number ( P = 0.034 ) and pregnancy rate , both per patient ( P = 0.024 ) and per embryo transfer ( P = 0.019 ) , was lower in group I. In the L-arginine group , an increased follicular fluid concentration of nitrite/nitrate was observed . On day 8 of the cycle , elevated plasma estradiol levels were associated with decreased blood flow resistances of perifollicular arteries . Follicular fluid concentrations of nitrite/nitrate were inversely correlated with embryo quality ( r = -0.613 ; P = 0.005 ) and perifollicular artery pulsatility index ( r = -0.609 ; P = 0.021 ) . CONCLUSIONS L-Arginine supplementation may be detrimental to embryo quality and pregnancy rate during controlled ovarian hyperstimulation cycles Insulin resistance is one of the most common features of polycystic ovary syndrome ( PCOS ) . Some studies suggest that vitamin D deficiency may have a role in insulin resistance ; thus , the aim of the current study was to determine the effect of vitamin D supplementation on insulin resistance in women with PCOS and a vitamin D deficiency . We hypothesized that vitamin D supplementation would lower the glucose level and insulin resistance in women with PCOS and a vitamin D deficiency . The current study was a r and omized , placebo-controlled , double-blinded trial with 50 women with PCOS and a vitamin D deficiency , 20 to 40 years old , assigned to receive 3 oral treatments consisting of 50,000 IU of vitamin D₃ or a placebo ( 1 every 20 days ) for 2 months ( vitamin D , n = 24 ; placebo , n = 26 ) . The fasting blood glucose , insulin , 25-hydroxyvitamin D , and parathyroid hormone levels , as well as the homeostasis model assessment of insulin resistance and quantitative insulin sensitivity check index were measured at baseline and after treatment . In the vitamin D group , the serum level of 25-hydroxyvitamin D increased ( 6.9 ± 2.8 to 23.4 ± 6.1 ng/mL , P < .0001 ) , and the parathyroid hormone level decreased ( 70.02 ± 43.04 to 50.33 ± 21.99 μ IU/mL , P = .02 ) . There were no significant changes in the placebo group . There was a significant increase in insulin secretion in the vitamin D group ( P = .01 ) , but this was not significant compared with the placebo group . The fasting serum insulin and glucose levels and the insulin sensitivity and homeostasis model assessment of insulin resistance did not change significantly by the end of the study . We were not able to demonstrate the effect of vitamin D supplementation on insulin sensitivity and insulin resistance in women with PCOS and vitamin D deficiency Introduction . We evaluated the effects of a therapy that combines myo-inositol ( MI ) and D-chiro-inositol ( DCI ) in young overweight women affected by polycystic ovary syndrome ( PCOS ) , characterized by oligo- or anovulation and hyper and rogenism , correlated to insulin resistance . Methods . We enrolled 46 patients affected by PCOS and , r and omly , we assigned them to two groups , A and B , treated , respectively , with the association of MI plus DCI , in a 40 : 1 ratio , or with placebo ( folic acid ) for six months . Thus , we analyzed pretreatment and posttreatment FSH , LH , 17-beta-Estradiol , Sex Hormone Binding Globulin , and rostenedione , free testosterone , dehydroepi and rosterone sulphate , HOMA index , and fasting glucose and insulin . Results . We recorded a statistically significant reduction of LH , free testosterone , fasting insulin , and HOMA index only in the group treated with the combined therapy of MI plus DCI ; in the same patients , we observed a statistically significant increase of 17-beta-Estradiol levels . Conclusions . The combined therapy of MI plus DCI is effective in improving endocrine and metabolic parameters in young obese PCOS affected women Purpose : To evaluate the impact of ascorbic acid of different doses as additional support during luteal phase in infertility treatment by means of a prospect i ve , r and omized , placebo-controlled , group comparative , double-blind study . Methods : Voluntary daily oral intake of either ascorbic acid ( 1 , 5 , or 10 g/day ) or Placebo for 14 days after follicle aspiration for IVF-ET procedure . Data was obtained on 620 cases of women , age < 40 years , undergoing first IVF-embryo transfer cycles in two private out-patient infertility clinics . All women were stimulated by the same protocol . The mean age was 31.73 ( ±4.4 SD ) years . Results : No differences in clinical pregnancy rate and implantation rate were noted in statistical logistic regression analysis between the four intake groups . Conclusions : There was no clinical evidence of any beneficial effect , as defined by main outcome measures , of ascorbic acid on IVF-ET . Our data suggest there is no obvious value of high dosed intake of vitamin C during luteal phase in infertility treatment The aim of this r and omized double-blind placebo-controlled pilot study was to evaluate N-acetyl-cysteine ( NAC ) as an adjunctive therapy following unilateral laparoscopic ovarian drilling ( LOD ) for clomiphene citrate-resistant women with polycystic ovary syndrome ( PCOS ) . A total of 60 patients with clomiphene citrate-resistant PCOS who underwent unilateral LOD were assigned r and omly to receive either NAC 1.2 g/d ( group A=30 ) or placebo ( group B=30 ) for 5 days starting at day 3 of the cycle for 12 consecutive cycles . The primary outcome was pregnancy rate ; secondary outcomes were ovulation rates , endometrial thickness and pregnancy outcome . Baseline clinical , endocrine , and sonographic characteristics were similar in the two groups . A significant increase in both ovulation and pregnancy rates was observed in the NAC group , compared with placebo [ 87 % versus 67 % ( RR 1.3 ; 95 % CI 1.2 - 2.7 ) and 77 % versus 57 % ( RR 1.4 ; 95 % CI 1.1 - 2.7 ) , respectively , P<0.01 ] . Moreover , miscarriage rates were significantly lower and live birth rates were significantly higher in the NAC group [ 8.7 % versus 23.5 % ( RR 0.4 ; 95 % CI 0.1 - 3.7 ) and 67 % versus 40 % ( RR 1.7 ; 95 % CI 0.3 - 3.5 ) , respectively , P<0.01 ] . In conclusion , NAC is a novel adjuvant therapy after unilateral LOD which might help improve overall reproductive outcome AIM The aim of this study was to evaluate the effect of oral N-acetylcysteine ( NAC ) administration as an adjuvant to clomiphene citrate ( CC ) on induction of ovulation outcomes in patients with polycystic ovary syndrome ( PCOS ) . MATERIAL AND METHODS In this placebo-controlled double-blind r and omized clinical trial , 180 PCOS infertile patients were r and omly divided into two groups for induction of ovulation . Patients in group 1 received CC 100 mg/d plus NAC 1.2 g/d and patients in group 2 received CC plus placebo for 5 days starting at day 3 of the cycle . On the 12th day of the menstrual cycle in the presence of at least one follicle with an 18 - 20-mm diameter in ultrasound evaluation , 10,000 U hCG was injected intramuscularly and timed intercourse was advised 36 h after hCG injection . Serum β-hCG level was measured on the 16th day after hCG injection . RESULTS The number of follicles > 18 mm and the mean endometrial thickness on the day of hCG administration were significantly higher among the CC+NAC group ( P-value = 0.001 ) . The ovulation and pregnancy rates were also significantly higher in the CC+NAC group ( P-value = 0.02 and 0.04 , respectively ) . No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC . CONCLUSION NAC as a safe and well-tolerated adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients . It may also have some beneficial impacts on endometrial thickness There is some controversy over the need for double data entry in clinical trials . In particular , does the number and types of errors identified with this approach justify the extra effort involved ? We report the results of a study carried out to address this question . Our main outcome measure was the frequency and types of errors involved in the entry of data for the CHART ( continuous , hyperfractionated , accelerated radiotherapy ) trials . Data were reentered for a sample of 44 patients by a data manager other than the one making the initial entry . The second entry was then compared with the first entry . The error rate for the two entries combined was 14 per 10,000 data items ( fields ) ( 95 % confidence interval 10 , 19 ) . The error rate for the initial entry alone was 15 per 10,000 fields ( 95 % confidence interval 9.5 , 22 ) , and the vital/important error rate ( defined as any error on a principal outcome measure or a major error on any other endpoint or variable ) was 2.5 per 10,000 fields ( 95 % confidence interval 0.68 , 6.4 ) . On this evidence double data entry is not performed for the CHART trials BackgroudPolycystic Ovary Syndrome ( PCOS ) is a multifactorial pathology that affects 10 % of the women in reproductive age being the main cause of infertility due to menstrual dysfunction . Since 1980 , it is known that PCOS is associated with insulin resistance ( IR ) . The recognition of this association has prompted extensive investigation on the relationship between insulin and gonadal function , and has turned insulin sensitizer agent as the main therapeutic choice . In particular two different polyalcohol myo-inositol and D-chiro-inositol have been shown to improve insulin resistance , hyper and rogenism and to induce ovulation in PCOS women . In particular , while data on myo-inositol and restored ovulation were consistent , data on D-chiro-inositol were not . Recently , a comparative study , proposed a D-chiro-inositol paradox in the ovary of PCOS patients hypothesizing that only myo-inositol has a specific ovarian action . In the present study we aim to further study the role played by D-chiro-inositol at ovarian level . Methods A total of 54 women , aged < 40 years and diagnosed with PCOS were enrolled in this study . Patients with insulin resistance and /or hyperglycaemia were excluded from the study . Patients were r and omly divided into 5 groups ( n=10 - 12 ) : a placebo group , and 4 groups ( A-D ) that received 300 - 600 - 1200 - 2400 mg of DCI daily respectively . All treatments were carried out for 8 weeks before follicle stimulating hormone ( rFSH ) administration . Results Total r-FSH units increased significantly in the two groups that received the higher doses of DCI . The number of immature oocytes was significantly increased in the three groups that received the higher doses of DCI . Concurrently , the number of MII oocytes was significantly lower in the D group compared to placebo group . Noteworthy , the number of grade I embryos was significantly reduced by DCI supplementation . Conclusions Indeed , increasing DCI dosage progressively worsens oocyte quality and ovarian response OBJECTIVE To determine Output:

In this review , there was very low- quality evidence to show that taking an antioxidant may provide benefit for subfertile women , but insufficient evidence to draw any conclusions about adverse events . At this time , there is limited evidence in support of supplemental oral antioxidants for subfertile women

MS2_1shot168

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Regular physical exercise is broadly recommended by current European and American hypertension guidelines . It remains elusive , however , whether exercise leads to a reduction of blood pressure in resistant hypertension as well . The present r and omized controlled trial examines the cardiovascular effects of aerobic exercise on resistant hypertension . Resistant hypertension was defined as a blood pressure ≥140/90 mm Hg in spite of 3 antihypertensive agents or a blood pressure controlled by ≥4 antihypertensive agents . Fifty subjects with resistant hypertension were r and omly assigned to participate or not to participate in an 8- to 12-week treadmill exercise program ( target lactate , 2.0±0.5 mmol/L ) . Blood pressure was assessed by 24-hour monitoring . Arterial compliance and cardiac index were measured by pulse wave analysis . The training program was well tolerated by all of the patients . Exercise significantly decreased systolic and diastolic daytime ambulatory blood pressure by 6±12 and 3±7 mm Hg , respectively ( P=0.03 each ) . Regular exercise reduced blood pressure on exertion and increased physical performance as assessed by maximal oxygen uptake and lactate curves . Arterial compliance and cardiac index remained unchanged . Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment . It should be included in the therapeutic approach to resistant hypertension Objectives The aim of the study was to examine the additive effect of resistance training ( RT ) to a dietary education ( DE ) intervention on emerging coronary heart disease ( CHD ) risk factors , concentration of apolipoproteins B ( apoB ) and A-I ( apoA-I ) , and Dietary Approaches to Stop Hypertension ( DASH ) Diet Index scores in overweight and obese older adults . Patients and methods This was an ancillary study of a r and omized clinical trial held in the Fall of 2008 at the University of Rhode Isl and . Participants were overweight or obese subjects ( mean body mass index [ BMI ] of 31.7 kg/m2 ) r and omized into two groups , one participating in DE only ( n = 12 ) and the other participating in DE plus RT ( DERT ) ( n = 15 ) . The intervention involved all subjects participating in 30 minutes of DE per week for 10 weeks . Subjects in the DERT group participated in an additional 40 minutes of RT three times per week for 10 weeks . Measurements taken were anthropometric ( height , weight , waist circumference , and body composition using the BOD POD ® [ Body Composition System , v 2.14 ; Life Measurement Instruments , Concord , CA ] ) , clinical ( blood pressure ) , and biochemical ( lipid profile and apoB and apoA-I concentrations ) , and the DASH Diet Index was used to measure diet quality . Results 27 subjects ( 11 males , 16 females ) , with a mean age of 66.6 ± 4.3 years , were included in analyses . The DERT subjects had significantly better triacylglycerol and apoB concentrations and DASH Diet Index scores than the DE subjects post-intervention . Improvements were seen within the DE group in energy intake , fat-free mass , and systolic blood pressure and within the DERT group in body weight , percentage of body fat , BMI , diastolic blood pressure , and oxidized low-density lipoprotein ( all P < 0.05 ) . Conclusion The addition of RT effectively reduced CHD risk factors , body composition , and diet quality in overweight and obese older adults ; DERT was more effective than DE alone in improving DASH Diet Index scores and lowering apoB concentrations but was not more effective in increasing apoA-I concentrations . Future research is needed to determine if apolipoproteins are superior to lipoprotein cholesterol concentrations in predicting CHD risk Objective : To determine the blood pressure responses in elderly normotensive men and women to dietary sodium and to the diunsaturated fatty acid dihomogammalinolenic acid ( DGLA ) , which is derived from linoleic acid Design : Blood pressure responses were assessed in 66 subjects ( 36 male , 30 female ; mean age 65 years ) on two diets differing by approximately 70mmol/day sodium , combined with daily supplements of either 1 g DGLA or 1 g safflower oil , giving a four-group parallel design . After a common period of salt restriction and salt supplementation , two sets of parallel groups continued with either salt or placebo tablets . The study was blinded , except for dietary adjustments based on 24-h urinary sodium excretion values measured once every 2 weeks . Blood pressures were also measured automatically once every 2 weeks Results : Urinary sodium excretion ( sodium intake ) correlated significantly with systolic and diastolic blood pressures . A strong interaction with sex ( P < 0.001 for systolic blood pressure ) reflected greater responsiveness in women to changing sodium intake . A second major determinant of blood pressure responsiveness was the waist : hip ratio , an index of central obesity ; this correlation was independent of the initial sodium intake , initial blood pressure or body mass index . The waist : hip ratio was a powerful predictor of blood pressure changes with sodium intake in women only ; women with and roid fat distribution were , similarly to men , less sensitive to dietary sodium . Daily supplements of 1 g DGLA doubled the concentration of DGLA in plasma but did not influence blood pressure Conclusions : Among elderly normotensive subjects , women responded to changes in sodium intake with greater changes in blood pressure than men did . Furthermore , this response was strongly related to the gynaecoid distribution of body OBJECTIVE We evaluated the effects of exercise on neurobehavioral function in healthy older people more than 75 years of age . DESIGN A r and omized controlled trial with 6-month follow-up was conducted . SETTING The study was performed in the rural town of Kahoku , Japan , the population of which is considered representative of the older population of Japan . PARTICIPANTS We studied 42 healthy volunteers ( 18 men and 24 women ; mean age , 79 years ( range 75 to 87 years ) ) who were r and omly assigned to one of two groups , exercise or control . INTERVENTION Subjects assigned to the exercise group were instructed to exercise for 60 minutes twice a week for 6 months . Subjects in the control group were not instructed to engage in an specific exercise regimen . MEASUREMENTS The following measurements were recorded for both groups at baseline and at 6-month follow-up : ( 1 ) Neurobehavioral function as determined by the following tests : Mini-Mental State Exam ( MMSE ) , Hasegawa Dementia Scale Revised ( HDSR ) , Visuospatial Cognitive Performance Test ( VCP-test ) , Button score , Up & Go test , and Functional Reach ; and ( 2 ) Body mass index and blood pressure . RESULTS The effects of exercise were shown in the Up & Go test , and Functional Reach ( ANOVA with repeated measures ) . CONCLUSION This study demonstrates the acceptability and effectiveness of exercise on neurobehavioral function , even in older people more than 75 years of age Objective : To describe the contribution of changes in fitness and fatness result ing from exercise training on changes in submaximal exercise blood pressure ( BP ) during treadmill testing . Design and setting : Prospect i ve , r and omised , controlled trial . Participants : Sedentary older adults ( n = 115 ) with untreated prehypertension or mild hypertension . Intervention : Six-month supervised aerobic and strength training . Main outcome measurement : Systolic BP ( SBP ) was assessed at rest and during each stage of a maximal grade d exercise test ( GXT ) that determined Vo2peak . General and regional fatness was assessed by anthropometry , dual-energy x-ray absorptiometry and MRI . BP changes were calculated for each GXT stage , and multivariate regression models were used to describe the association of changes in exercise BP with changes in fitness and fatness . Results : After training , exercisers versus controls had significantly increased Vo2peak and significantly lower measures of general and regional fatness . Also , stage-specific SBP was significantly lower at stage 3 ( −9.4 vs −1.6 mm Hg , p = 0.03 ) and stage 4 ( −7.9 vs −1.2 mm Hg , p = 0.03 ) . Pooled regression analysis across all stages showed that exercisers had a 7.1 mm Hg reduction in SBP , but this reduction fell short of statistical significance ( p = 0.12 ) compared with controls . A 1.0 ml/kg/min increase in Vo2peak and a 1.0 cm decrease in waist circumference independently predicted a 1.0 mm Hg decrease in exercise SBP ( p = 0.04 and p = 0.001 , respectively ) . Conclusions : Decreased exercise SBP was independently associated with decreased waist circumference , a marker of abdominal obesity and increased fitness . These findings suggest that exercise training improves multiple factors that have an independent influence on SBP Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers BACKGROUND there have been few population -based , r and omized controlled trials on the effects of strength or endurance training on cardiovascular fitness in older women . OBJECTIVE to study the effects of strength or endurance training on cardiovascular fitness in women aged 76 - 78 years . DESIGN a population -based , r and omized controlled trial . SETTING exercise laboratory in a university faculty of sport and health sciences . SUBJECTS we r and omly assigned 42 medically-screened women aged 76 - 78 years , drawn from the population register to strength ( n=16 ) , endurance ( n=15 ) or control ( n=11 ) groups . METHODS subjects in the two exercise groups performed a supervised , individually tailored 18-week strength or endurance training programme . Controls continued with physical activity at their normal level . RESULTS the strength training group showed an increase in cycle ergometer peak power from 68.1 to 70.3 W ( P=0.035 compared with controls ) . Their peak power per kg body weight increased from 1.02 to 1.05 , while that of the endurance training group increased from 0.91 to 0.93 ( P=0.027 and P=0.049 respectively ) . Peak oxygen uptake increased from 18.1 to 19.7 ml x kg(-1 ) x min(-1 ) in the strength and from 17.1 to 18.2 in the endurance group ( non-significant ) . Six subjects ( 19 % ) in the exercise groups withdrew from the study because of health problems . CONCLUSIONS even with its limitations , the study suggests that the effect of 18-week strength or endurance training on cardiovascular fitness among women aged > /=75 is relatively small . Furthermore , health problems can emerge during training programmes in medically-screened elderly women The purpose of this study was to investigate the effect of resistance training on resting blood pressure and heart rate variability in elderly postmenopausal women . 29 untrained , non-hypertensive elderly women were r and omly assigned to 2 groups : an intervention group ( n=15 , 65.5±5.0 years , 57.3±6.5 kg , 156.7±5.1 cm ) that underwent a supervised resistance training program ( 8 exercises , 2 sets , 10 - 15 repetitions , 3 times/week ) or a control group ( n=14 , 66.2±4.1 years , 61.1±11.7 kg , 157.5± Output:

Aerobic exercise training , dynamic resistance exercise training , COM , and isometric exercise training all elicited significant reductions in both systolic and diastolic BP , with no additional benefit of COM compared with single modality exercise training . Three months of traditional exercise-based lifestyle intervention may produce a reduction in BP of approximately 5 mmHg systolic and 3 mmHg diastolic in older individuals , similar to that expected in younger individuals

MS2_1shot169

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Aims /hypothesisThere has been long-st and ing debate about whether diabetes is a causal risk factor for pancreatic cancer or a consequence of tumour development . Prospect i ve epidemiological studies have shown variable relationships between pancreatic cancer risk and blood markers of glucose and insulin metabolism , overall and as a function of lag times between marker measurements ( blood donation ) and date of tumour diagnosis . Methods Pre-diagnostic levels of HbA1c and C-peptide were measured for 466 participants with pancreatic cancer and 466 individually matched controls within the European Prospect i ve Investigation into Cancer and Nutrition . Conditional logistic regression models were used to estimate ORs for pancreatic cancer . Results Pancreatic cancer risk gradually increased with increasing pre-diagnostic HbA1c levels up to an OR of 2.42 ( 95 % CI 1.33 , 4.39 highest [ ≥6.5 % , 48 mmol/mol ] vs lowest [ ≤5.4 % , 36 mmol/mol ] category ) , even for individuals with HbA1c levels within the non-diabetic range . C-peptide levels showed no significant relationship with pancreatic cancer risk , irrespective of fasting status . Analyses showed no clear trends towards increasing hyperglycaemia ( as marked by HbA1c levels ) or reduced pancreatic beta cell responsiveness ( as marked by C-peptide levels ) with decreasing time intervals from blood donation to cancer diagnosis . Conclusions /interpretationOur data on HbA1c show that individuals who develop exocrine pancreatic cancer tend to have moderate increases in HbA1c levels , relatively independently of obesity and insulin resistance — the classic and major risk factors for type 2 diabetes . While there is no strong difference by lag time , more data are needed on this in order to reach a firm conclusion CONTEXT Diabetes is a serious and costly disease that is becoming increasingly common in many countries . The role of diabetes as a cancer risk factor remains unclear . OBJECTIVE To examine the relationship between fasting serum glucose and diabetes and risk of all cancers and specific cancers in men and women in Korea . DESIGN , SETTING , AND PARTICIPANTS Ten-year prospect i ve cohort study of 1,298,385 Koreans ( 829,770 men and 468,615 women ) aged 30 to 95 years who received health insurance from the National Health Insurance Corp and had a biennial medical evaluation in 1992 - 1995 ( with follow-up for up to 10 years ) . MAIN OUTCOME MEASURES Death from cancer and registry-documented incident cancer or hospital admission for cancer . RESULTS During the 10 years of follow-up , there were 20,566 cancer deaths in men and 5907 cancer deaths in women . Using Cox proportional hazards models and controlling for smoking and alcohol use , the stratum with the highest fasting serum glucose ( > or = 140 mg/dL [ > or = 7.8 mmol/L ] ) had higher death rates from all cancers combined ( hazard ratio [ HR ] , 1.29 ; 95 % confidence interval [ CI ] , 1.22 - 1.37 in men and HR , 1.23 ; 95 % CI , 1.09 - 1.39 in women ) compared with the stratum with the lowest level ( < 90 mg/dL [ < 5.0 mmol/L ] ) . By cancer site , the association was strongest for pancreatic cancer , comparing the highest and lowest strata in men ( HR , 1.91 ; 95 % CI , 1.52 - 2.41 ) and in women ( HR , 2.05 ; 95 % CI , 1.43 - 2.93 ) . Significant associations were also found for cancers of the esophagus , liver , and colon/rectum in men and of the liver and cervix in women , and there were significant trends with glucose level for cancers of the esophagus , colon/rectum , liver , pancreas , and bile duct in men and of the liver and pancreas in women . Of the 26,473 total cancer deaths in men and women , 848 were estimated as attributable to having a fasting serum glucose level of less than 90 mg/dL. For cancer incidence , the general patterns reflected those found for mortality . For persons with a diagnosis of diabetes or a fasting serum glucose level greater than 125 mg/dL ( 6.9 mmol/L ) , risks for cancer incidence and mortality were generally elevated compared with those without diabetes . CONCLUSION In Korea , elevated fasting serum glucose levels and a diagnosis of diabetes are independent risk factors for several major cancers , and the risk tends to increase with an increased level of fasting serum glucose BACKGROUND Viruses ( such as Epstein-Barr virus ) and pathological conditions ( mainly involving immunosuppression ) have been shown to increase the risk of haematolymphopoietic malignancies . Other associations ( diabetes , tonsillectomy , autoimmune diseases ) have been inconsistently reported . METHODS The association between different haematolymphopoietic malignancies ( lymphomas , myelomas and leukaemias ) and the previous medical history has been studied in a population -based case-control investigation conducted in Italy , based on face to face interviews to 2669 cases and 1718 population controls ( refusal rates 10 % and 19 % , respectively ) . Controls were a r and om sample of the general population . RESULTS Previous findings were confirmed concerning the association between non-Hodgkin 's lymphoma ( NHL ) and lupus erythematosus ( odds ratio , OR=8.4 ; 95 % CI 1.6 , 45 ) , tuberculosis ( OR=1.6 ; 1.05 , 2.5 ) and hepatitis ( 1.8 ; 1.4 , 2.3 ) . An association was found also between NHL and maternal ( OR=2.8 ; 1.1 , 6.9 ) or paternal tuberculosis ( OR=1.7 ; 0.7 , 3.9 ) . Odds ratios of 4.0 ( 1.4 , 11.8 ) and 4.4 ( 1.1 , 6.6 ) were detected for the association between NHL and Hodgkin 's disease , respectively , and previous infectious mononucleosis , but recall bias can not be ruled out . No association was found with diabetes , tonsillectomy and adenoidectomy . An association with malaria at young age and “ low grade ” lymphatic malignancies is suggested . One interesting finding was the observation of four cases of poliomyelitis among NHL patients , one among Hodgkin 's disease and one among myeloid leukaemia patients , compared with none among the controls ( Fisher 's exact test for NHL and Hodgkin 's disease , p= 0.03 , one tail ) . CONCLUSIONS Some of these findings are confirmatory of previous evidence . Other observations , such as the putative role of the polio virus and of malaria are new . A unifying theory on the mechanisms by which previous medical history may increase the risk of haematolymphopoietic malignancies is still lacking Background A large prospect i ve study in patients with type 2 diabetes ( T2D ) , the German D2C cohort , is presently being enumerated to investigate risk factors of incident cancer in diabetic patients . Study setting A disease management program was offered , on a voluntary basis , to all T2D patients who were members of a statutory health insurance fund in Germany . This first feasibility report uses data from 26.742 T2D patients , who were 40 to 79 years old , resided in the Muenster District , and who were enrolled between June 2003 and July 2008 . Cancer cases were identified through the regional Cancer Registry . Methods Invasive cancer cases were identified using probabilistic record linkage procedures and pseudonymised personal identifiers . Censoring date was December 31 , 2008 . We included only first cancers , leaving 12.650 male and 14.092 female T2D with a total of 88.778 person-years ( py ) . We computed st and ardised incidence ratios ( SIR ) for external comparisons and we employed Cox regression models and hazard ratios ( HR ) within the cohort . Results We identified 759 first cancers among male T2D patients ( 18.7 per 1,000 py ) and 605 among females ( 12.7 per 1,000 py ) . The risk of any incident cancer in T2D was raised ( SIR = 1.14 ; 95 % confidence interval [ 1.10 - 1.21 ] ) , in particular for cancer of the liver ( SIR = 1.94 [ 1.15 - 2.94 ] ) and pancreas ( SIR = 1.45 [ 1.07 - 1.92 ] ) . SIRs decreased markedly with time after T2D diagnosis . In Cox models , adjusting for diabetes duration , body mass index and sex , insulin therapy was related to higher cancer risk ( HR = 1.25 [ 1.17 - 1.33 ] ) . No effect was seen for metformin . Discussion Our study demonstrates feasibility of record linkage between DMP and cancer registries . These first cohort results confirm previous reports . It is envisaged to enhance this cohort by inclusion of further regions of the state , expansion of the follow-up times , and collection of a more detailed medication history Aims /hypothesisDespite the vast body of epidemiological literature on the risk of cancer in people with diabetes , few studies have examined the pattern of cancer risk during different time windows following diabetes onset . The objective of the study was to examine the risks of site-specific cancer in people with incident type 2 diabetes during different time windows following diabetes onset . Methods This was a population -based retrospective cohort study . The study period was 1 April 1994 to 31 March 2006 ; censoring occurred at 31 March 2006 , at death or on departure from British Columbia , Canada . Using linked health data bases , we identified incident cohorts with and without diabetes , who were matched by age , sex and index year . Following a minimum 2-year cancer washout period , first site-specific cancers were identified prospect ively in both cohorts . Results Within 3 months following diabetes onset , participants with diabetes had significantly increased risks of colorectal , lung , liver , cervical , endometrial , ovarian , pancreatic and prostate cancers . After the initial 3-month period , the risks for colorectal ( HR 1.15 , 95 % CI 1.05 , 1.25 ) , liver ( HR 2.53 , 95 % CI 1.93 , 3.31 ) and endometrial ( HR 1.58 , 95 % CI 1.28 , 1.94 ) cancers remained significantly elevated compared with those without diabetes . The diabetes cohort remained at increased risk of pancreatic cancer in later years , but followed a different pattern : HR 3.71 at 3 months–1 year , 2.94 at 1–2 years , 1.78 at 2–3 years and 1.65 at 3–10 years ( p value for all < 0.01 ) . After an initial period of elevated risk , men with type 2 diabetes subsequently had a decreased risk of prostate cancer ( HR 0.82 , 95 % CI 0.76 , 0.88 ) . Conclusions /interpretationPeople with type 2 diabetes are at increased risk of select cancers ; this risk is particularly elevated at the time of diabetes onset , which is likely to be due to increased ascertainment OBJECTIVE To quantify the association of treated diabetes with cancer incidence and cancer mortality as well as cancer case fatality and all-cause mortality in adults who subsequently develop cancer and to calculate attributable fractions due to diabetes on various cancer outcomes . RESEARCH DESIGN AND METHODS Prospect i ve data on 599 diabetic and 17,681 nondiabetic adults from the CLUE II ( Give Us a Clue to Cancer and Heart Disease ) cohort in Washington County , Maryl and , were analyzed . Diabetes was defined by self-reported use of diabetes medications at baseline . Cancer incidence was ascertained using county and state cancer registries . Mortality data were obtained from death certificates . RESULTS From 1989 to 2006 , 116 diabetic and 2,365 nondiabetic adults developed cancer , corresponding to age-adjusted incidence of 13.25 and 10.58 per 1,000 person-years , respectively . Adjusting for age , sex , education , BMI , smoking , hypertension treatment , and high cholesterol treatment using Cox proportional hazards regression , diabetes was associated with a higher risk of incident cancer ( hazard ratio 1.22 [ 95 % CI 0.98–1.53 ] ) and cancer mortality ( 1.36 [ 1.02–1.81 ] ) . In individuals who developed cancer , adults with diabetes had a higher risk of cancer case fatality ( 1.34 [ 1.002–1.79 ] ) and all-cause mortality ( 1.61 [ 1.29–2.01 ] ) . For colorectal , breast , and prostate cancers , the attributable fractions result ing from diabetes were larger for cancer fatality and mortality than cancer incidence . CONCLUSIONS In this Output:

The findings were similar for men and women , and unrelated to study design . Meta-regression analyses showed limited effect modification of body mass index , and possible effect modification of age , gender , with some influence of study characteristics ( population source , cancer- and diabetes ascertainment ) . The systematic review and meta- analysis confirm the previous results of increased cancer risk in diabetes and extend this to additional cancer sites .

MS2_1shot170

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Insulin-like growth factor I ( IGF-I ) stimulates cell proliferation and inhibits apoptosis in the lung and other tissues by interacting with the IGF-I receptor . The major binding protein for IGF-I , insulin-like growth factor-binding protein 3 ( IGFBP-3 ) , modulates the effects of IGF-I but also inhibits cell growth and induces apoptosis independent of IGF-I and its receptor . In a prospect i ve study of men in Shanghai , China , we examined the association between serum levels of IGF-I and IGFBP-3 and the subsequent risk of lung cancer . METHODS From 1986 to 1989 , serum was collected from 18,244 men aged 45 - 64 years living in Shanghai without a history of cancer . We analyzed IGF-I and IGFBP-3 levels in serum from 230 case patients who developed incident lung cancer during follow-up and from 740 control subjects . RESULTS Among 230 case patients and 659 matched control subjects , increased IGF-I levels were not associated with increased risk of lung cancer . However , for subjects in the highest quartile relative to the lowest quartile of IGFBP-3 , the odds ratio ( OR ) for lung cancer , adjusted for smoking and IGF-I , was 0.50 ( 95 % confidence interval [ CI ] = 0.25 to 1.02 ) . When the analysis was restricted to ever smokers ( 184 case patients and 344 matched control subjects ) , the OR for lung cancer in men in the highest quartile of IGFBP-3 relative to those in the lowest quartile , adjusted for smoking and IGF-I , was 0.41 ( 95 % CI = 0.18 to 0.92 ) . CONCLUSIONS In this prospect i ve study of Chinese men , higher serum levels of IGF-I did not increase the risk of lung cancer . However , subjects with higher serum levels of IGFBP-3 were at reduced risk of lung cancer . This finding is consistent with experimental data that indicate that IGFBP-3 can inhibit cellular proliferation and induce apoptosis independent of IGF-I and the IGF-I receptor We investigated the acute ( 4 - 5 h ) and short-term ( 5 days ) effects of GH treatment on hepatic messenger RNA ( mRNA ) levels of the genes for the insulin-like growth factors ( IGFs ) , insulin-like growth factor binding protein-1 , -2 , and -3 ( IGFBPs ) , and the acid labile subunit ( ALS ) , as well as serum levels of these proteins in humans . At the mRNA level , we observed an increase in IGF-1 transcription ( + 173 % ) following GH treatment in the acute group , which remained elevated in the short-term treatment group . IGFBP-2 mRNA decreased after short-term GH treatment , without changes in IGFBP-1 or -3 expression . The ALS transcript level increased after 5 days . In serum , we found increased levels of IGF-I and insulin , and decreased levels of IGF-II , in the short-term treatment group . IGFBP-1 decreased in both treatment groups , whereas IGFBP-2 was reduced after 5 days treatment . ALS increased in the short-term group . We observed increased IGFBP-3 serum levels after 5 days of GH treatment , likely due to increased formation of the ternary complex . Our results show that the metabolic effects by GH on the IGF axis are complex . In addition to a direct stimulation of IGF-I and ALS expression , GH inhibits IGFBP-1 serum levels and IGFBP-2 expression in an indirect manner , possibly facilitating enhanced IGF bioavailability to target tissues BACKGROUND Insulin-like growth factor-I ( IGF-I ) is a potent mitogen for normal and neoplastic cells , whereas IGF-binding protein-3 ( IGFBP-3 ) inhibits cell growth in many experimental systems . Acromegalics , who have abnormally high levels of growth hormone and IGF-I , have higher rates of colorectal cancer . We therefore examined associations of plasma levels of IGF-I and IGFBP-3 with the risk of colorectal cancer in a prospect i ve case-control study nested in the Physicians ' Health Study . METHODS Plasma sample s were collected at baseline from 14916 men without diagnosed cancer . IGF-I , IGF-II , and IGFBP-3 were assayed among 193 men later diagnosed with colorectal cancer during 14 years of follow-up and among 318 age- and smoking-matched control subjects . All P values are two-sided . RESULTS IGFBP-3 levels correlated with IGF-I levels ( r=.64 ) and with IGF-II levels ( r=.90 ) . After controlling for IGFBP-3 , age , smoking , body mass index ( weight in kg/[height in m]2 ) , and alcohol intake , men in the highest quintile for IGF-I had an increased risk of colorectal cancer compared with men in the lowest quintile ( relative risk [RR]=2.51 ; 95 % confidence interval [CI]=1.15 - 5.46 ; P for trend = .02 ) . After controlling for IGF-I and other covariates , men with higher IGFBP-3 had a lower risk ( RR=0.28 ; 95 % CI=0.12 - 0.66 ; P for trend = .005 , comparing extreme quintiles ) . The associations were consistent during the first and the second 7-year follow-up intervals and among younger and older men . IGF-II was not associated with risk . CONCLUSIONS Our findings suggest that circulating IGF-I and IGFBP-3 are related to future risk of colorectal cancer BACKGROUND Insulin-like growth factor (IGF)-I , a mitogenic and antiapoptotic peptide , can affect the proliferation of breast epithelial cells , and is thought to have a role in breast cancer . We hypothesised that high circulating IGF-I concentrations would be associated with an increased risk of breast cancer . METHODS We carried out a nested case-control study within the prospect i ve Nurses ' Health Study cohort . Plasma concentrations of IGF-I and IGF binding protein 3 ( IGFBP-3 ) were measured in blood sample s collected in 1989 - 90 . We identified 397 women who had a diagnosis of breast cancer after this date and 620 age-matched controls . IGF-I concentrations were compared by logistic regression with adjustment for other breast-cancer risk factors . FINDINGS There was no association between IGF-I concentrations and breast-cancer risk among the whole study group . In postmenopausal women there was no association between IGF-I concentrations and breast-cancer risk ( top vs bottom quintile of IGF-I , relative risk 0.85 [ 95 % CI 0.53 - 1.39 ] ) . The relative risk of breast cancer among premenopausal women by IGF-I concentration ( top vs bottom tertile ) was 2.33 ( 1.06 - 5.16 ; p for trend 0.08 ) . Among premenopausal women less than 50 years old at the time of blood collection , the relative risk was 4.58 ( 1.75 - 12.0 ; p for trend 0.02 ) . After further adjustment for plasma IGFBP-3 concentrations these relative risks were 2.88 and 7.28 , respectively . INTERPRETATION A positive relation between circulating IGF-I concentration and risk of breast cancer was found among premenopausal but not postmenopausal women . Plasma IGF-I concentrations may be useful in the identification of women at high risk of breast cancer and in the development of risk reduction strategies . Additional larger studies of this association among premenopausal women are needed to provide more precise estimates of effect BACKGROUND Insulin-like growth factors ( IGFs ) , in particular IGF-I and IGF-II , strongly stimulate the proliferation of a variety of cancer cells , including those from lung cancer . To examine the possible causal role of IGFs in lung cancer development , we compared plasma levels of IGF-I , IGF-II , and an IGF-binding protein ( IGFBP-3 ) in patients with newly diagnosed lung cancer and in control subjects . METHODS From an ongoing hospital-based , case-control study , we selected 204 consecutive patients with histologically confirmed , primary lung cancer and 218 control subjects who were matched to the case patients by age , sex , race , and smoking status . IGF-I , IGF-II , and IGFBP-3 plasma levels were measured by enzyme-linked immunosorbent assay and then divided into quartiles , based on their distribution in the control subjects . Associations between the IGF variables and lung cancer risk were estimated by use of odds ratios ( ORs ) . Reported P values are two-sided . RESULTS IGF and IGFBP-3 levels were positively correlated ( all r>.27 ; all P<.001 ) . High plasma levels of IGF-I were associated with an increased risk of lung cancer ( OR = 2.06 ; 95 % confidence interval [ CI ] = 1.19 - 3.56 ; P = .01 ) , and this association was dose dependent in both univariate and multivariate analyses . Plasma IGFBP-3 showed no association with lung cancer risk unless adjusted for IGF-I level ; when both of these variables were analyzed together , high plasma levels of IGFBP-3 were associated with reduced risk of lung cancer ( OR = 0.48 ; 95 % CI = 0.25 - 0.92 ; P = .03 ) . IGF-II was not associated with lung cancer risk . CONCLUSIONS Plasma levels of IGF-I are higher and plasma levels of IGFBP-3 are lower in patients with lung cancer than in control subjects . If these findings can be confirmed in prospect i ve studies , measuring levels of IGF-I and IGFBP-3 in blood may prove useful in assessing lung cancer risk Recent prospect i ve studies have suggested that insulin-like growth factor (IGF)-I levels are related to risk of some epithelial cancers . We previously reported in a case-control study a significant association between IGF-I level and lung cancer risk , with a 2-fold increased risk in the highest quartile . We now report the results of a lung cancer case-control study nested in the placebo arm of the beta-Carotene and Retinol Efficacy Trial in heavy smokers . We identified 159 cases for whom sera had been collected at least 3 years before diagnosis and for whom 2 suitable controls/case ( final number , 297 ) could be matched from the same study arm on age ( within 5-year intervals ) , sex , ethnicity , year of enrollment into the beta-Carotene and Retinol Efficacy Trial , year of blood draw , and exposure category ( smoking or asbestos ) . The cases were significantly heavier smokers than the controls ( mean pack-years , 58.7 and 45.9 , respectively ; P < 0.001 ) . An inverse relationship between IGF-I level and age was evident only for former smokers , and not for those who were current smokers at the time of blood draw . Both IGF-I and IGF-binding protein (IGFBP)-3 levels were higher in cases than in controls , but none of the differences achieved statistical significance . The odds ratios for IGF-I were around unity , except for subsets of heaviest smokers and those who had quit smoking for the longest period of time , in whom there were elevated risks in the second to fourth quartiles of IGF-I relative to the first quartile ( odds ratios , 2.21 - 2.91 ) , although again , none achieved statistical significance . For younger subjects , IGF-I was inversely associated with lung cancer risk in the models that also controlled for IGFBP-3 . Elevated risks for lung cancer were noted in the highest quartile of IGFBP-3 level , and these tended to be higher in current smokers and more recent quitters . These results do not support the conclusions of our prior case-control study . It is possible that current smoking or recent cessation may exert a suppressive effect on IGF-I levels ( notably in younger subjects with higher baseline levels ) that may obscure a relatively modest association between IGF-I level and lung cancer risk . On the other h and , risks associated with elevated IGFBP-3 level tended to be higher in current smokers and more recent quitters . This trend toward a positive association with IGFBP-3 level is unexpected and requires further investigation . Finally , from these data , we can not exclude the possibility that risk of lung cancer in nonsmokers may be related to IGF-I levels Output:

Conclusion The association between circulating IGF- I levels and the risk of lung cancer were not statistically significant ; IGFBP-3 , acts as a tumor suppressor and has a inverse correlation with the risk of lung cancer

MS2_1shot171

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIM To evaluate the effects of metformin on insulin resistance , and rogen concentration , ovulation rates and pregnancy rates in infertile women with polycystic ovary syndrome ( PCOS ) . METHODS Forty-two infertile women with PCOS were selected in this r and omized clinical study . Basal steroid and gonadotropin levels were measured , and oral glucose tolerance test ( OGTT ) was performed . The patients were r and omly divided into group 1 ( n = 21 ) and group 2 ( n = 21 ) . Group 1 patients were treated with laparoscopic ovarian drilling ( LOD ) . Group 2 patients underwent laparoscopic ovarian drilling ( LOD ) and received 1700 mg per day of metformin for 6 months . LOD was performed in women with PCOS using a unipolar electrode . Serum progesterone ( P ) level > 5 ng/mL was considered as a confirmation of ovulation . Ovulation and pregnancy rates were determined after six cycles . RESULTS Serum and rogens and insulin response to OGTT decreased significantly after metformin therapy . Mean serum P levels and endometrial thickness were significantly higher in cycles treated with metformin plus LOD ( 34.6 + /- 25.4 ng/mL , 8.4 + /- 1.1 mm ) than in those treated with LOD alone ( 26.2 + /- 24.7 ng/mL , 7.9 + /- 2.8 mm ) ( P < 0.05 ) . The ovulation ( 56 of 65 cycles , 86.1 % vs 29 of 65 cycles , 44.6 % ) and pregnancy rates ( nine of 21 women , 47.6 % vs four of 21 women , 19.1 % ) were significantly higher in group 2 than in group I. CONCLUSIONS Metformin improves insulin resistance , reduces and rogen levels and significantly increases the ovulation and pregnancy rates in infertile women , following LOD We prospect ively estimated the prevalence of the polycystic ovary syndrome ( PCOS ) , as defined by the NIH/NICHHD 1990 endocrine criteria , in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation . Anthropometric data ; the presence of hirsutism , acne , and and rogenic alopecia ; and the menstrual history were recorded by a single investigator . In 145 women , blood sample s were also obtained for measurement of serum and rogen levels . PCOS was defined by the presence of 1 ) oligomenorrhea , 2 ) clinical and /or biochemical hyper and rogenism , and 3 ) exclusion of hyperprolactinemia , thyroid disorders , and nonclassic 21-hydroxylase deficiency . Hirsutism was defined by a modified Ferriman-Gallwey score of 8 or more , acne was considered as a sign of hyper and rogenism when persistent after the second decade of life , and hyper and rogenemia was defined by an increase in circulating testosterone or dehydroepi and rosterone sulfate or an increase in the free and rogen index above the 95th percentile of the control values derived from the nonhirsute , nonacneic women having regular menses who were not receiving hormonal therapy . PCOS was present in 10(6.5 % ) , hirsutism was present in 11 ( 7.1 % ) , and acne was present in 19 ( 12.3 % ) of the 154 women . Our results demonstrate a 6.5 % prevalence of PCOS , as defined , in a minimally biased population of Caucasian women from Spain . The polycystic ovary syndrome , hirsutism , and acne are common endocrine disorders in women OBJECTIVE To evaluate the effect of ultra-short ( 12 days ) metformin pretreatment in clomiphene-citrate ( CC ) resistant polycystic ovary syndrome ( PCOS ) . METHOD Eighty women with CC-resistant PCOS were r and omly allocated to metformin pretreatment or usual treatment . Forty women received 1500 mg metformin daily for 12 days , followed by clomiphene 150 mg daily for 5 days along with metformin . Forty women ( control group ) received the same dose of clomiphene but no metformin pretreatment . RESULTS In the metformin group , 17 ( 42.5 % ) women ovulated , and 6 ( 15 % ) conceived . In the control group , 5 ( 12.5 % ) women ovulated but none conceived . Compared with the control group , the metformin group had significantly higher ovulation ( P = 0.03 ) and pregnancy rates ( P = 0.026 ) . CONCLUSION Twelve days of metformin pretreatment improves ovulation and pregnancy rates in women with CC-resistant PCOS BACKGROUND Obese women with the polycystic ovary syndrome are relatively unresponsive to the induction of ovulation by clomiphene . We hypothesized that reducing insulin secretion by administering metformin would increase the ovulatory response to clomiphene . METHODS We performed oral glucose-tolerance tests before and after the administration of 500 mg of metformin or placebo three times daily for 35 days in 61 obese women with the polycystic ovary syndrome . Women who did not ovulate spontaneously were then given 50 mg of clomiphene daily for five days while continuing to take metformin or placebo . Serum progesterone was measured on days 14 , 28 , 35 , 44 , and 53 , and ovulation was presumed to have occurred if the concentration exceeded 8 ng per milliliter ( 26 nmol per liter ) on any of these days . RESULTS Twenty-one women in the metformin group and 25 women in the placebo group were given clomiphene because they did not ovulate spontaneously during the first phase of the study . Among the 21 women given metformin plus clomiphene , the mean ( + /-SE ) area under the serum insulin curve after oral glucose administration decreased from 6745+/-2021 to 3479+/-455 microU per milliliter per minute ( 40.5+/-12.1 to 20.9+/-2.7 nmol per liter per minute , P=0.03 ) , but it did not change significantly in the 25 women given placebo plus clomiphene . Nineteen of the 21 women ( 90 percent ) who received metformin plus clomiphene ovulated ( mean peak serum progesterone concentration , 23.8+/-3.4 ng per milliliter [ 7.6+/-10.9 nmol per liter ] ) . Two of the 25 women ( 8 percent ) who received placebo plus clomiphene ovulated ( P<0.001 ) . Overall , 31 of the 35 women ( 89 percent ) treated with metformin ovulated spontaneously or in response to clomiphene , as compared with 3 of the 26 women ( 12 percent ) treated with placebo . CONCLUSIONS The ovulatory response to clomiphene can be increased in obese women with the polycystic ovary syndrome by decreasing insulin secretion with metformin BACKGROUND There are few data in the literature regarding the utility of metfomin before and during gonadotrophin administration in women with polycystic ovary syndrome ( PCOS ) . The aim of the present study was to assess the effect of the pre-treatment and co-administration of metformin in infertile PCOS women treated with controlled ovarian stimulation ( COS ) followed by timed intercourse ( TI ) or intrauterine insemination ( IUI ) . METHODS Seventy insulin-resistant primary infertile women with PCOS were r and omized to receive metformin cloridrate ( 850 mg twice daily ; group A ) or placebo tablets ( two tablets daily ; group B ) for 3 months . Three trials of COS using highly purified urinary FSH ( hpFSH ) plus TI/IUI were performed . Number of ampoules of gonadotrophin used , duration of the ovarian stimulation , cycle cancellation , ovulation , pregnancy , abortion , live birth , mono-ovulatory cycles , multiple pregnancies and ovarian hyperstimulation syndrome ( OHSS ) rates were assessed . RESULTS No difference between groups was detected in ovulation , cycle cancellation , pregnancy , abortion , live birth , multiple pregnancies and OHSS rates . The mono-ovulatory cycle rates were significantly ( P = 0.002 ) more frequent in group A than in group B , whereas the days of stimulation for non-cancelled cycles and the number of vials of gonadotrophins used were significantly ( P < 0.001 ) higher in group A than in group B. CONCLUSION In insulin-resistant women with PCOS , metformin pre-treatment and co-administration with hpFSH increases the mono-ovulatory cycles Estimates of the prevalence of the polycystic ovary syndrome ( PCOS ) in the general population have ranged from 2 - 20 % . The vast majority of these reports have studied White population s in Europe , used limited definitions of the disorder , and /or used bias population s , such as those seeking medical care . To estimate the prevalence of this disorder in the United States and address these limitations , we prospect ively determined the prevalence of PCOS in a reproductive-aged population of 369 consecutive women ( 174 White and 195 Black ; aged 18 - 45 yr ) , examined at the time of their preemployment physical . Body measures were obtained , and body hair was quantified by a modified Ferriman-Gallwey ( F-G ) method . All exams were initially performed by 2 trained nurses , and any subject with an F-G score above 3 was reexamined by a physician , the same for all patients . Of the 369 women , 277 ( 75.1 % ) also agreed to complete a question naire and have additional blood drawn . Subjects were studied regardless of current estrogen/progestin hormonal use ( 28.5 % ) . PCOS was defined as 1 ) oligoovulation , 2 ) clinical hyper and rogenism ( i.e. hirsutism ) and /or hyper and rogenemia , and 3 ) exclusion of other related disorders , such as hyperprolactinemia , thyroid abnormalities , and non-classic adrenal hyperplasia . Hirsutism was defined by a F-G score of 6 or more , and hyper and rogenemia was defined as a total or free testosterone , and rostenedione , and /or dehydroepi and rosterone sulfate level above the 95th percentile of control values [ i.e. all eumenorrheic women in the study , who had no hirsutism ( F-G < or = 5 ) or acne and were receiving no hormonal therapy ; n = 98 ] . Considering all 369 women studied , White and Black women had similar mean ages ( 29.4 + /- 7.1 and 31.1 + /- 7.8 yr , respectively ) , although White women had a lesser body mass than Black women ( 24.9 + /- 6.1 vs. 29.2 + /- 8.1 kg/m2 , respectively ; P < 0.001 ) . Of these 7.6 % , 4.6 % , and 1.9 % demonstrated a F-G score of 6 or more , 8 or 10 , respectively , and there was no significant racial difference , with hirsutism prevalences of 8.0 % , 2.8 % , and 1.6 % in Whites , and 7.1 % , 6.1 % , and 2.1 % in Blacks , respectively . Of the 277 women consenting to a history and hormonal evaluation , 4.0 % had PCOS as defined , 4.7 % ( 6 of 129 ) of Whites and 3.4 % ( 5 of 148 ) of Blacks . In conclusion , in our consecutive population of unselected women the prevalence of hirsutism varied from 2 - 8 % depending on the chosen cut-off F-G score , with no significant difference between White and Black women . Using an F-G score of 6 or more as indicative of hirsutism , 3.4 % of Blacks and 4.7 % of Whites had PCOS as defined . These data suggest that PCOS may be one of most common reproductive endocrinological disorders of women OBJECTIVES To evaluate the clinical features , endocrine and metabolic profiles in clomiphene ( CC ) responders and non-responders with polycystic ovarian disease ( PCOD ) , and to examine the effects of metformin ( MTF ) on the above parameters of CC resistance . METHODS A prospect i ve clinical trial was undertaken at the infertility division of a university teaching hospital . Forty-one CC responders were selected and their hormonal and clinical features were determined . Forty-one CC-resistant PCOD women were also selected and clinical features ; metabolic and hormonal profiles before and after treatment with MTF 1500 mg/day for 6 - 8 weeks were evaluated . Women who failed to conceive were treated by CC while continuing to take MTF . RESULTS CC responders had higher insulin levels while non-responders were hyperinsulinemic . Menstrual irregularities improved in 30 % . Mean+/-S.D. area under curve of insulin decreased from 297.58+/-19 Output:

This meta- analysis demonstrates that CC is still first choice therapy for women with therapy naïve PCOS . In CC-resistant women , the combination of CC plus metformin is the preferred treatment option before starting with LOD or FSH . At present , there is no evidence of an improvement in live birth when adding metformin to LOD or FSH . In IVF , metformin leads to a reduced risk of OHSS

MS2_1shot172

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : Recently , a Risk of Ovarian Malignancy Algorithm ( ROMA ) utilising human epididymis secretory protein 4 ( HE4 ) and CA125 successfully classified patients as presenting a high or low risk for epithelial ovarian cancer ( EOC ) . We vali date d this algorithm in an independent prospect i ve study . Methods : Women with a pelvic mass , who were scheduled to have surgery , were enrolled in a prospect i ve study . Preoperative serum levels of HE4 and CA125 were measured in 389 patients . The performance of each of the markers , as well as that of ROMA , was analysed . Results : When all malignant tumours were included , ROMA ( receiver operator characteristic (ROC)-area under curve (AUC)=0.898 ) and HE4 (ROC-AUC)=0.857 ) did not perform significantly better than CA125 alone ( ROC – AUC=0.877 ) . Using a cutoff for ROMA of 12.5 % for pre-menopausal patients , the test had a sensitivity of 67.5 % and a specificity of 87.9 % . With a cutoff of 14.4 % for post-menopausal patients , the test had a sensitivity of 90.8 % and a specificity of 66.3 % . For EOC vs benign disease , the ROC – AUC of ROMA increased to 0.913 and for invasive EOC vs benign disease to 0.957 . Conclusion : This independent validation study demonstrated similar performance indices to those recently published . However , in this study , HE4 and ROMA did not increase the detection of malignant disease compared with CA125 alone . Although the initial reports were promising , measurement of HE4 serum levels does not contribute to the diagnosis of ovarian cancer Objective Women presenting with a large or complex ovarian cyst are referred to extensive surgical staging to ensure the correct diagnosis and treatment of a possible epithelial ovarian cancer . We hypothesized that measurement of the biomarkers HE4 and CA-125 preoperatively would improve the assignment of these patients to the correct level of care . Methods Patients diagnosed with a cystic ovarian mass and scheduled for an operation at our center of excellence for ovarian cancer surgery from 2001 to 2010 were prospect ively included ( n=394 ) and plasma was collected consecutively . Cut-off for HE4 was calculated at 75 % specificity ( 85 pM and 71.8 pM for post and premenopausal women ) . For CA-125 , 35 U/mL cut-off was used . The study population included women with malignant ( n=114 ) , borderline ( n=45 ) , and benign ( n=215 ) ovarian tumors . Results Receiver operator characteristic ( ROC ) area under the curve ( AUC ) in the benign versus malignant cohorts was 86.8 % for CA-125 and 84.4 % for HE4 . Negative predictive value was 91.7 % when at least one of the biomarkers was positive , with only early stage epithelial ovarian cancer showing false negative results . Sensitivity at set specificity ( 75 % ) was 87 % for risk of ovarian malignancy algorithm ( ROMA ) in the postmenopausal cohort ( cut-off point , 26.0 % ) and 81 % in the premenopausal cohort ( cut-off point , 17.3 % ) . ROC AUC in the benign versus stage I epithelial ovarian cancer was only 72 % for HE4 and 76 % for CA-125 . Conclusion In our study , population HE4 did not outperform CA-125 . Based on our data a prospect i ve trial with patients already diagnosed with an ovarian cyst may be conducted OBJECTIVE To derive simple and clinical ly useful ultrasound-based rules for discriminating between benign and malignant adnexal masses . METHODS In a multicenter study involving nine centers consecutive patients with persistent adnexal tumors underwent transvaginal gray-scale and Doppler ultrasound examination using a st and ardized examination technique and st and ardized terms and definitions . Information on 42 gray-scale ultrasound variables and six Doppler variables was collected and entered into a research protocol . When developing simple ultrasound-based rules to predict malignancy ( M-rules ) we chose the ultrasound variable or the combination of ultrasound variables that had the highest positive predictive value ( PPV ) with regard to malignancy ; when developing simple rules to predict a benign tumor ( B-rules ) we chose the ultrasound variable or the combination of ultrasound variables that had the lowest PPV with regard to malignancy . We selected ten rules that were in agreement with our clinical experience and were applicable to at least 30 tumors and then tested them prospect ively on 507 tumors examined in three of the nine centers . RESULTS 1066 patients with 1233 adnexal tumors were included . There were 903 benign tumors ( 73 % ) and 330 malignant tumors ( 27 % ) . In 167 patients the tumors were bilateral . We selected five simple rules to predict malignancy ( M-rules ) : ( 1 ) irregular solid tumor ; ( 2 ) ascites ; ( 3 ) at least four papillary structures ; ( 4 ) irregular multilocular-solid tumor with a largest diameter of at least 100 mm ; and ( 5 ) very high color content on color Doppler examination . We chose five simple rules to suggest a benign tumor ( B-rules ) : ( 1 ) unilocular cyst ; ( 2 ) presence of solid components where the largest solid component is < 7 mm in largest diameter ; ( 3 ) acoustic shadows ; ( 4 ) smooth multilocular tumor less than 100 mm in largest diameter ; and ( 5 ) no detectable blood flow on Doppler examination . These ten rules were applicable to 76 % of all tumors , where they result ed in a sensitivity of 93 % , specificity of 90 % , positive likelihood ratio ( LR+ ) of 9.45 and negative likelihood ratio ( LR- ) of 0.08 . When prospect ively tested the rules were applicable in 76 % ( 386/507 ) of the tumors , where they had a sensitivity of 95 % ( 106/112 ) , a specificity of 91 % ( 249/274 ) , LR+ of 10.37 , and LR- of 0.06 . CONCLUSION Most adnexal tumors in an ordinary tumor population can be correctly classified as benign or malignant using simple ultrasound-based rules . For tumors that can not be classified using simple rules , ultrasound examination by an expert examiner might be useful OBJECTIVE : It is often difficult to distinguish a benign pelvic mass from a malignancy and tools to help referring physician are needed . The purpose of this study was to vali date the Risk of Ovarian Malignancy Algorithm in women presenting with a pelvic mass . METHODS : This was a prospect i ve , multicenter , blinded clinical trial that included women who presented to a gynecologist , a family practitioner , an internist , or a general surgeon with an adnexal mass . Serum HE4 and CA 125 were determined preoperatively . A Risk of Ovarian Malignancy Algorithm score was calculated and classified patients into high-risk and low-risk groups for having a malignancy . The sensitivity , specificity , negative predictive value , and positive predictive value of the Risk of Ovarian Malignancy Algorithm were estimated . RESULTS : A total of 472 patients were evaluated with 383 women diagnosed with benign disease and 89 women with a malignancy . The incidence of all cancers was 15 % and 10 % for ovarian cancer . In the postmenopausal group , a sensitivity of 92.3 % and a specificity of 76.0 % and for the premenopausal group the Risk of Ovarian Malignancy Algorithm had a sensitivity of 100 % and specificity of 74.2 % for detecting ovarian cancer . When considering all women together , the Risk of Ovarian Malignancy Algorithm had a sensitivity of 93.8 % , a specificity of 74.9 % , and a negative predictive value of 99.0 % . CONCLUSION : The use of the serum biomarkers HE4 and CA 125 with the Risk of Ovarian Malignancy Algorithm has a high sensitivity for the prediction of ovarian cancer in women with a pelvic mass . These findings support the use of the Risk of Ovarian Malignancy Algorithm as a tool for the triage of women with an adnexal mass to gynecologic oncologists . LEVEL OF EVIDENCE : The aim of this work was to test and compare the accuracy of five different morphological scoring systems to identify malignant ovarian masses in a prospect i ve multicenter study . Four of the systems had previously been reported by Granberg , Sassone , De Priest and Lerner and the fifth is newly developed . A total of 330 ovarian neoplasms were collected in three different centers , which adopted the same diagnostic procedures . Of these , 261 masses were benign ( mean diameter 50 + /- 26 mm ) and 69 were malignant ( mean diameter 69 + /- 33 mm ) ( prevalence 21 % ) . The area under the receiver operating characteristic ( ROC ) curve for the multicenter score was 0.84 . This was significantly better than the areas of the other four scores which ranged from 0.72 to 0.75 . The cut-off levels derived from the five ROC curves achieved a sensitivity that ranged from 74 % ( Sassone score ) to 88 % ( De Priest score > or = 5 ) , and a specificity from 40 % ( De Priest ) to 67 % ( multicenter ) ; the highest positive predictive value was 41 % ( multicenter ) . With a cut-off level of 9 , the accuracy of the multicenter score was significantly better than the scores of Granberg and De Priest ( McNemar 's test p < 0.0001 ) . Similar results were obtained in 207 ovarian masses of < or = 5 cm in mean diameter , and when 19 borderline and 11 stage 1 cancers only were considered . For the clinical purpose s of a screening test we also checked a possible cut-off level of > or = 8 , which increased the sensitivity to 93 % with a drop of specificity to 56 % . With the use of the same criteria for the scores of the different authors , the following values were obtained for sensitivity : 96 % , 81 % , 93 % and 90 % ; and for specificity : 23 % , 56 % , 28 % and 49 % . The multicenter score performed well at distinguishing malignant from benign lesions , and was better than the other four traditional scores , for both large and small masses . This was mainly due to the introduction of two criteria that allowed correction for typical dermoids and endohemorrhagic corpora lutea . A completely reliable differentiation of benign from malignant masses can not be obtained by sonographic imaging alone OBJECTIVE To assess the value of ovarian Histo-Scanning ( ™ ) , a novel computerized technique for interpreting ultrasound data , in combination with the risk of malignancy index ( RMI ) in improving triage for women with adnexal masses . METHODS RMI indices were assessed in 199 women enrolled in a prospect i ve study to investigate the use of HistoScanning . Ultrasound scores were obtained by blinded analysis of archived images . The following sequential test was developed : HistoScanning was modeled as a second-line test for RMI between a lower cut-off and an upper cut-off . The optimal combination of these cut-offs that together maximized the Youden index ( Sensitivity + Specificity - 1 ) was determined . RESULTS Using RMI at the st and ard cut-off value of 250 result ed in a sensitivity of 74 % and a specificity of 86 % . When RMI was combined with HistoScanning , the highest accuracy was achieved by using HistoScanning as a sequential second-line test for patients with RMI values between 105 and 2100 . At these cut-off values , sequential use of RMI and HistoScanning result ed in mean sensitivity and specificity estimates of 88 % and 95 % , respectively . CONCLUSIONS Our data suggest that HistoScanning may have the potential to improve the diagnostic accuracy of RMI , which could result in better triage for women with adnexal masses . Further prospect i ve validation is warranted Background : Correct characterisation of ovarian tumours is critical to optimise patient care . The purpose of this study is to evaluate the diagnostic performance of the International Ovarian Tumour Analysis ( IOTA ) logistic regression model ( LR2 ) , ultrasound Simple Rules ( SR ) , the Risk of Malignancy Index ( RMI ) and subjective assessment ( SA ) for preoperative characterisation of adnexal masses , when ultrasonography is performed by examiners with different background training and experience . Methods : A 2-year prospect i ve multicentre cross-sectional study . Thirty-five level II ultrasound examiners contributed in three UK hospitals . Transvaginal ultrasonography was performed using a st and ardised approach . The final outcome was the surgical findings and histological diagnosis . To characterise the adnexal masses , the six-variable prediction model ( LR2 ) with a cutoff of 0.1 , the RMI with cutoff of 200 , ten SR ( five rules for malignancy and five rules for benignity ) and SA were applied . The area under the curves ( AUCs ) for performance of LR2 and RMI were calculated . Diagnostic performance measures for all models assessed were sensitivity , specificity , positive and negative likelihood ratios ( LR+ and LR− ) , and the diagnostic odds ratio ( DOR ) . Results : Nine-hundred and si Output:

The Risk of Malignancy Index ( RMI ) was the most frequently vali date d model .

MS2_1shot173

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Computer models of different strategies for the management of dyspepsia in primary care indicate that a ' test- and -treat ' approach is likely to be associated with the lowest costs and acceptable clinical outcomes . We present information on computer modelling studies and report the findings of a r and omised trial comparing a Helicobacter pylori test- and -treat strategy with referral to direct access endoscopy in the management of dyspepsia in general practice . We compared costs and clinical outcomes in patients managed for one year in study ( test- and -treat ) and control ( endoscopy ) practice s in south London . Patients aged less than 45 years presenting with persistent dyspepsia without alarm symptoms ( 141 study patients , 91 control patients ) were studied . In the one-year follow-up period there were 17 endoscopies in the study group : all the control patients underwent initial endoscopy and five further endoscopies were performed . None revealed peptic ulcer or cancer . Forty-three ( 30 % ) of the study patients compared with 16 ( 17 % ) of the controls were referred to hospital clinics ( p < 0.025 ) . The cost of management per patient for one year in the study group was 205.67 Pounds , compared with 404.31 Pounds in the control group ( p < 0.0001 ) . Clinical outcomes in both groups at one year were comparable . An H. pylori test- and -treat strategy for dyspeptic patients aged less than 45 , employing office-based serology testing , appears to be associated with substantially lower costs than initial endoscopy and with similar clinical outcomes Abstract Objective : To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care . Design : Multicentre r and omised controlled trial . Setting : 51 general practice s linked to nine Scottish maternity hospitals . Subjects : 1765 women at low risk of antenatal complications . Intervention : Routine antenatal care by general practitioners and midwives according to a care plan and protocol s for managing complications . Main outcome measures : Comparisons of health service use , indicators of quality of care , and women 's satisfaction . Results : Continuity of carer was improved for the general practitioner and midwife group as the number of carers was less ( median 5 carers v 7 for shared care group , P<0.0001 ) and the number of routine visits reduced ( 10.9 v 11.7 , P<0.0001 ) . Fewer women in the general practitioner and midwife group had antenatal admissions ( 27 % ( 222/834 ) v 32 % ( 266/840 ) , P<0.05 ) , non-attendances ( 7 % ( 57 ) v 11 % ( 89 ) , P<0.01 ) and daycare ( 12 % ( 102 ) v 7 % ( 139 ) , P<0.05 ) but more were referred ( 49 % ( 406 ) v 36 % ( 305 ) , P<0.0001 ) . Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders ( pregnancy induced hypertension , 5 % ( 37 ) v 8 % ( 70 ) , P<0.01 ) and fewer had labour induced ( 18 % ( 149 ) v 24 % ( 201 ) , P<0.01 ) . Few failures to comply with the care protocol occurred , but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check ( 2.5 % ( 20 ) v 0.4 % ( 3 ) , P<0.0001 ) . Both groups expressed high satisfaction with care ( 68 % ( 453/663 ) v 65 % ( 430/656 ) , P=0.5 ) and acceptability of allocated style of care ( 93 % ( 618 ) v 94 % ( 624 ) , P=0.6 ) . Access to hospital support before labour was similar ( 45 % ( 302 ) v 48 % ( 312 ) visited labour rooms before giving birth , P=0.6 ) . Conclusion : Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit . Key messages Key messages Care by general practitioners and midwives improved continuity of care : there were fewer carers , non-attendances , and hospital admissions , and marginally fewer routine visits than with specialist led shared care ; incidences of hypertension , proteinuria , pre-eclampsia , and induction of labour were also lower Overall there were few deviations from the care protocol , but a greater proportion of Rhesus negative women in the general practitioner and midwife group did not have an appropriate check for antibodies The women in both trial groups were equally highly satisfied with all aspects of their care ; only a small minority of women in the general practitioner and midwife group said they would have liked to have seen a hospital doctor but did not Although there was no net benefit from routine specialist antenatal visits , over half of women developed some complication during their pregnancy ; in the general practitioner and midwife model of care , low risk women see a specialist when required and not at predefined routine In a two year trial general practitioners in the West Midl and s were provided with extended waiting time information for hospital consultation and treatment in general surgery . Selected general practitioners were sent monthly bulletins on comparative times to wait for both outpatient appointment and inpatient treatment throughout the region . Their referrals to consultant general surgeons were monitored , alongside those of a matched control group not receiving such information . Differences were found between the two groups which indicate the willingness of general practitioners to change their referral practice when adequate information is available . In addition , patients referred to their local hospital had longer waiting times than patients matched for clinical condition and district of origin who were sent to hospitals where it was indicated that a shorter wait might be expected Abstract Objective : To investigate the effect of clinical guidelines on the management of infertility across the primary care- secondary care interface . Design : Cluster r and omised controlled trial . Setting : General practice s and NHS hospitals accepting referrals for infertility in the Greater Glasgow Health Board area . Participants : All 221 general practice s in Glasgow ; 214 completed the trial . Intervention : General practice s in the intervention arm received clinical guidelines developed locally . Control practice s received them one year later . Dissemination of the guidelines included educational meetings . Main outcome measures : The time from presentation to referral , investigations completed in general practice , the number and content of visits as a hospital outpatient , the time to reach a management plan , and costs for referrals from the two groups . Results : Data on 689 referrals were collected . No significant difference was found in referral rates for infertility . Fewer than 1 % of couples were referred inappropriately early . Referrals from intervention practice s were significantly more likely to have all relevant investigations carried out ( odds ratio 1.32 , 95 % confidence interval 1.00 to 1.75 , P=0.025 ) . 70 % of measurements of serum progesterone concentrations during the midluteal phase and 34 % of semen analyses were repeated at least once in hospital , despite having been recorded as normal when checked in general practice . No difference was found in the proportion of referrals in which a management plan was reached within one year or in the mean duration between first appointment and date of management plan . NHS costs were not significantly affected . Conclusions : Dissemination of infertility guidelines by commonly used methods results in a modest increase in referrals having recommended investigations completed in general practice , but there are no detectable differences in outcome for patients or reduction in costs . Clinicians in secondary care tended to fail to respond to changes in referral practice by doctors . Guidelines that aim to improve the referral process need to be disseminated and implemented so as to lead to changes in both primary care and secondary care . What is already known on this topic Most previous research into clinical guidelines has focused on their development and implementation Evidence is lacking about the outcomes and costs associated with the use of clinical guidelines What this study adds Clinical guidelines that may alter the balance of care between general practice and hospital setting s require more intensive implementation than guidelines aim ed at either setting on its own The cost effectiveness of clinical guidelines should not be BACKGROUND Counselling in primary care setting s remains largely unevaluated . Such evaluation has been strongly recommended . AIM To determine the relative effectiveness and cost-effectiveness of generic counselling and usual general practitioner ( GP ) care for patients with minor mental health problems . METHOD A r and omized controlled trial and health economic evaluation were carried out in nine general practice s. Access to generic counselling ( brief counselling , generally involving up to six 50-minute sessions ) was compared with usual GP care . A total of 162 patients aged 16 years and over with diverse mental health problems ( excluding phobic conditions and psychoses ) were r and omized . The Hospital Anxiety and Depression ( HAD ) scale , COOP/WONCA ( World Organization of Family Doctors ) functional health assessment charts , and the delighted-terrible faces scale were used to assess outcome four months after r and omization . RESULTS The two groups were similar at baseline . There were significant improvements in both groups between r and omization and follow-up for most outcome measures , but no significant differences between the study arms . The 95 % confidence limits were narrow and excluded clinical ly significant effects . Under various assumptions concerning the cost of secondary care referrals and of counselling time , no clear cost advantage was associated with either intervention . CONCLUSIONS This pragmatic trial demonstrates no difference in functional or mental health outcome at four months between subjects offered access to counselling and those given usual care by their GP . There is no clear difference in the cost-effectiveness of the two interventions . Purchasers should take account of these findings in allocating re sources within primary care OBJECTIVE --To evaluate guidelines for general practice management and referral of infertile couples . Guidelines were implemented with a disease specific reminder at the time of consultation ( the guidelines were embedded within a structured infertility management sheet for each couple ) . DESIGN --Pragmatic r and omised controlled trial . Participating practice s were r and omised to a group that received the guidelines and a control group . SETTING --82 general practice s in Grampian region . SUBJECTS--100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners . MAIN OUTCOME MEASURES --Whether the general practitioner had taken a full sexual history and examined and investigated both partners appropriately . RESULTS --Characteristics of patients referred by study and control general practitioners did not differ significantly at baseline . Compliance with the guidelines increased for all targeted activities . General practitioners in the study group were more likely to take a sexual history ( for example , couples ' use of fertile period , 85 % v 69 % , p < 0.01 ) ; examine both partners ( female partner , 68 % v 52 % , p < 0.05 ; male partner 39 % v 13 % , p < 0.01 ) ; and investigate both partners ( day 21 progesterone , 72 % v 41 % , p < 0.001 ; semen analysis , 51 % v 41 % , p > 0.05 ) . Improvements were greater when general practitioners used the disease specific reminder . CONCLUSION --Receiving guidelines led to improvements in the process of care of infertile couples within general practice . This effect was enhanced when the guidelines were embedded in a structured infertility management sheet for each couple A r and omized controlled trial of outpatient open-access physiotherapy was carried out at West Cornwall Hospital during 1979/80 . The referral rate to consultant outpatient clinics for those patients offered open-access physiotherapy was considerably lower than for the control group ( 17 per cent and 56 per cent respectively ) . Patients using the service received physiotherapy promptly although this did not result in shorter treatments . Those of the control group who eventually received physiotherapy had faced considerable delays . An analysis of self-reported information showed that patients receiving open-access physiotherapy recovered more rapidly . Taken overall , the results support the concept of open-access physiotherapy OBJECTIVE --To assess the clinical and economic impact of surgery based near patient testing in general practice for six commonly used biochemical and bacteriological tests . DESIGN --After four months ' monitoring , equipment for two bacteriological and four biochemical tests was introduced without cost into 12 practice s using a crossover design . Structured request forms were used to monitor laboratory investigations . SETTING --12 general practice s in west midl and s and south west Thames with list sizes above 9000 . MAIN OUTCOME MEASURES --Investigation rates per 1000 consultations . Changes from baseline rates . Reasons for requesting investigations and provisional diagnoses . Cost per test and sensitivity of costs to rate of use . RESULTS --Investigation rates for the six tests rose by 16.5 % ( from 78.6/1000 consultations to 91.6/1000 ) when equipment was available in the surgery and reverted to baseline rates when it was withdrawn . The average weekly number of tests when equipment was available ranged from 0.5 to 10.5 ( mean 9.0 ) . Cholesterol tests were used as an addition to laboratory testing , usually for screening . Midstream urine analysis was often done in the surgery instead of in the laboratory , although 30 % of sample s were tested by both methods . Doctors ' reasons for investigation and conditions tested were largely unaffected by availability of surgery tests . Costs for surgery tests were higher for all tests except midstream urine . CONCLUSIONS --Availability of surgery based testing increased the number of tests performed . It was cost effective only for midstream urine analysis OBJECTIVES This study Output:

Referral was not the primary outcome of interest in the majority of included studies . Professional interventions generally had an impact on referral rates consistent with the intended change in clinician behaviour . Similarly , specialist ' outreach ' or other primary care-based specialist provider schemes had at least a small effect upon referral rates to secondary care with the direction of effect being that intended or rational from a clinical and sociological perspective . Organisational innovations in the structure of service provision need not increase total costs to the National Health Service ( NHS ) , even though costs associated with referral may increase .

MS2_1shot174

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The optimal strategy to achieve palliation of malignant pleural effusions ( MPEs ) is unknown . This multi-institutional , prospect i ve , r and omized trial compares 2 established methods for controlling symptomatic unilateral MPEs . Patients with unilateral MPEs were r and omized to either daily tunneled catheter drainage ( TCD ) or bedside talc pleurodesis ( TP ) . This trial is patterned after a previous r and omized trial that showed that bedside TP was equivalent to thoracoscopic TP ( CALGB 9334 ) . The primary end point of the current study was combined success : consistent/reliable drainage/pleurodesis , lung expansion , and 30-day survival . A secondary end point , survival with effusion control , was added retrospectively . This trial r and omized 57 patients who were similar in terms of age ( 62 years ) , active chemotherapy ( 28 % ) , and histologic diagnosis ( lung , 63 % ; breast , 12 % ; other/unknown cancers , 25 % ) to either bedside TP or TCD . Combined success was higher with TCD ( 62 % ) than with TP ( 46 % ; odds ratio , 5.0 ; P = .064 ) . Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores ( 8.7 vs. 5.9 ; P = .036 ) , especially in the subgroup with impaired expansion ( 9.1 vs. 4.6 ; P = .042 ) . Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP ( 82 % vs. 52 % , respectively ; P = .024 ) . In this prospect i ve r and omized trial , TCD achieved superior palliation of unilateral MPEs than TP , particularly in patients with trapped lungs The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with recurrent symptomatic malignant pleural effusions ( MPE ) STUDY OBJECTIVE To demonstrate the efficacy , safety , and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions ( MPEs ) . DESIGN A prospect i ve , r and omized trial was design ed to compare thoracoscopy with talc insufflation ( TTI ) to thoracostomy and talc slurry ( TS ) for patients with documented MPE . MEASUREMENTS The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-exp and ed > 90 % . Morbidity , mortality , and quality of life were also assessed . RESULTS Of 501 patients registered , those eligible were r and omized to TTI ( n = 242 ) or TS ( n = 240 ) . Patient demographics and primary malignancies were similar between study arms . Overall , there was no difference between study arms in the percentage of patients with successful 30-day outcomes ( TTI , 78 % ; TS , 71 % ) . However , the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS ( 82 % vs 67 % ) . Common morbidity included fever , dyspnea , and pain . Treatment-related mortality occurred in nine TTI patients and seven TS patients . Respiratory complications were more common following TTI than TS ( 14 % vs 6 % ) . Respiratory failure was observed in 4 % of TS patients and 8 % of TTI patients , accounting for five toxic deaths and six toxic deaths , respectively . Quality -of-life measurement demonstrated less fatigue with TTI than TS . Patient ratings of comfort and safety were also higher for TTI , but there were no differences on perceived value or convenience of the procedures . CONCLUSIONS Both methods of talc delivery are similar in efficacy ; TTI may be better for patients with either a lung or breast primary . The etiology and incidence of respiratory complications from talc need further exploration BACKGROUND Malignant pleural effusion is associated with short life expectancy and significant morbidity . A r and omized controlled trial comparing indwelling pleural catheters ( IPCs ) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events . METHODS Using data from the clinical trial , we compared costs associated with use of IPCs and with talc pleurodesis . Re source use and adverse events were captured through case report forms over the 1-year trial follow-up . Costs for outpatient and inpatient visits , diagnostic imaging , nursing , and doctor time were obtained from the UK National Health Service reference costs and University of Kent 's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index . Procedure supply costs were obtained from the manufacturer . Difference in mean costs was compared using nonparametric bootstrapping . All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index . RESULTS Overall mean cost ( SD ) for managing patients with IPCs and talc pleurodesis was $ 4,993 ( $ 5,529 ) and $ 4,581 ( $ 4,359 ) , respectively . The incremental mean cost difference was $ 401 , with 95 % CI of -$1,387 to $ 2,261 . The mean cost related to ongoing drainage in the IPC group was $ 1,011 ( $ 732 ) vs $ 57 ( $ 213 ) in the talc pleurodesis group ( P = .001 ) . This included the cost of drainage bottles , dressing changes in the first month , and catheter removal . There was no significant difference in cost of the initial intervention or adverse events between the groups . For patients with survival < 14 weeks , IPC is significantly less costly than talc pleurodesis , with mean cost difference of -$1,719 ( 95 % CI , -$3,376 to -$85 ) . CONCLUSIONS There is no significant difference in the mean cost of managing patients with IPCs compared with talc pleurodesis . For patients with limited survival , IPC appears less costly . TRIAL REGISTRY is rct n.org ; No. : IS RCT N87514420 ; URL : www.is rct n.org PURPOSE To assess the effectiveness of tunneled pleural catheters ( TPCs ) in the treatment of malignant pleural effusions ( MPEs ) . MATERIAL S AND METHODS Twenty-eight patients with symptomatic MPEs had 31 hemithoraces treated with TPCs placed under image guidance . Chemical sclerotherapy had failed in two patients and two had symptomatic locules . Drainage was accomplished by intermittent connection to vacuum bottles . Pleurodesis was considered achieved when three consecutive outputs were scant and imaging showed no residual fluid . RESULTS All catheters were successfully placed . Dyspnea improved in 94 % ( 29 of 31 hemithoraces ) at 48 hours and 91 % ( 20 of 22 patients ) at 30 days . Control of the MPE was achieved in 90 % of hemithoraces ( 28/31 ) , although five required ancillary procedures . Pleurodesis occurred in 42 % ( 13 of 31 ) of hemithoraces , including both that underwent an earlier attempt at chemical sclerotherapy and one treated locule . Continued drainage without pleurodesis controlled the effusion in 48 % ( 15 of 31 ) . In only 7 % was hospital time necessary for care related to the TPC . Early , transient catheter-related pain was common , but only three complications ( in two patients ) occurred . Neither of these altered patient care . CONCLUSIONS Regardless of whether pleurodesis is achieved , TPCs provide effective long-term outpatient palliation of MPEs BACKGROUND Patients with malignant pleural effusion ( MPE ) have limited prognoses . They require long-lasting symptom relief with minimal hospitalization . Indwelling pleural catheters ( IPCs ) and talc pleurodesis are approved treatments for MPE . Establishing the implication s of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment . Therefore , our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days ( from procedure to death or end of follow-up ) and safety . METHODS In this prospect i ve , 12-month , multicenter study , patients with MPE were treated with IPC or talc pleurodesis , based on patient choice . Key end points were hospital bed days from procedure to death ( total and effusion-related ) . Complications , including infection and protein depletion , were monitored longitudinally . RESULTS One hundred sixty patients with MPE were recruited , and 65 required definitive fluid control ; 34 chose IPCs and 31 pleurodesis . Total hospital bed days ( from any causes ) were significantly fewer in patients with IPCs ( median , 6.5 days ; interquartile range [ IQR ] = 3.75 - 13.0 vs pleurodesis , mean , 18.0 ; IQR , 8.0 - 26.0 ; P = .002 ) . Effusion-related hospital bed days were significantly fewer with IPCs ( median , 3.0 days ; IQR , 1.8 - 8.3 vs pleurodesis , median , 10.0 days ; IQR , 6.0 - 18.0 ; P < .001 ) . Patients with IPCs spent significantly fewer of their remaining days of life in hospital ( 8.0 % vs 11.2 % , P < .001 , χ(2 ) = 28.25 ) . Fewer patients with IPCs required further pleural procedures ( 13.5 % vs 32.3 % in pleurodesis group ) . There was no difference in rates of pleural infection ( P = .68 ) and protein ( P = .65 ) or albumin loss ( P = .22 ) . More patients treated with IPC reported immediate ( within 7 days ) improvements in quality of life and dyspnea . CONCLUSIONS Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis . Safety profiles and symptom control were comparable CONTEXT Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy . Palliation is achieved by fluid drainage , but the most effective first-line method has not been determined . OBJECTIVE To determine whether indwelling pleural catheters ( IPCs ) are more effective than chest tube and talc slurry pleurodesis ( talc ) at relieving dyspnea . DESIGN Unblinded r and omized controlled trial ( Second Therapeutic Intervention in Malignant Effusion Trial [ TIME2 ] ) comparing IPC and talc ( 1:1 ) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated at 7 UK hospitals . Patients were screened from April 2007-February 2011 and were followed up for a year . INTERVENTION Indwelling pleural catheters were inserted on an outpatient basis , followed by initial large volume drainage , education , and subsequent home drainage . The talc group were admitted for chest tube insertion and talc for slurry pleurodesis . MAIN OUTCOME MEASURE Patients completed daily 100-mm line visual analog scale ( VAS ) of dyspnea over 42 days after undergoing the intervention ( 0 mm represents no dyspnea and 100 mm represents maximum dyspnea ; 10 mm represents minimum clinical ly significant difference ) . Mean difference was analyzed using a mixed-effects linear regression model adjusted for minimization variables . RESULTS Dyspnea improved in both groups , with no significant difference in the first 42 days with a mean VAS dyspnea score of 24.7 in the IPC group ( 95 % CI , 19.3 - 30.1 mm ) and 24.4 mm ( 95 % CI , 19.4 - 29.4 mm ) in the talc group , with a difference of 0.16 mm ( 95 % CI , −6.82 to 7.15 ; P = .96 ) . There was a statistically significant improvement in dyspnea in the IPC group at 6 months , with a mean difference in VAS score between the IPC group and the talc group of −14.0 mm ( 95 % CI , −25.2 to −2.8 mm ; P = .01 ) . Length of initial hospitalization was significantly shorter in the IPC group with a median of 0 days ( interquartile range [ IQR ] , 0 - 1 day ) and 4 days ( IQR , 2 - 6 days ) for the talc group , with a difference of −3.5 days ( 95 % CI , −4.8 to −1.5 days ; P < .001 ) . There was no significant difference in quality of life . Twelve patients ( 22 % ) in the talc group required further pleural procedures compared with 3 ( 6 % ) in the IPC group ( odds ratio [ OR ] , 0.21 ; 95 % CI , 0.04 - 0.86 ; P = .03 ) . Twenty-one of the 52 patients in the catheter group experienced adverse events vs 7 of 54 in the talc group ( OR , 4.70 ; 95 % CI , 1 Output:

Current evidence suggests that TPC and chemical pleurodesis are both effective treatment for recurrent MPE with similar success and complication rate .

MS2_1shot175

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: MATERIAL S AND METHODS 83 adult patients included in the study were divided into two groups . Patients of the group-1 ( n-49 ) had medium level of pain after cancer head and neck surgery . Patients of the group-2 ( n-34 ) had severe pain . Three first postoperative days their post-operative multimodal analgesia started with tenoxycam 20 mg i.m . after induction of anesthesia , then every 24 hour ( 58 patients ) . 25 patients got ketoprofen 100 mg i.m . every 8 - 12 hours instead of tenoxycam . All patients had nefopam 30 mg i.m . 30 min prior the end of surgery procedure , and every 8 hours afterwards . 7 patients of the group-1 had more than 4 pain scores ( day 1 ) , 4 patients --at the day 2 . They received tramadol or paracetamol additionally . 7 patients ( group-2 ) also had up to 5 pain scores on the day 1 , 5 patients had 4 pain scores on the day 2 , and 3 patients 4 pain scores on the day 3 . All that patients received additional analgesia with tramadol or trimeperidine once a day . 8.4 % of patients suffered from adverse reactions ( tachycardia , PONV and sweating ) . CONCLUSION This method of multimodal postoperative analgesia is very simple and fairly efficient Objective . To assess whether early or immediate removal of a 12F in‐dwelling Foley catheter after total abdominal hysterectomy affects the level of subjective pain assessment postoperatively . Design . R and omized controlled trial . Setting . University Hospital . Population . Seventy women underwent total abdominal hysterectomies for various benign gynecological diseases . Methods . Women were r and omized to have the urinary catheter removed in the operating room after the surgical procedure or to have it removed on postoperative day 1 . Main outcome measures . The primary outcome was patients ’ pain assessment and the secondary outcomes were rate of re‐catheterization and symptomatic urinary tract infection . Results . There was no difference in the pain assessment between the two groups . A significantly higher number of urinary retention episodes requiring re‐catheterization were found in the immediate removal group compared with the delayed removal group ( 20 vs. 0 % ; p= 0.011 ) . The incidence of symptomatic urinary tract infection did not differ between the two groups . Conclusions . There are pros and cons regarding the policy of one‐day in‐dwelling catheterization compared to immediate catheter removal BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations OBJECTIVE To examine the effects of an educational intervention , in the form of printed material , on patient knowledge and recall of possible risks from parotidectomy or thyroidectomy . DESIGN Prospect i ve , r and omized , controlled study conducted during a 9-month period . SETTING Head and neck surgery clinic of an academic tertiary care hospital . PATIENTS One hundred twenty-five consecutive patients older than 16 years who were undergoing thyroidectomy or parotidectomy at the head and neck surgery clinic were recruited . Four patients were excluded from analysis because their follow-up interview was not within the required limits . INTERVENTION At the preoperative visit during the routine consent process , both groups received a verbally delivered checklist of risks specific for the surgery to be performed . The intervention group was also given a pamphlet with written information accompanied by illustrations . MAIN OUTCOME MEASURES The effectiveness of the educational intervention was determined by comparing the average rate of risk recall between the intervention and control groups . The effects of age , sex , level of education , and time between the consent and recall interviews on recall rate were also assessed . RESULTS The overall risk recall rate for both procedures was 39.1 % . The recall rate of the intervention group was 50.3 % compared with 29.5 % for the control group ( P<.001 ) . CONCLUSIONS The intervention consistently improved risk recall for all patients regardless of age , sex , and level of education . Patients ' ability to recall potential risks was significantly increased by an educational intervention ; all patients would benefit from this intervention Closed-suction drainage was compared prospect ively to open , passive drainage ( Penrose drains ) in 128 patients undergoing cholecystectomy . Patients were r and omized at the time of operation to receive either closed-suction drains ( Group I , 67 patients ) or Penrose drains ( Group II , 61 patients ) . The preoperative clinical parameters of the two groups were similar . The patients in Group I when compared with those in Group II had a shorter duration of drainage ( 3.3 days and 4.1 days , respectively , p less than 0.01 ) , a lesser volume of drainage in the first 48 hours postoperatively ( 78 ml and 132 ml , respectively , p less than 0.001 ) , a decreased incidence of fever on the night of operation ( 24 of 67 patients and 39 of 61 patients , respectively , p less than 0.05 ) and on the first postoperative day ( 26 of 67 patients and 32 of 61 patients , respectively , p less than 0.05 ) , and a lower leukocyte count on the first postoperative day ( 12,000 cells/mm3 and 14,100 cells/mm3 , respectively , 0.05 less than p less than 0.1 ) . Patients in Group I tended to have a lower rate of wound infection ( 1 of 67 patients versus 5 of 61 patients in Group II , 0.05 less than p less than 0.1 ) and had a much lower incidence of drain site tenderness ( 8 of 67 patients in Group I versus 24 of 61 patients in Group II , p less than 0.05 ) . This study demonstrates the superiority of closed-suction drains over open , passive drains after cholecystectomy OBJECTIVE To assess the effects of 2 different anesthetic techniques on early complications after superior pharyngeal flap surgery . DESIGN R and omized , prospect i ve , single-blind study . SETTING Large referral hospital . PATIENTS One hundred patients undergoing superior pharyngeal flap surgery for the correction of velopharyngeal insufficiency were r and omly divided into 2 equal groups to receive either isoflurane or propofol-based anesthesia . INTERVENTIONS Following induction of anesthesia with fentanyl citrate and propofol , patients were r and omized to receive either isoflurane or propofol for the maintenance of general anesthesia . The inspired isoflurane concentration and propofol infusion rate were adjusted to maintain a stable depth of anesthesia as judged by clinical signs and hemodynamic responses to surgical stimuli . MAIN OUTCOME MEASURES Recovery from anesthesia , recovery from surgery , and early postoperative complications . RESULTS The groups were similar in age , weight , height , induction time , surgery time , extubation time , and anesthetic time . The time ( mean + /- SD ) required to achieve a maximal Steward Recovery Score was 7 + /- 14 minutes in the propofol group compared with 32 + /- 28 minutes in the isoflurane group ( P<.04 ) . No significant differences in postoperative patient satisfaction scores , time to first swallow , drinking time , and time to " home readiness " were noted . Overall , 17 patients ( 17 % ) developed airway-related complications and 2 of the patients ( 2 % ) were accounted as severe . Two patients ( 2 % ) bled from the operation site . However , there was no difference in the incidence of postoperative complications between the groups . CONCLUSIONS When compared with isoflurane administration for maintenance of general anesthesia , propofol-based anesthesia was associated with more rapid mental and psychomotor recovery . However , airway-related complications and " home readiness " were similar between the groups Study Design A preintervention and postintervention design was used to examine a total of 200 patients . Objective After successful implementation at our institution of a perioperative oral multimodal analgesia protocol in major joint arthroplasty , a modified regimen was provided to patients undergoing spine procedures . Summary of Background Data A proactive , multimodal approach is currently recommended for the management of acute postoperative pain . Inadequate postoperative analgesia can negatively influence surgical outcome and duration of rehabilitation . Routine use of intravenous patient controlled analgesia ( IV PCA ) after surgery can result in substantial functional interference , side effects , and lead to untoward events as a result of programming errors . Methods A preintervention and postintervention design was used to compare a historical control group of spine surgery patients who received conventional IV PCA ( N=100 ) with a prospect i ve group who received some form of perioperative oral multiodal analgesis ( N=100 ) . The new regimen included preoperative and postoperative scheduled extended-release oxycodone , gabapentin , and acetaminophen , intraoperative dolasetron and as-needed postoperative short-acting oral oxycodone . Patient surveys and chart audits were used to measure pain intensity , functional interference from pain , opioid consumption , analgesic-related side effects , and patient satisfaction over the first 24 hours postoperatively . Results Patients who received the new perioperative multimodal oral regimen had significantly less opioid consumption ( P<0.001 ) , lower ratings of Least Pain ( P<0.01 ) , and experienced less nausea ( P<.001 ) , drowsiness ( P<0.05 ) , interference with walking ( P=0.05 ) , and coughing and deep breathing ( P<0.05 ) compared with the IV PCA group . Conclusions This quality improvement study shows some safety and significant advantages of a multimodal perioperative oral analgesic regimen compared with st and ard IV PCA after spine surgery Background : The almost single disadvantage of conventional polyurethane film dressings , uncontrolled leakage , is probably as often described as its numerous advantages for split-thickness skin graft donor sites . This shortcoming can be overcome by perforating the polyurethane dressing , which permits controlled leakage into a secondary absorbent dressing . The study was conducted to compare the polyurethane dressing system and Aquacel , a hydrofiber wound dressing , which also seems to fulfill all criteria of an ideal donor-site dressing . Methods : This prospect i ve , r and omized , double-blind clinical trial included 50 adult patients . Skin graft donor sites were divided equally for the application of Aquacel and polyurethane dressing . The dressings were kept unchanged for 10 days . After removal of the dressing at day 10 , the epithelialization rate of both sites was evaluated . Pain scores were assessed according to a 0 to 5 numeric pain scale every postoperative day and during dressing removal . Results : On postoperative day 10 , 86.4 percent of the polyurethane dressing donor sites showed complete reepithelialization compared with 54.5 percent of the Aquacel-treated donor sites ( p < 0.001 ) . Polyurethane dressing was significantly less painful until and during removal of the dressing ( p < 0.001 ) . There was no significant difference with respect to scar formation . Conclusions : Overall , polyurethane dressing was superior to Aquacel . Further attributes of the polyurethane dressing such as ease of application , low labor input , high patient comfort , and protection against secondary wound infection qualify this dressing system as an ideal wound covering for donor sites . CLINICAL QUESTION /LEVEL OF EVIDEN Output:

Best practice includes several elements of perioperative care .

MS2_1shot176

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: An open-label r and omized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m . depot injection for the relief of chronic pelvic pain in women with endometriosis . A total of 30 women aged 18 - 38 years were allocated to the 3-monthly depot arm ( n = 15 ) or to the monthly depot arm ( n = 15 ) after laparoscopic diagnosis of pelvic endometriosis . Mean ( SD ) deep dyspareunia scores according to a 0 - 3 point verbal rating scale decreased from 1.8 ( 0.9 ) at baseline to 1.3 ( 0.7 ) at the end of treatment in the 3-monthly depot group and from 2.1 ( 1.2 ) to 1.3 ( 0.7 ) in the monthly depot group . Corresponding values in non-menstrual pain scores fell from 2.1 ( 0.6 ) to 1.1 ( 0.3 ) , and from 2.1 ( 0.8 ) to 1.2 ( 0.4 ) respectively , without statistically significant differences between the groups . Serum luteinizing hormone ( LH ) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values , without differences between the groups . The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone ( FSH ) levels with respect to the 3-monthly preparation . Mean ( SD ) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 ( 25.1 ) and 12.2 ( 9.3 ) in the 3-monthly depot group and 29.0 ( 22.7 ) and 13.1 ( 15.3 ) in the monthly depot group ( paired t-test , P < 0.05 ) . Mean percentage decrease in lumbar spine bone mineral density was 5.2 % in the former and 4.9 % in the latter subjects . In the 3-monthly depot group , 13 women grade d the tolerability of their treatment schedule as " good ' compared with seven in the monthly depot group ( chi 2 = 5.40 , P = 0.02 ) OBJECTIVE To compare the efficacy and safety of goserelin depot and danazol for endometriosis . DESIGN Open , r and omized comparative trial . SETTING Multicenter European academic clinical institutions . PATIENTS A total of 307 patients with laparoscopically diagnosed endometriosis were r and omized to goserelin ( n = 204 ) or danazol ( n = 103 ) ; 249 patients underwent second look laparoscopy ( 175 received goserelin and 74 danazol ) and were analyzed for efficacy . INTERVENTIONS A 3.6-mg depot of goserelin monthly subcutaneously or oral danazol 200 mg three times a day administered for 24 weeks . MAIN OUTCOME MEASURES Efficacy assessment s were based on changes in visible deposits at laparoscopy before and after treatment and subjective symptom scores at 4-week intervals during treatment and 8-week intervals after treatment for up to 24 weeks . Safety was assessed by adverse event reporting and clinical laboratory measures . RESULTS There were similar proportions of symptomatic ( 73 % ) and asymptomatic ( but infertile ) ( 27 % ) and comparable distribution of different severity of endometriosis r and omized to each treatment . Significantly fewer patients r and omized to goserelin ( 6.4 % ) withdrew during treatment compared with 20.4 % r and omized to danazol ( P less than 0.05 ) . There were significantly reduced visible deposits of endometriosis found post-treatment ( P less than 0.0001 ) within each group but no differences between the treatments . The mean total subjective symptoms scores remained significantly less than entry at 24 weeks post-treatment ( P less than 0.05 ) . Hypoestrogenic side effects were more common in those receiving goserelin , particularly hot flushes , but anabolic/ and rogenic side effects of weight gain and muscle cramps were more common in those receiving danazol . CONCLUSIONS The monthly administered 3.6-mg depot preparation of goserelin was highly effective at inducing resolution of endometriotic implants and relieving the symptoms of endometriosis with prevention of their return during 24 weeks follow-up in the majority of patients . However , results were not significantly different from those achieved with danazol 600 mg/d OBJECTIVE To compare the effect of a GnRH-agonist , triptorelin , versus placebo on the symptoms of endometriosis . DESIGN A prospect i ve , r and omized , double-blind study of 6 months of treatment followed by 12 months of follow-up . SETTING Departments of Obstetrics and Gynecology at two universities and one general hospital . PATIENT(S ) Forty-nine women with symptoms of laparoscopically verified endometriosis . INTERVENTION(S ) Triptorelin depot or placebo was given every 4 weeks . Clinical evaluation , including the Duration Intensity Behavior Scale and Visual Analogue Scale for pain , was performed before the injections and up to 12 months after treatment . A control laparoscopy was performed 4 - 6 weeks after the last injection . MAIN OUTCOME MEASURE(S ) Quantitation of pain . RESULT ( S ) Twenty-four patients had active treatment and 25 received placebo . Pain symptoms according to both scales were significantly more reduced after 2 months of triptorelin treatment compared to placebo . The extent of endometriotic lesions was reduced 50 % during triptorelin treatment and increased 17 % during placebo . The average area of endometriotic lesions was reduced 45 % during triptorelin treatment but was unchanged during placebo . Side effects , mainly hot flushes , were experienced by 80 % of the actively treated group but also by 33 % of patients in the placebo group . Because of recurrent symptoms , only five patients could be observed for 12 months after completion of treatment . CONCLUSION ( S ) Triptorelin reduces endometriotic lesions and pain to a significantly higher degree than placebo BACKGROUND The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system ( LNG-IUS ) compared with the GnRH analogue ( GnRHa ) leuprolide acetate on these risk markers after 6 months of treatment . STUDY DESIGN This was a r and omized , prospect i ve , open clinical study , with 44 patients with laparoscopically and histologically confirmed endometriosis . Patients were r and omized into two groups : the LNG-IUS group , composed of 22 patients who underwent LNG-IUS insertion , and the GnRHa group , composed of 22 patients who received a monthly GnRHa injection for 6 months . Body mass index ; systolic and diastolic arterial blood pressure ; heart rate ; and laboratory cardiovascular risk markers such as interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-alpha ) , C-reactive protein ( CRP ) , homocysteine ( HMC ) , lipid profile , total leukocytes and vascular cell adhesion molecule ( VCAM ) were measured before and 6 months after treatment . RESULTS After 6 months of treatment , a significant reduction in pain score occurred in both groups with no significant difference in improvement between the two medications evaluated . In the LNG-IUS group , from pretreatment to posttreatment period , there was a significant reduction in the levels ( mean+/-SD ) of VCAM ( 92.8+/-4.2 to 91.2+/-2.7 ng/mL , p=.04 ) , CRP ( 0.38+/-0.30 to 0.28+/-0.21 mg/dL , p=.03 ) , total cholesterol ( 247.0+/-85.0 to 180.0+/-31.0 mg/dL , p=.0002 ) , triglycerides ( 118.0+/- 76.0 to 86.5+/-41.5 mg/dL , p=.003 ) , low-density lipoprotein cholesterol ( 160.5+/-66.0 to 114.5+/-25.5 mg/dL , p=.0005 ) and high-density lipoprotein cholesterol ( 63.0+/-20.5 to 48.5+/-10.5 mg/dL , p=.002 ) . The GnRHa group showed an increase in HMC levels ( 11.5+/-2.9 to 13.0+/-2.7 mumol/L , p=.04 ) and a reduction in IL-6 levels ( 4.3+/-3.9 to 2.3+/-0.8 pg/mL , p=.005 ) , VCAM ( 94.0+/-3.8 to 92.0+/-1.6 ng/mL , p=.03 ) and total leukocytes ( 7330+/-2554 to 6350+/-1778 , p=.01 ) . In the GnRH group , the remaining variables , including lipid profile , did not show any statistical difference . CONCLUSIONS This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-IUS , but the latter had a greater positive impact on the lipid profile , which could lead to a favorable effect during long-term treatment Minor degrees of endometriosis have often been regarded as being of no import and hence remain untreated , but a study of the natural history of endometriosis has demonstrated that 47 % ( 95 % confidence limits , 23–71 % ) of patients ( n=35 ) given placebo in a double‐blind , r and omized controlled trial showed progression of the disease when assessed before and after treatment by laparoscopy . The active agent , the progestogen gestrinone , was given at a dose of 2.5 mg twice weekly and result ed in an improvement of the disease ( p < 0.004 ) . Furthermore , follow‐up over 12 months showed no significant difference between those patients treated with active agent or placebo , and none between those with persistent disease and those in whom it had been obliterated . These data suggest that a diagnosis of mild endometriosis should be followed by treatment to prevent progressive disease , but that the treatment does not influence subsequent fertility . They indicate that expectant treatment has no place and that even if fertility is not an immediate requirement , active treatment should be instituted , and that the new gestogen , gestrinone is efficacious . Other treatments , such as danazol or luteinizing hormone releasing hormone ( LHRH ) agonists , or the older contraceptive or pseudopregnancy regimens , must be set against spontaneous improvement ( in 5 of 17 patients i.e. 29 % ) or elimination ( in 4 of 17 patients i.e. 24 % ) in the placebo group . Infertile patients with mild endometriosis have disorders of follicular and luteal function , and in vitro fertilization suggests a reduced fertilization rate . Nevertheless , these patients require active treatment if these problems are not to be compounded by adhesions , possibly leading to ovarian enclosure , that would further reduce the untreated cumulative conception rate OBJECTIVE To further eluci date the origin and significance of serum CA-125 in pelvic endometriosis . DESIGN Retrospective . PATIENTS Ninety-seven women with endometriosis who participated in two trials : ( 1 ) open-label study on buserelin acetate ( n = 51 ) and ( 2 ) comparative , placebo-controlled study on nafarelin ( n = 31 ) versus danazol ( n = 15 ) ( 2:1 ratio ) . INTERVENTIONS ( 1 ) Buserelin acetate 900 micrograms/d intranasally ( IN ) ; ( 2 ) nafarelin 400 micrograms/d IN versus danazol 400 mg/d orally during 6 months . MAIN OUTCOME MEASURE(S ) Serum CA-125 and estradiol concentrations ; severity of endometriosis-related symptoms ; scores according to The American Fertility Society ( AFS ) classification for endometriosis and /or adhesions ( before and on last day of therapy ) . RESULTS Menstruation and adhesions appeared major factors influencing pretreatment serum CA-125 concentrations . Compared with nonmenstruating women without adhesions , both menses and adhesions induced a slight increase tending to significancy , whereas the elevating effect of adhesions and menses together was highly significant and more than expected . All three treatment regimens reduced CA-125 concentrations to the same extent ; cessation of therapy was followed by restoration to pretreatment concentrations . Of the AFS scores for implants and /or adhesions , only pretreatment scores for adhesions correlated significantly with CA-125 concentrations . Severity scores for endometriosis-related complaints did not correlate . CONCLUSIONS The findings indicate that adhesions play a major role in the presence of CA-125 in the systemic circulation and suggest that reductions of serum CA-125 concentrations during gonadotropin-releasing hormone agonist and danazol therapy are hormonally determined Gonadotropin releasing hormone ( GnRH ) agonists have shown to be effective in the treatment of several sex-hormone Output:

The evidence suggested that GnRHas were more effective at symptom relief than no treatment/placebo . Evidence was limited on optimal dosage or duration of treatment for GnRHas . No route of administration appeared superior to another . GnRHas appear to be more effective at relieving pain associated with endometriosis than no treatment/placebo . There was no evidence of a difference in pain relief between GnRHas and danazol although more adverse events reported in the GnRHa groups . There was no evidence of a difference in pain relief between GnRHas and levonorgestrel and no studies compared GnRHas with analgesics

MS2_1shot177

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background and Purpose — Studies suggest a protective role for statins after intracerebral hemorrhage , but many failed to assess statin discontinuation , did not include postdischarge outcomes , or did not account for withdrawal of care . We studied the relationship between preintracerebral hemorrhage statin use and in-hospital statin discontinuation on stroke severity and 30-day mortality . Methods — We analyzed data from the Registry of the Canadian Stroke Network and determined the adjusted ORs for statin use and outcomes , controlling for stroke severity and other covariates . Results — We analyzed 2466 consecutive patients with intracerebral hemorrhage from 2003 to 2008 : median age was 71 years , 53.6 % were male , and 30-day mortality rate was 36.5 % . Overall , 537 ( 21.7 % ) were taking statins before presentation . Compared with nonusers , statin users were less likely to have severe strokes on presentation ( 54.7 % versus 63.3 % ) but had similar rates of poor outcome ( 70 % versus 67 % ) and 30-day mortality ( 36 % versus 37 % ) . Statins were discontinued on admission in 158 of 537 ( 29.4 % ) ; these patients were more likely to have severe stroke ( 65 % versus 27 % , P<0.01 ) , poor outcome ( 90 % versus 62 % , P<0.01 ) , and to have died by 30 days ( 71 % versus 21 % , P<0.01 ) . After adjusting for stroke severity , statin discontinuation was still associated with poor outcome ( adjusted OR , 2.4 ; 95 % CI , 1.13–4.56 ) and higher mortality ( adjusted OR , 2.0 ; 95 % CI , 1.30–3.04 ) . However , these associations were attenuated and no longer significant after excluding patients treated palliatively . Conclusions — We found no association between preadmission statin use and outcomes in intracerebral hemorrhage . Statin discontinuation may worsen outcomes or may simply be a marker of worse underlying prognosis BACKGROUND Soluble CD40L ( sCD40L ) , a substance that maximally reflects in vivo platelet activation , is increased in patients with hypercholesterolemia . We investigated the relation between sCD40L and platelet CD4OL in hypercholesterolemic patients before and after a short-term treatment with atorvastatin . METHODS AND RESULTS Collagen-induced platelet CD40L and plasma levels of sCD40L and prothrombin fragment F1 + 2 , a marker of thrombin generation , were investigated in 30 hypercholesterolemic patients and 20 healthy subjects . Hypercholesterolemic patients were then r and omized to either diet ( n=15 ; group A ) or atorvastatin 10 mg/d ( group B ) ; the aforementioned variables were measured at baseline and after 3 days of treatment . Compared with referents , hypercholesterolemic patients showed higher values of platelet CD40L ( P<0.005 ) , sCD40L ( P<0.005 ) , and F1 + 2 ( P<0.003 ) . Platelet CD40L was significantly correlated with sCD40L ( P<0.001 ) , and the latter was significantly correlated with F1 + 2 ( P<0.001 ) . The intervention trial showed no changes in group A but a significant decrease in platelet CD40L ( P<0.01 ) , sCD40L ( P<0.002 ) , and F1 + 2 ( P<0.03 ) in group B. In vitro studies demonstrated that cholesterol enhanced platelet CD40L and CD40L-mediated clotting activation by human monocytes ; also , atorvastatin dose-dependently inhibited platelet CD40L expression and clotting activation by CD40L-stimulated monocytes . CONCLUSIONS This study shows that , in hypercholesterolemia , platelet overexpression of CD40L may account for enhanced plasma levels of sCD40L and F1 + 2 . Atorvastatin exerts a direct antithrombotic effect via inhibition of platelet CD40L and CD40L-mediated thrombin generation , independently of its cholesterol-lowering effect Abstract Objective To investigate risk factors , such as heavy alcohol consumption , that might explain any increased risk of haemorrhagic stroke associated with low blood cholesterol . Design Prospect i ve cohort study . Setting Korea . Participants 787 442 civil servants ( 661 700 men , 125 742 women ) aged 30 - 64 . Main outcome measures Cardiovascular risk factors were assessed at biennial health check . Data on morbidity and mortality were ascertained from 1990 to 2001 using hospital admissions and mortality surveillance systems . Results 6328 cases of ischaemic stroke ( 6021 men , 307 women ) , 3947 cases of haemorrhagic stroke ( 3748 men , 199 women ) , 3170 cases of undefined stroke ( 2902 men , 268 women ) , and 4417 cases of myocardial infa rct ion ( 4305 men , 112 women ) occurred . Ischaemic stroke and myocardial infa rct ion were strongly and positively associated with blood cholesterol ( hazard ratio per 1 mmol/l cholesterol 1.20 ( 95 % confidence 1.16 to 1.24 ) and 1.48 ( 1.43 to 1.53 ) , respectively ) . Haemorrhagic stroke showed an inverse association in fully adjusted models ( 0.91 , 0.87 to 0.95 ) . This inverse association was confined to participants with hypertension . When stratified by concentration of γ glutamyl transferase ( GGT ) , an indicator of alcohol consumption , the association was not seen in participants with low concentrations of GGT , and it was independent of hypertension in those with high concentrations of GGT ( > 80 U/l ) . Conclusion High alcohol consumption may underlie the association between low blood cholesterol and increased risk of haemorrhagic stroke BACKGROUND A recent post hoc analysis of a large r and omized trial in patients with cerebrovascular disease suggested that statins may increase the risk of intracerebral hemorrhage ( ICH ) . OBJECTIVE To examine the association between statins and ICH in patients with recent ischemic stroke in a population -based setting . DESIGN Retrospective propensity-matched cohort study with accrual from July 1 , 1994 , to March 31 , 2008 . SETTING Ontario , Canada . PARTICIPANTS A total of 17 872 patients aged 66 years and older who initiated statin therapy following acute ischemic stroke and were followed for a median of 4.2 years ( interquartile range , 2.4 - 5.0 years ) . To enhance causal inference , we conducted several tests of specificity to exclude healthy user bias in this sample . Main Outcome Measure Hospitalization or emergency department visit for ICH defined using vali date d diagnosis coding . RESULTS Overall , 213 episodes of ICH occurred . In the primary analysis comparing statin users with nonusers , we found no association between statins and ICH ( hazard ratio = 0.87 ; 95 % confidence interval , 0.65 - 1.17 ) . Subgroup and dose-response analyses yielded similar results . In tests of specificity , statin therapy was not associated with bone mineral density testing , vitamin D or B(12 ) screening , gastrointestinal endoscopy , or elective knee arthroplasty , suggesting that results were not due to healthy user bias or differences in quality of care . CONCLUSION Statin exposure following ischemic stroke was not associated with ICH Background and Purpose — The association of total and high-density lipoprotein ( HDL ) cholesterol with stroke risk is unclear , especially regarding hemorrhagic stroke . Methods — We prospect ively investigated the associations of serum total and HDL cholesterol and total/HDL cholesterol ratio with total and type-specific stroke incidence among 58 235 Finnish people aged 25 to 74 years and free of coronary heart disease and stroke at baseline . Results — During a mean follow-up period of 20.1 years , 3914 participants developed stroke events ( 3085 ischemic , 497 intracerebral hemorrhage , and 332 subarachnoid hemorrhage ) . The multivariable-adjusted hazard ratios at different levels of total cholesterol ( < 5 [ reference ] , 5–5.9 , 6–6.0 , ≥7.0 mmol/L ) were 1.00 , 1.05 , 1.16 , and 1.22 for total stroke ( Ptrend=0.036 ) and 1.00 , 1.06 , 1.19 , and 1.27 for ischemic stroke ( Ptrend=0.02 ) in men and 1.00 , 0.58 , 0.61 , and 0.50 for intracerebral hemorrhagic stroke ( Ptrend=0.02 ) in women , respectively . Low levels of HDL cholesterol and high total/HDL cholesterol ratio were associated with increased risks of total and ischemic stroke in both men and women . These associations disappeared in men but remained significant in women after further adjustment for body mass index , blood pressure , and history of diabetes . Conclusions — The study showed a positive association between total cholesterol and total and ischemic stroke risks in men and an inverse association between total cholesterol and intrahemorrhagic stroke risk in women . The inverse association of HDL cholesterol and a positive association of total/HDL cholesterol ratio with total and ischemic stroke risks were found in men and women . These associations attenuated after adjustment for body mass index , blood pressure , and history of diabetes BACKGROUND Lower blood cholesterol concentrations have consistently been found to be strongly associated with lower risks of coronary disease but not with lower risks of stroke . Despite this observation , previous r and omised trials had indicated that cholesterol-lowering statin therapy reduces the risk of stroke , but large-scale prospect i ve confirmation has been needed . METHODS 3280 adults with cerebrovascular disease , and an additional 17256 with other occlusive arterial disease or diabetes , were r and omly allocated 40 mg simvastatin daily or matching placebo . Subgroup analyses were prespecified of first " major vascular event " ( ie , non-fatal myocardial infa rct ion or coronary death , stroke of any type , or any revascularisation procedure ) in prior disease subcategories . Subsidiary outcomes included any stroke , and stroke sub-type . Comparisons are of all simvastatin-allocated versus all placebo-allocated participants ( ie , " intention-to-treat " ) , which yielded an average difference in LDL cholesterol of 1.0 mmol/L ( 39 mg/dL ) during the 5-year treatment period . FINDINGS Overall , there was a highly significant 25 % ( 95 % CI 15 - 34 ) proportional reduction in the first event rate for stroke ( 444 [ 4.3 % ] simvastatin vs 585 [ 5.7 % ] placebo ; p<0.0001 ) , reflecting a definite 28 % ( 19 - 37 ) reduction in presumed ischaemic strokes ( p<0.0001 ) and no apparent difference in strokes attributed to haemorrhage ( 51 [ 0.5 % ] vs 53 [ 0.5 % ] ; rate ratio 0.95 [ 0.65 - 1.40 ] ; p=0.8 ) . In addition , simvastatin reduced the numbers having transient cerebral ischaemic attacks alone ( 2.0 % vs 2.4 % ; p=0.02 ) or requiring carotid endarterectomy or angioplasty ( 0.4 % vs 0.8 % ; p=0.0003 ) . The reduction in stroke was not significant during the first year , but was already significant ( p=0.0004 ) by the end of the second year . Among patients with pre-existing cerebrovascular disease there was no apparent reduction in the stroke rate , but there was a highly significant 20 % ( 8 - 29 ) reduction in the rate of any major vascular event ( 406 [ 24.7 % ] vs 488 [ 29.8 % ] ; p=0.001 ) . The proportional reductions in stroke were about one-quarter in each of the other subcategories of participant studied , including : those with coronary disease or diabetes ; those aged under or over 70 years at entry ; and those presenting with different levels of blood pressure or lipids ( even when the pretreatment LDL cholesterol was below 3.0 mmol/L [ 116 mg/dL ] ) . INTERPRETATION Much larger numbers of people in the present study suffered a stroke than in any previous cholesterol-lowering trial . The results demonstrate that statin therapy rapidly reduces the incidence not only of coronary events but also of ischaemic strokes , with no apparent effect on cerebral haemorrhage , even among individuals who do not have high cholesterol concentrations . Allocation to 40 mg simvastatin daily reduced the rate of is Output:

Whether statins indeed increase the risk of intracranial hemorrhage ( ICH ) , as well as the underlying mechanisms for this potential risk , have not been clearly eluci date d. It has been hypothesized that patients treated with lipophilic statins may be more prone to ICH as these cross the blood – brain barrier more freely compared with hydrophilic statins . In this population -based , nested case-control study conducted in patients who had experienced an ICH within 1 year following an ischemic stroke , the lipophilicity of statins did not influence the risk of hemorrhagic stroke [ 4 ] .

MS2_1shot178

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES The RESPECT trial was aim ed at evaluating safety/efficacy of a new extravascular closure system in diagnostic ( Dx ) and interventional ( Ix ) procedures performed through 6 or 7 Fr introducer sheaths . BACKGROUND Although vascular closure devices ( VCDs ) have been available for two decades , manual compression ( MC ) remains the st and ard of care in many institutions . VCDs have not been shown to have greater safety than MC . METHODS The RESPECT trial was a multicenter , r and omized comparison of the Vascade VCD ( Cardiva Medical , Inc ) versus MC in Dx and Ix patients undergoing femoral access . Endpoints included time to hemostasis ( TTH ) , time to ambulation ( TTA ) , time to discharge eligibility ( TTDe ) , device and procedure success , major and minor complications . Subjects were r and omized 2:1 ( Vascade vs MC ) . RESULTS A total of 420 patients were enrolled ( 211 Dx , 209 Ix ) . Mean age was 62 ± 11 years and 29 % were female . For Ix Vascade/MC patients , 77%/69 % received bivalirudin , 27%/26 % received heparin , and 8%/3 % received glycoprotein IIb/IIIa inhibitors , respectively . Patients were followed for 30 ± 7 days . A total of 415 subjects ( 98.8 % ) completed follow-up . TTH was 3.0 minutes ( range , 0.6 - 31.6 minutes ) for Vascade vs 20.0 minutes ( range , 0.0 - 97.0 minutes ) for MC ; TTA was 3.2 hours ( range , 1.0 - 78.0 hours ) for Vascade vs. 5.2 hours ( range , 1.7 - 22.8 hours ) for MC ; and TTDe was 3.6 hours ( range , 1.4 - 78.4 hours ) for Vascade vs. 5.7 hours ( range , 2.2 - 23.2 hours ) for MC . Device and procedure success rates were 98 % for Vascade and 100 % for MC . Minor events were 1.1 % for Vascade and 7 % for MC . No major access-site related complications were reported in either arm . CONCLUSION Despite high percentage of bivalirudin use , there were no major access-site related complications in either arm . Vascade use reduced rates of minor access-site related complications , and significantly shortened TTH , TTA , and TTDe compared to MC OBJECTIVE The first multicenter r and omized controlled trial was design ed and conducted to assess the safety and effectiveness of totally percutaneous endovascular aortic aneurysm repair ( PEVAR ) with use of a 21F endovascular stent graft system and either an 8 F or 10 F suture-mediated closure system ( the PEVAR trial , NCT01070069 ) . A noninferiority trial design was chosen to compare percutaneous access with st and ard open femoral exposure . METHODS Between 2010 and 2012 , 20 U.S. institutions participated in a prospect i ve , Food and Drug Administration-approved r and omized trial to evaluate percutaneous femoral artery access and closure by a " preclose " technique in conjunction with endovascular abdominal aortic aneurysm repair . A total of 151 patients were allocated by a 2:1 design to percutaneous access/closure ( n = 101 ) or open femoral exposure ( n = 50 [ FE ] ) . PEVAR procedures were performed with either the 8 F Perclose ProGlide ( n = 50 [ PG ] ) or the 10 F Prostar XL ( n = 51 [ PS ] ) closure devices . All endovascular abdominal aortic aneurysm repair procedures were performed with the Endologix 21 F profile ( outer diameter ) sheath-based system . Patients were screened by computed tomography with three-dimensional reconstruction and independent physician review for anatomic suitability and adequate femoral artery anatomy for percutaneous access . The primary trial end point ( treatment success ) was defined as procedural technical success and absence of major adverse events and vascular complications at 30 days . An independent access closure sub study evaluated major access-related complications . Clinical utility and procedural outcomes , ankle-brachial index , blood laboratory analyses , and quality of life were also evaluated with continuing follow-up to 6 months . RESULTS Baseline characteristics were similar among groups . Procedural technical success was 94 % ( PG ) , 88 % ( PS ) , and 98 % ( FE ) . One-month primary treatment success was 88 % ( PG ) , 78 % ( PS ) , and 78 % ( FE ) , demonstrating noninferiority vs FE for PG ( P = .004 ) but not for PS ( P = .102 ) . Failure rates in the access closure sub study analyses demonstrated noninferiority of PG ( 6 % ; P = .005 ) , but not of PS ( 12 % ; P = .100 ) , vs FE ( 10 % ) . Compared with FE , PG and PS yielded significantly shorter times to hemostasis and procedure completion and favorable trends in blood loss , groin pain , and overall quality of life . Initial noninferiority test results persist to 6 months , and no aneurysm rupture , conversion to open repair , device migration , or stent graft occlusion occurred . CONCLUSIONS Among trained operators , PEVAR with an adjunctive preclose technique using the ProGlide closure device is safe and effective , with minimal access-related complications , and it is noninferior to st and ard open femoral exposure . Training , experience , and careful application of the preclose technique are of paramount importance in ensuring successful , sustainable outcomes Objectives : To compare Angio‐Seal ( AS ) and StarClose ( SC ) and manual compression ( MC ) on efficacy of hemostasis , complication rate , safety of early mobilization , and patient comfort . Background : Closure of the femoral artery after cardiac catheterization can be obtained through different methods . Today , physicians can choose from a number of different devices to achieve arterial closure . Methods : In a prospect i ve trial 450 patients were r and omized to AS , SC , or MC . Patients were mobilized 1 to 2 hr after device placement , and 6 hr after MC . Data were collected during hospital admission and by telephone at one month after hospital discharge . Results : Devices were used in 138/150 allocated to AS and 124/150 allocated to SC patients ( 92 % vs. 83 % , P = 0.015 ) Patients with MC experienced more pain during sheath removal than patients receiving a device , and rated their period of bed rest as less comfortable . Oozing and need for pressure b and age at the puncture site were observed in 37 AS patients and 57 SC patients ( 25 % vs. 38 % , P = 0.002 ) . Hematoma occurred in 15 AS patients , in 17 SC patients , and in 14 MC patients ( 11 vs. 14 vs. 9 % , ns ) . Conclusion : There is no difference in safety between the three methods of arterial closure . SC was more often not used or successfully deployed . SC patients more often had continuing oozing . On patient comfort , closure devices performed better than MC . Early ambulation in patients with a closure device is safe . AS is the preferred method of arterial closure after cardiac catheterization . © 2008 Wiley‐Liss , BACKGROUND Collagen-based vascular closure devices ( VCD ) are commonly used after catheterization with femoral access . However , data about complication rates due to the utilization of VCDs in patients with known peripheral artery disease ( PAD ) of the lower limbs are inconsistent and patients with significant PAD are excluded in most VCD trials . In this study , we aim ed to assess complication rates of collagen-based VCDs in patients with significant PAD . METHODS Patients with significant PAD treated with a VCD ( Angio-Seal ; St Jude Medical , Inc ) after percutaneous therapeutic interventions of lower extremities were included in this study . Significant PAD was defined as Fontaine ≥2b . In-hospital complications ( bleeding , spurious aneurysm , vessel occlusion , dissection , surgical repair , vasovagal reaction ) were recorded . RESULTS A total of 121 patients ( 64.6 ± 11.3 years , 77 % male ) were included . PAD stage IIb was present in 99 patients ( stage III in 8 patients , stage IV in 14 patients ) . A total of 112 treatments ( 93.3 % ) processed without complications ( major complication rate , 1.7 % ; minor complication rate , 5.0 % ) . There was a trend toward higher prevalence of complications with increasing size of closure device and with the stage of PAD ; however , this trend was not statistically significant ( P>.05 for all ) . CONCLUSION We report moderate complication rates of collagen-based VCDs in patients with significant PAD . Our data suggest that Angio-Seal may be safe in patients with PAD after catheter intervention . Further r and omized trials with larger sample size comparing VCD with st and ard manual compression in patients with significant PAD are required Background Access for endovascular repair of abdominal aortic aneurysms ( EVAR ) is obtained through surgical cutdown or percutaneously . The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery ( CFA ) are the Prostar ™ and Proglide ™ devices ( Abbott Vascular ) . Positive effects of these devices seem to consist of a lower infection rate , and shorter operation time and hospital stay . This conclusion was published in previous reports comparing techniques in patients in two different groups ( cohort or r and omized ) . Access techniques were never compared in one and the same patient ; this research simplifies comparison because patient characteristics will be similar in both groups . Methods / Design Percutaneous access of the CFA is compared to surgical cutdown in a single patient ; in EVAR surgery , access is necessary in both groins in each patient . R and omization is performed on the introduction site of the larger main device of the endoprosthesis . The contralateral device of the endoprosthesis is smaller . When we use this type of r and omization , both groups will contain a similar number of main and contralateral devices . Preoperative nose cultures and perineal cultures are obtained , to compare colonization with postoperative wound cultures ( in case of a surgical site infection ) . Furthermore , patient comfort will be considered , using VAS-scores ( Visual analog scale ) . Punch biopsies of the groin will be harvested to retrospectively compare skin of patients who suffered a surgical site infection ( SSI ) to patients who did not have an SSI . Discussion The PiERO trial is a multicenter r and omized controlled clinical trial design ed to show the consequences of using percutaneous access in EVAR surgery and focuses on the occurrence of surgical site infections . Trial registration NTR4257 10 November 2013 , NL44578.042.13 PURPOSE This study was design ed to describe and evaluate our preliminary results with a percutaneous arterial closure device as compared to those obtained with conventional femoral surgical cut down during endovascular repair of abdominal aortic aneurysms ( AAA ) . MATERIAL AND METHODS Between January 2004 and December 2006 , 40 of 86 AAA patients selected for endovascular repair met the criteria for inclusion in this study . Nineteen of these patients ( Group A ) received a bifurcated endograft placed by direct puncture of the femoral arteries ( 38 femoral triangles ) with closure by a Prostar((R ) ) percutaneous arterial closure device ( Abbott ) . The other 21 patients ( control group B ) were managed with a bifurcated endograft placed by conventional open surgery ( 42 femoral triangles ) . Data concerning all 40 patients were collected prospect ively and analyzed . RESULTS The technical success rate was 92 % ( group A ) vs 90 % ( group B ) , P=0.79 . The incidence of perioperative complications was 16 % ( 3/19 ) in group A and 14 % ( 3/21 ) in group B ( P=0.89 ) . The mean hospital stay was 5.8 days in group A and 7.8 days in group B ( P=0.05 ) . The difference in the length of hospitalisation was associated with reduced cost for the percutaneous group ( 5579.60 euros vs. 7503.60 euros ; P=0.04 ) , that counterbalanced the cost induced by the Prostar XL((R ) ) suture mediated device . Mean follow-up in both groups was 12 months . The overall incidence of locoregional complications after one year of follow-up was 11 % ( 2/19 ) in group A and 19 % ( 4/21 ) in group B ( P=0.45 ) . CONCLUSION This study confirms the feasibility and safety of total percutaneous endovascular AAA repair . Our preliminary results suggest that the costs paid by healthcare providers for endovascular AAA repair might not be increased with the selective use of percutaneous closure devices This article addresses the utility of Angio-Seal versus manual hemostasis in anticoagulated patients following neurointerventional procedures . In a study of 174 punctures , 104 were closed with Angio-Seal and the rest with manual compression . All patients had activated clotting time values between 250–500 seconds at the time of closure . Mean hemostasis times were significantly longer with manual compression and hematomas 3 times more common . Using Angio-Seal led to arterial occlusion in Output:

The review demonstrated that VCDs provided improvement in the patients ’ comfort and satisfaction as well as in the time to hemostasis and ambulation . Conclusions VCDs have shown marked improvement in patients ’ comfort and satisfaction as well as in time to hemostasis and ambulation after percutaneous vascular procedures . VCDs have a low incidence of major complications and high success rates , which provides convenience for the practitioner and facilitates turnover of patients .

MS2_1shot179

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To evaluate the clinical efficacy and toxicity of simultaneous integrated boost intensity-modulated radiotherapy ( SIB-IMRT ) in patients with esophageal squamous cell carcinoma ( ESCC ) in Chinese population . PATIENTS AND METHODS Patients with ESCC , who received SIB-IMRT from September 2011 to January 2013 were retrospectively analyzed . The SIB-IMRT plans were design ed to deliver primary gross tumor volume at 60 - 64.4 Gy in 28 - 30 fractions , and planning target volume at 50.4 - 56 Gy in 28 - 30 fractions . Treatment-related toxicities were estimated based on Common Terminology Criteria for Adverse Events version 4.0 , and tumor response after the treatment was estimated according to Response Evaluation Criteria in Solid Tumors version 1.0 . Overall survival ( OS ) , locoregional progression-free survival ( LPFS ) , and progression-free survival ( PFS ) were estimated with Kaplan-Meier . RESULTS All patients completed definitive radiotherapy , 54 ( 78.3 % ) received combined chemotherapy , of which 31 ( 44.9 % ) were concurrent chemoradiotherapy and 23 ( 33.3 % ) were sequential chemotherapy . The objective response rate is 82.6 % ( 56/69 ) , with complete response 11 ( 15.9 % ) , partial response 45 ( 65.2 % ) , stable disease 8 ( 11.6 % ) , and progressive disease 5 ( 7.2 % ) . The 1- , 2- and 3-year LPFS was 74.4 % , 57.8 % , and 55.6 % , respectively . The 1- , 2- and 3-year PFS was 62.3 % , 41.0 % , and 34.2 % , respectively , and the 1- , 2- , and 3-year OS was 73.8 % , 57.4 % , and 41.0 % , respectively , with a median OS of 27.1 months ( 4.5 - 54.9 m ) . For those who received concurrent chemotherapy , the 1- , 2- , and 3-year OS was 75.9 % , 69.0 % , and 55.2 % , respectively , better than those who had sequential chemotherapy or radiotherapy alone ( χ2 = 3.115 , P = 0.078 ) . Radiation esophagitis occurred in 63.8 % and 14.5 % with Grade 2 and 3 , respectively . No patients occurred ≥ Grade 3 radiation pneumonia . CONCLUSIONS It is safe and effective using SIB-IMRT technology to treat patients with ESCC . More prospect i ve clinical studies should be needed PURPOSE / OBJECTIVE ( S ) Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony l and marks , and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy ( IMRT ) . Therefore , we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume ( CTV ) in esophageal or gastroesophageal junction ( GEJ ) cancer . METHODS AND MATERIAL S Eight expert academically based gastrointestinal radiation oncologists participated . Three sample cases were chosen : a GEJ cancer , a distal esophageal cancer , and a mid-upper esophageal cancer . Uniform computed tomographic ( CT ) simulation data sets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert , and the expert was instructed to generate gross tumor volume ( GTV ) and CTV contours for each case . All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours . The panel then refined these contours to generate the contouring atlas . RESULTS The κ statistics indicated substantial agreement between panelists for each of the 3 test cases . A consensus CTV atlas was generated for the 3 test cases , each representing common anatomic presentations of esophageal cancer . The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases . CONCLUSIONS This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas . This atlas will serve as a reference for IMRT contours for clinical practice and prospect i ve trial design . Subsequent patterns of failure analyses of clinical data sets using these guidelines may require modification in the future The optimized concurrent chemoradiotherapy has not been established for patients with advanced esophageal squamous cell carcinoma ( SCC ) . The aim of the present study was to evaluate the safety and efficacy of concurrent chemotherapy and selective lymph node ( SLN ) late course accelerated hyperfractionated ( LCAF ) intensity modulated radiotherapy ( IMRT ) for the patients with thoracic SCC . Twelve patients with T3 - 4N0 - 1M0 - 1a thoracic esophageal SCC were included . The total dose of SLN LCAF IMRT was 59.6 Gy/34 fractions in 5.4 weeks . The concurrent chemotherapy protocol was as following : cisplatin 10 mg/m(2 ) on days 1 - 5 and 22 - 26 , pemetrexed in escalating doses , from the base level of 500 mg/m(2 ) once every 21 days . The primary objectives were to determine the maximum tolerated dose ( MTD ) , recommended dose ( RD ) , and dose limiting toxicities ( DLTs ) . Secondary end point included determination of preliminary radiographic response rates . As a result , three patients were enrolled in dose level 1 with pemetrexed 500 mg/m(2 ) and nine patients in dose level 0 with 400 mg/m(2 ) , respectively . At dose level 1 , DLTs occurred in two of three patients . However , only two of nine patients in Level 0 developed DLTs . The complete response and partial response were observed in eight and four patients , respectively . Furthermore , no patient experienced cancer progression with a median follow-up of 9 months . In conclusion , the concurrent SLN LCAF IMRT and chemotherapy is feasible . The MTD of pemetrexed in this regimen was 500 mg/m(2 ) and RD was 400 mg/m(2 ) . Although toxicities were common , the protocol was safe , well tolerated , and achieved an encouraging outcome Cisplatin-based concurrent chemoradiotherapy for patients with unresectable , locally advanced esophageal squamous cell carcinoma ( ESCC ) is associated with significant toxicities that are often intolerable . Prognosis for this subgroup of patients remains poor , and new therapeutic approaches are urgently needed . We investigated the efficacy and safety of paclitaxel combined with erlotinib and concurrent radiotherapy in patients with inoperable ESCC . Erlotinib ( 150 mg ) was administered daily for 60 days beginning at the start of radiotherapy , and paclitaxel ( 45 mg/m² ) was administered weekly along with intensity modulated conformal radiotherapy ( 60 Gy in 30 fractions ) . The median follow-up time was 21 months . The associations between EGFR and VEGF expression and treatment outcome were evaluated . Among the 21 patients treated , the overall response rate ( CR + PR ) was 85.6 % . The median LPFS , PFS and OS were : 17.5 , 14.3 , and 22.9 months , respectively . Treatment-related grade 3 toxicities included esophagitis ( two patients ) and hypoleukemia ( one patient ) . Grade 4 pulmonary toxicity was observed in one patient . Patients expressing EGFR had longer PFS , while those expressing VEGF or with a history of smoking had worse outcomes . Weekly paclitaxel combined with erlotinib and concurrent radiotherapy shows promise as an effective , tolerated regimen for patients with inoperable ESCC Purpose Volumetric-modulated arc therapy ( VMAT ) achieves high conformity to the planned target volume ( PTV ) and good sparing of organs at risk ( OAR ) . This study compares dosimetric parameters and toxicity in esophageal cancer ( EC ) patients treated with VMAT and 3D conformal radiotherapy ( 3D-CRT ) . Material s and methods Between 2007 and 2014 , 17 SC patients received neoadjuvant chemoradiation ( CRT ) with VMAT . Dose – volume histograms and toxicity were compared between these patients and 20 treated with 3D-CRT . All patients were irradiated with a total dose of 45 Gy . All VMAT patients received simultaneous chemotherapy with cisplatin and 5‑fluorouracil ( 5-FU ) in treatment weeks 1 and 5 . Of 20 patients treated with 3D-CRT , 13 ( 65 % ) also received CRT with cisplatin and 5‑FU , whereas 6 patients ( 30 % ) received CRT with weekly oxaliplatin and cetuximab , and a continuous infusion of 5‑FU ( OE-7 ) . Results There were no differences in baseline characteristics between the treatment groups . For the lungs , VMAT was associated with a higher V5 ( median 90.1 % vs. 79.7 % ; p = 0.013 ) and V10 ( 68.2 % vs. 56.6 % ; p = 0.014 ) , but with a lower V30 ( median 6.6 % vs. 11.0 % ; p = 0.030 ) . Regarding heart parameters , VMAT was associated with a higher V5 ( median 100.0 % vs. 91.0 % ; p = 0.043 ) , V10 ( 92.0 % vs. 79.2 % ; p = 0.047 ) , and Dmax ( 47.5 Gy vs. 46.3 Gy ; p = 0.003 ) , but with a lower median dose ( 18.7 Gy vs. 30.0 Gy ; p = 0.026 ) and V30 ( 17.7 % vs. 50.4 % ; p = 0.015 ) . Complete resection was achieved in 16 VMAT and 19 3D-CRT patients . Due to systemic progression , 2 patients did not undergo surgery . The most frequent postoperative complication was anastomosis insufficiency , occurring in 1 VMAT ( 6.7 % ) and 5 3D-CRT patients ( 27.8 % ; p = 0.180 ) . Postoperative pneumonia was seen in 2 patients of each group ( p = 1.000 ) . There was no significant difference in 3‑year overall ( 65 % VMAT vs. 45 % 3D-CRT ; p = 0.493 ) or 3‑year progression-free survival ( 53 % VMAT vs. 35 % 3D-CRT ; p = 0.453 ) . Conclusion Although dosimetric differences in lung and heart exposure were observed , no clinical ly relevant impact was detected in either patient group . In a real-life patient cohort , VMAT enables reduction of lung and heart V30 compared to 3D-CRT , which may contribute to reduced toxicity . ZusammenfassungZielDie volumetrisch modulierte Rotationstherapie ( VMAT ) erreicht eine hohe Abdeckung des Planungszielvolumens mit guter Schonung der Risikoorgane . Verglichen wurden dosimetrische Parameter und Toxizität zwischen VMAT und 3D-konformaler Strahlentherapie ( 3D-CRT ) bei Patienten mit Ösophaguskarzinom . Material und Method enZwischen 2007 und 2014 erhielten 17 Patienten während der neoadjuvanten Radiochemotherapie eine VMAT . Dosis-Volumen-Histogramme und Toxizität wurden mit 20 mit 3D-CRT beh and elten Patienten verglichen . Die Gesamtdosis aller Patienten betrug 45 Gy ( Tagesdosis 1,8 Gy ) . Die VMAT-Gruppe erhielt eine simultane Chemotherapie mit Cisplatin und 5‑Fluoruracil ( 5-FU ) in der 1 . und 5 . Woche . In der 3D-CRT-Gruppe bekamen 13 Patienten ( 65 % ) ebenfalls eine Chemotherapie mit Cisplatin und 5‑FU , 6 Patienten ( 30 % ) eine wöchentliche Chemotherapie mit Oxaliplatin und Cetuximab , sowie eine kontinuierliche Chemotherapie mit 5‑FU (OE-7).ErgebnisseHinsichtlich der Basischarakteristika zeigte sich kein Unterschied zwischen den Gruppen . Für die Lungen war VMAT mit einer höheren V5 ( Median 90,1 % vs. 79,7 % ; p = 0,013 ) und V10 ( 68,2 % vs. 56,6 % ; p = 0,014 ) , aber einer niedrigeren V30 assoziiert ( Median 6,6 % vs. 11,0 % ; p = 0,030 ) . Für das Herz waren für VMAT V5 ( Median 100 % vs. 91 % ; p = 0,043 ) , V10 ( 92 % vs. 79,2 % , p = 0,047 ) und Dmax ( 47,5 Gy vs. 46,3 Gy ; p = Output:

In conclusion , our institutional data and the literature consistently show a low incidence of symptomatic RP after radiochemotherapy in patients with esophageal cancer treated with IMRT .

MS2_1shot180

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To evaluate the effect of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity . METHODS A total of 126 patients with bilateral knee osteoarthritis and obesity were classified into 3 groups by their stages of osteoarthritis . Each group was divided into subgroups a , b , and c. The subjects in subgroup a received weight reduction treatment , those in subgroup b received weight reduction and electrotherapy modalities , and those in subgroup c received electrotherapy modalities to relieve pain . RESULTS Pain reduction , weight reduction , ambulation speed , and changes of Lequesne 's index were greater in patients in subgroups a and b than in subgroup c after treatment . Although the last pain scores in subgroup b were less than those in subgroup a , as measured by a visual analog scale ( VAS ) , there was no significant difference between their functional status . Significant pain relief ( VAS < 2 ) and an acceptable functional status ( Lequesne 's index < 7 ) were indicated when weight reduction was more than 15 % and 12 % , respectively , of the initial body weight of the individual . CONCLUSION Weight reduction was found to be a practical adjuvant treatment in the rehabilitation of patients with knee osteoarthritis Therapeutic trials often attempt to “ blind ” patient and investigator to the true nature of treatments received , reducing the influences of conscious or subconscious prejudices . In drug trials , this is accomplished with placebo tablets , but blinding in trials of physical treatments is more problematic . This issue arose in a clinical trial of transcutaneous electrical nerve stimulation ( TENS ) for patients with chronic low back pain . Several study design features were incorporated to promote blinding : use of sham TENS units visually identical with real units , exclusion of potential subjects with previous TENS experience , avoidance of a crossover design and use of identical visit frequency , instructions and modifications in electrode placement . Subjects were asked not to discuss treatments with the clinicians who performed outcome assessment s. Both patients and clinicians were asked to guess actual treatment assignments at the trial 's end . Every patient in the true TENS group believed the unit was functioning properly , but the degree of certainty varied . In the sham TENS group , 84 % also believed they had functioning units , but their certainty was significantly less than in the active treatment group . Differences in patient perceptions did not affect compliance , as the two groups had similar dropout rates , appointment compliance , days of TENS use and daily duration of TENS use . Clinicians guessed treatments correctly 61 % of the time ( as opposed to 50 % expected by chance ) , again suggesting partial success in blinding . These efforts at blinding may partly explain the negative trial results for TENS efficacy . We conclude that complete blinding is difficult to achieve because of sensory difference in treatment and unintended communication between patient and examiner . Nonetheless , trials of physical treatments can achieve partial blinding with the techniques described here , and the success of blinding can be assessed with simple questions at study completion BACKGROUND Glucosamine and chondroitin sulfate are used to treat osteoarthritis . The multicenter , double-blind , placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial ( GAIT ) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis . METHODS We r and omly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily , 1200 mg of chondroitin sulfate daily , both glucosamine and chondroitin sulfate , 200 mg of celecoxib daily , or placebo for 24 weeks . Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia . Assignment was stratified according to the severity of knee pain ( mild [ N=1229 ] vs. moderate to severe [ N=354 ] ) . The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24 . RESULTS The mean age of the patients was 59 years , and 64 percent were women . Overall , glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent . As compared with the rate of response to placebo ( 60.1 percent ) , the rate of response to glucosamine was 3.9 percentage points higher ( P=0.30 ) , the rate of response to chondroitin sulfate was 5.3 percentage points higher ( P=0.17 ) , and the rate of response to combined treatment was 6.5 percentage points higher ( P=0.09 ) . The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group ( P=0.008 ) . For patients with moderate-to-severe pain at baseline , the rate of response was significantly higher with combined therapy than with placebo ( 79.2 percent vs. 54.3 percent , P=0.002 ) . Adverse events were mild , infrequent , and evenly distributed among the groups . CONCLUSIONS Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee . Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain . ( Clinical Trials.gov number , NCT00032890 . ) Results of a r and omized , double-blind pilot study indicate that transcranial electrotherapy stimulation may be an effective treatment for the temporary reduction of pain in osteoarthritis patients . Presently , the predominant method for pain management is medication . One very different approach is the application of micro- to milliamp current applied to specific areas of the head , result ing in a release of endogenous opioids from pain management regions of the brain . For the pilot study , 64 subjects suffering from osteoarthritis of the knee and /or hip were enrolled . For two weeks prior , then during and after treatment , subject pain was self-assessed using the visual scale ( VS ) . In addition , subjects were globally assessed by a physician . All subjects , device operators and physicians were blinded as to whether subjects were treated with an active or sham device . Data collected from the study indicate both a decrease in VS pain scores and a significant improvement ( p = 0.05 ) in physician assessment in subjects treated with active devices compared to those treated with the sham device Background The heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose The purpose of this study was to compare the effectiveness of transcutaneous nerve stimulation ( TENS ) , electroacupuncture ( EA ) , and ice massage with placebo treatment for the treatment of pain . Subjects ( n = 100 ) diagnosed with osteoarthritis ( OA ) of the knee were treated with these modalities . The parameters for evaluating the effectiveness of treatment include pain at rest , stiffness , 50 foot walking time , quadriceps muscle strength , and knee flexion degree . The results showed ( a ) that all three methods could be effective in decreasing not only pain but also the objective parameters in a short period of time ; and ( b ) that the treatment results in TENS , EA and ice massage were superior to placebo Background The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation ( TENS ) is more effective than acupuncture or TENS alone for treating knee osteoarthritis ( OA ) . Methods Thirty-two patients with knee OA were r and omly allocated to four groups . The acupuncture group ( ACP ) received only acupuncture treatment at selected acupoints for knee pain ; the TENS group ( TENS ) received only TENS treatment at pain areas ; the acupuncture and TENS group ( A&T ) received both acupuncture and TENS treatments ; the control group ( CT ) received topical poultice ( only when necessary ) . Each group received specific weekly treatment five times during the study . Outcome measures were pain intensity in a visual analogue scale ( VAS ) and knee function in terms of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results The ACP , TENS and A&T groups reported lower VAS and WOMAC scores than the control group . Significant reduction in pain intensity ( P = 0.039 ) and significant improvement in knee function ( P = 0.008 ) were shown in the A&T group . Conclusion Combined acupuncture and TENS treatment was effective in pain relief and knee function improvement for the sample d patients suffering from knee OA Acupuncture is one of the oldest healing methods which is used in traditional medicine . In the modern medicine , we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain . A number of modern technological changes are being applied to replace , or modify , the classical needle treatment . Among many modalities used today is the novel addition in Transcutaneous Electrical Nerve Stimulation ( TENS ) called CODETRON which delivers acupuncture-like stimulation in a r and om order . CODETRON was developed by a Canadian Scientist and had been evaluated in a clinical trial in a multidisciplinary pain clinic on patients who came for acupuncture therapy over a period of two years . Indications , effectiveness and experiences with this form of treatment are presented . In addition , results obtained from a six week double-blind r and omized placebo controlled pilot trial of osteoarthritis of the hip/knee with CODETRON which was conducted later . The results were highly suggestive of the beneficial effect of this nonhabituating mode of therapy and confirmed our initial uncontrolled trial results OBJECTIVES To examine the relative effectiveness of electro-acupuncture ( EA ) and transcutaneous electrical nerve stimulation ( TENS ) in alleviating osteoarthritic (OA)-induced knee pain . DESIGN Single-blinded , r and omized controlled study . SUBJECTS Twenty-four ( 24 ) subjects ( 23 women and 1 man ) , mean age 85 , were recruited from eight subsidized Care & Attention Homes for the elderly . INTERVENTIONS Subjects were r and omly assigned to the EA , TENS , or control groups . Subjects in the EA group ( n = 8) received low-frequency EA ( 2 Hz ) on two acupuncture points ( ST-35 , Dubi and EX-LE-4 , Neixiyan ) of the painful knee for 20 minutes . Subjects in the TENS group ( n = 8) received low-frequency TENS of 2 Hz and pulse width of 200 micros on the same acupuncture points for 20 minutes . In both treatment groups , electrical treatment was carried out for a total of eight sessions in 2 weeks . Eight subjects received osteoarthritic knee care and education only in a control group . All subjects were evaluated before the first treatment , after the last treatment , and at 2-week follow-up periods . RESULTS After eight sessions of treatment , there was significant reduction of knee pain in both EA group and TENS group , as measured by the Numeric Rating Scale ( NRS ) of pain ( p < 0.01 ) . Prolonged analgesic effect was maintained in the EA and the TENS groups at a 2-week follow-up evaluation . The Timed Up- and -Go Test ( TUGT ) score of the EA group was significantly lower than that of the control group ( p < 0.05 ) , but such change was not observed in the TENS group . CONCLUSIONS Both EA and TENS treatments were effective in reducing OA-induced knee pain . EA had the additional advantage of enhancing the TUGT results as opposed to TENS treatment or no treatment , which did not produce such corollary effect OBJECTIVE This study examined the optimal stimulation duration of transcutaneous electrical nerve stimulation ( TENS ) for relieving osteoarthritic knee pain and the duration ( as measured by half-life ) of post-stimulation analgesia . SUBJECTS Thirty-eight patients received either : ( i ) 20 minutes ( TENS20 ) ; ( ii ) 40 minutes ( TENS40 ) ; ( iii ) 60 Output:

In this up date , we could not confirm that transcutaneous electrostimulation is effective for pain relief .

MS2_1shot181

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The efficacy of post-percutaneous coronary intervention ( PCI ) intracoronary injection with bone marrow mesenchymal stem cells ( BMSCs ) in patients with acute myocardial infa rct ion ( AMI ) remains controversial . Here , 58 patients with AMI undergoing PCI were r and omly divided into two groups : BMSC and control groups . Autologous BSMCs were then generated in vitro from the BMSC patients . After transplantation , left ventricular ejection fraction ( LVEF ) , left ventricular end-diastolic dimensions ( LVDd ) , and infa rct size ( IS ) were evaluated in both groups . LVEF , LVDd , and IS improved after BMSC transplantation but the changes were not significantly different from those in the controls . The number of adverse events and rehospitalization rates after 1 month were significantly higher in the control group than in the BMSC group . BMSC transplantation thus benefits patients by decreasing the number of adverse events and reducing the rehospitalization rate in the early stages following PCI BACKGROUND Fractional flow reserve ( FFR ) measured on catheterization is now widely used for the diagnosis of functional myocardial ischemia in patients with coronary artery disease ( CAD ) . FFR , however , is invasive and carries potential procedural complications . Therefore , the aim of this study was to compare the diagnostic capability in functionally significant stenosis identified on FFR , between cardiac magnetic resonance myocardial perfusion imaging ( CMR-MPI ) , single-photon emission computed tomography MPI ( SPECT-MPI ) , and dobutamine stress echocardiography ( DSE ) in patients with CAD . METHODS AND RESULTS A total of 25 patients who had at least 1 angiographic stenosis ≥50 % on coronary angiography was studied . CMR-MPI , SPECT-MPI and DSE were done before FFR measurement . FFR was measured in all 3 major epicardial coronary arteries . Out of 71 vascular territories excluding 4 territories due to inadequate imaging , 29 ( 41 % ) had FFR < 0.80 . The sensitivity of CMR-MPI was significantly higher than that of SPECT-MPI and DSE ( P=0.02 and P=0.001 , respectively ) . The area under the receiver operating characteristic curve ( AUC ) for CMR-MPI ( AUC , 0.92 ) was significantly greater than for SPECT-MPI ( AUC , 0.73 ; P=0.006 ) and DSE ( AUC , 0.69 ; P<0.001 ) . CONCLUSIONS CMR-MPI performed well in the detection of functionally significant stenosis defined according to FFR , and had the highest diagnostic sensitivity among the 3 modalities tested in patients with CAD Rationale : Mesenchymal precursor cells ( MPCs ) are a specific Stro-3 + sub population of mesenchymal stem cells isolated from bone marrow . MPCs exert extensive cardioprotective effects , and are considered to be immune privileged . Objective : This study assessed the safety , feasibility , and efficacy of intracoronary delivery of allogeneic MPCs directly after acute myocardial infa rct ion in sheep . Methods and Results : Initially , intracoronary delivery conditions were optimized in 20 sheep . These conditions were applied in a r and omized study of 68 sheep with an anterior acute myocardial infa rct ion . Coronary flow was monitored during MPC infusion , and cardiac function was assessed using invasive hemodynamics and echocardiography at baseline and during 8 weeks follow-up . Coronary flow remained within thrombolysis in myocardial infa rct ion III definitions in all sheep during MPC infusion . Global left ventricular ejection fraction as measured by pressure – volume loop analysis deteriorated in controls to 40.7±2.6 % after 8 weeks . In contrast , MPC treatment improved cardiac function to 52.8±0.7 % . Echocardiography revealed significant improvement of both global and regional cardiac functions . Infa rct size decreased by 40 % in treated sheep , whereas infa rct and border zone thickness were enhanced . Left ventricular adverse remodeling was abrogated by MPC therapy , result ing in a marked reduction of left ventricular volumes . Blood vessel density increased by > 50 % in the infa rct and border areas . Compensatory cardiomyocyte hypertrophy was reduced in border and remote segments , accompanied by reduced collagen deposition and apoptosis . No microinfa rct ions in remote myocardial segments or histological abnormalities in unrelated organs were found . Conclusions : Intracoronary infusion of allogeneic MPCs is safe , feasible , and markedly effective in a large animal model of acute myocardial infa rct ion BACKGROUND Pilot trials suggest that the intracoronary administration of autologous progenitor cells may improve left ventricular function after acute myocardial infa rct ion . METHODS In a multicenter trial , we r and omly assigned 204 patients with acute myocardial infa rct ion to receive an intracoronary infusion of progenitor cells derived from bone marrow ( BMC ) or placebo medium into the infa rct artery 3 to 7 days after successful reperfusion therapy . RESULTS At 4 months , the absolute improvement in the global left ventricular ejection fraction ( LVEF ) was significantly greater in the BMC group than in the placebo group ( mean [ + /-SD ] increase , 5.5+/-7.3 % vs. 3.0+/-6.5 % ; P=0.01 ) . Patients with a baseline LVEF at or below the median value of 48.9 % derived the most benefit ( absolute improvement in LVEF , 5.0 % ; 95 % confidence interval , 2.0 to 8.1 ) . At 1 year , intracoronary infusion of BMC was associated with a reduction in the prespecified combined clinical end point of death , recurrence of myocardial infa rct ion , and any revascularization procedure ( P=0.01 ) . CONCLUSIONS Intracoronary administration of BMC is associated with improved recovery of left ventricular contractile function in patients with acute myocardial infa rct ion . Large-scale studies are warranted to examine the potential effects of progenitor-cell administration on morbidity and mortality Background The use of adult stem cells is limited by the quality and quantity of host stem cells . It has been demonstrated that Wharton ’s jelly – derived mesenchymal stem cells ( WJMSCs ) , a primitive stromal population , could integrate into ischemic cardiac tissues and significantly improve heart function . In this r and omized , controlled trial , our aim was to assess the safety and efficacy of intracoronary WJMSCs in patients with ST-elevation acute myocardial infa rct ion ( AMI ) . Methods In a multicenter trial , 116 patients with acute ST-elevation MI were r and omly assigned to receive an intracoronary infusion of WJMSCs or placebo into the infa rct artery at five to seven days after successful reperfusion therapy . The primary endpoint of safety : the incidence of adverse events ( AEs ) within 18 months , was monitored and quantified . The endpoint of efficacy : the absolute changes in myocardial viability and perfusion of the infa rct ed region from baseline to four months , global left ventricular ejection fraction ( LVEF ) from baseline to 18 months were measured using F-18-fluorodeoxyglucose positron emission computed tomography ( F-18-FDG-PET ) and 99mTc-sestamibi single-photon emission computed tomography ( 99mTc-SPECT ) , and two-dimensional echocardiography , respectively . Results During 18 months follow-up , AEs rates and laboratory tests including tumor , immune , and hematologic indexes were not different between the two groups . The absolute increase in the myocardial viability ( PET ) and perfusion within the infa rct ed territory ( SPECT ) was significantly greater in the WJMSC group [ 6.9 ± 0.6 % ( 95 % CI , 5.7 to 8.2 ) ] and [ 7.1 ± 0.8 % ( 95 % CI , 5.4 to 8.8 ) than in the placebo group [ 3.3 ± 0.7 % ( 95 % CI , 1.8 to 4.7 ) , P < 0.0001 ] and 3.9 ± 0.6(95 % CI , 2.8 to 5.0 ) , P = 0.002 ] at four months . The absolute increase in the LVEF at 18 months in the WJMSC group was significantly greater than that in the placebo group [ 7.8 ± 0.9 ( 6.0 to approximately 9.7 ) vs. 2.8 ± 1.2 ( 0.4 to approximately 5.1 ) , P = 0.001 ] . Concomitantly , the absolute decreases in LV end-systolic volumes and end-diastolic volumes at 18 months in the WJMSC group were significantly greater than those in the placebo group ( P = 0.0004 , P = 0.004 , respectively ) . Conclusions Intracoronary infusion of WJMSCs is safe and effective in patients with AMI , providing clinical ly relevant therapy within a favorable time window . This study encourages additional clinical trials to determine whether WJMSCs may serve as a novel alternative to BMSCs for cardiac stem cell-based therapy . Trial registration Clinical Trials NCT01291329 ( 02/05/2011 ) Recent studies suggest that the intracoronary administration of bone marrow (BM)-derived mesenchymal stem cells ( MSCs ) may improve left ventricular function in patients with acute myocardial infa rct ion ( AMI ) . However , there is still argumentative for the safety and efficacy of MSCs in the AMI setting . We thus performed a r and omized pilot study to investigate the safety and efficacy of MSCs in patients with AMI . Eighty patients with AMI after successful reperfusion therapy were r and omly assigned and received an intracoronary administration of autologous BM-derived MSCs into the infa rct related artery at 1 month . During follow-up period , 58 patients completed the trial . The primary endpoint was changes in left ventricular ejection fraction ( LVEF ) by single-photon emission computed tomography ( SPECT ) at 6 month . We also evaluated treatment-related adverse events . The absolute improvement in the LVEF by SPECT at 6 month was greater in the BM-derived MSCs group than in the control group ( 5.9%±8.5 % vs 1.6%±7.0 % ; P=0.037 ) . There was no treatment-related toxicity during intracoronary administration of MSCs . No significant adverse cardiovascular events occurred during follow-up . In conclusion , the intracoronary infusion of human BM-derived MSCs at 1 month is tolerable and safe with modest improvement in LVEF at 6-month follow-up by SPECT . ( Clinical Trials.gov registration number : NCT01392105 BACKGROUND There are only few data on long-term effectiveness of the stem cell therapy . AIM We studied the time course of global and regional left ventricular function in patients with acute myocardial infa rct ion within 1 year after the autologous mononuclear bone marrow cell transplantation . METHODS Sixty patients with a first acute myocardial infa rct ion , who had been r and omized into 3 groups , completed a 12-month protocol . Two groups were intracoronarily given bone marrow cells in either higher ( 10(8 ) cells , HD group , n=20 ) or lower ( 10(7 ) cells , LD group , n=20 ) doses . Twenty patients without cell transplantation served as a control ( C ) group . Doppler tissue imaging and the gated technetium-99 m sestamibi single photon emission computed tomography were performed before cell transplantation and at 3 , 6 , and 12 months later . RESULTS The baseline peak systolic velocities of longitudinal contraction of the infa rct ed wall ( S(infa rct ) ) of 5.2 cm/s , 4.6 cm/s , and 4.4 cm/s in C , LD , and HD groups increased by 0.0 cm/s , 0.3 cm/s ( p = NS vs. C group ) , and by 0.7 cm/s ( p<0.05 vs. C group ) , respectively , at 3 months . At 12 months , however , the corresponding changes from baseline values of 0.1 cm/s , 0.2 cm/s , and 0.6 cm/s did not differ significantly ( all p = NS ) . In contrast , the post-transplant improvements in the left ventricular ejection fraction by 6 % , 7 % , and 7 % at months 3 , 6 , and 12 , respectively , were preserved in HD group patients during the whole 12-month follow-up and remained significantly better as compared to controls . CONCLUSIONS In our study , the autologous mononuclear bone marrow cell transplantation provided sustained improvement in global left ventricular systolic function in patients with acute myocardial infa rct ion . However , when evaluating regional systolic function of the infa rct ed wall , the short-term benefit was partially lost during the 12-month follow-up Objectives : Intracoronary cell transplantation during catheter balloon inflations may be associated with Output:

Conclusions Transplantation time and injected cell dose are key factors that determine the therapeutic effect of stem cell therapy . The injection of no more than 107 MSCs within 1 week for AMI after percutaneous coronary intervention might improve left ventricular systolic function .

MS2_1shot182

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Evidence -based practice s design ed for large urban clinics are not necessarily portable into smaller isolated clinics . Implementing practice -based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists . Objective The purpose of the Telemedicine Enhanced Antidepressant Management ( TEAM ) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists . Design Matched sites were r and omized to the intervention or usual care . Participants Small VA Community-based outpatient clinics with no on-site psychiatrists , but access to telepsychiatrists . In 2003–2004 , 395 primary care patients with PHQ9 depression severity scores ≥12 were enrolled , and followed for 12 months . Patients with serious mental illness and current substance dependence were excluded . Measures Medication adherence , treatment response , remission , health status , health-related quality of life , and treatment satisfaction . Results The sample comprised mostly elderly , white , males with substantial physical and behavioral health comorbidity . At baseline , subjects had moderate depression severity ( Hopkins Symptom Checklist , SCL-20 = 1.8 ) , 3.7 prior depression episodes , and 67 % had received prior depression treatment . Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 ( odds ratio [ OR ] = 2.1 , p = .04 ) and 12 months ( OR = 2.7 , p = .01 ) . Intervention patients were more likely to respond by 6 months ( OR = 2.0 , p = .02 ) , and remit by 12 months ( OR = 2.4 , p = .02 ) . Intervention patients reported larger gains in mental health status and health-related quality of life , and reported higher satisfaction . Conclusions Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies Background Treatments and organizational changes supported by eHealth are beginning to play an important role in improving disease treatment outcome and providing cost-efficient care management . “ Improvehealth.eu ” is a novel eHealth service to support the treatment of patients with depressive disorder . It offers active patient engagement and collaborative care management by combining Web- and mobile-based information and communication technology systems and access to care managers . Objectives Our objective was to assess the feasibility of a novel eHealth service . Methods The intervention — the “ Improvehealth.eu ” service — was explored in the course of a pilot study comparing two groups of patients receiving treatment as usual and treatment as usual with eHealth intervention . We compared patients ’ medication adherence and outcome measures between both groups and additionally explored usage and overall perceptions of the intervention in intervention group . Results The intervention was successfully implemented in a pilot with 46 patients , of whom 40 were female . Of the 46 patients , 25 received treatment as usual , and 21 received the intervention in addition to treatment as usual . A total of 55 % ( 12/25 ) of patients in the former group and 45 % ( 10/21 ) in the latter group finished the 6-month pilot . Available case analysis indicated an improvement of adherence in the intervention group ( odds ratio [ OR ] = 10.0 , P = .03 ) . Intention-to-treat analysis indicated an improvement of outcome in the intervention group ( ORs ranging from 0.35 to 18 ; P values ranging from .003 to .20 ) , but confidence intervals were large due to small sample sizes . Average duration of use of the intervention was 107 days . The intervention was well received by 81 % ( 17/21 ) of patients who reported feeling actively engaged , in control of their disease , and that they had access to a high level of information . In all , 33 % ( 7/21 ) of the patients also described drawbacks of the intervention , mostly related to usability issues . Conclusions The results of this pilot study indicate that the intervention was well accepted and helped the patients in the course of treatment . The results also suggest the potential of the intervention to improve both medication adherence and outcome measures of treatment , including reduction of depression severity and patients becoming “ healthy . Context Few studies have evaluated whether health care assistants can improve care for depressed patients . Contribution Patients who were r and omly assigned to receive telephone case management by health care assistants reported slightly greater improvements in depression symptoms , better adherence to antidepressant therapies , and more favorable assessment s of the quality of their care than did patients r and omly assigned to receive usual care . Implication Telephone case management facilitated by health care assistants may be a feasible mechanism for small primary care practice s to improve care of their patients with depression . The Editors Depression causes a substantial disease burden ( 1 ) and is responsible for annual health care costs of about $ 83.1 billion in the United States ( 2 , 3 ) . Most patients with depression are treated in primary care ( 46 ) . Collaborative care can improve depression outcomes by providing decision support and clinical information for family physicians , as well as self-management support and follow-up for patients . However , evidence regarding collaborative depression care stems mostly from academic or managed care setting s in the United States ( 711 ) . In these trials , family physicians generally relied on mental health case managers and decision support from mental health specialists ( 12 ) . Case management is a patient-centered element of collaborative care that may be effective in primary care ( 13 ) . It comprises systematic tracking of patients , support for continuing the treatment , and taking action in the case of nonadherence or lack of improvement ( 14 ) . Collaborative depression care has generally yielded positive results in diverse primary care setting s ( 7 ) . The IMPACT ( Improving MoodPromoting Access to Collaborative Treatment ) trial found that care managers who were supervised by psychiatrists and who provided education and support for medication adherence reduced depression symptoms in older patients ( 15 ) . Dietrich and colleagues ( 16 ) found that telephone support , provided by a trained , central ly based mental health care manager who was supervised by a psychiatrist , improved depression symptoms . Dobscha and colleagues ( 17 ) evaluated a primary care decision-support team for depression ( comprising a psychiatrist and a mental health nurse ) and found improved care processes but no differences in depression symptoms ( 17 ) , possibly because of less intensive follow-up of patients . Small , isolated primary care setting s often have limited re sources ( 18 ) . In the United States , 26 % of primary care practice s are solo practice s or 2-person partnerships , in which extensive collaborative models would be difficult to implement , and 22 % are located in rural areas with limited access to mental health specialists ( 19 ) . Health care assistants are established professionals in primary care setting s. They have less training than U.S. physician assistants or nurse practitioners , who provide first-contact care , and need not be college graduates ( 20 ) . In Germany , health care assistants have 3 years of on-the-job training . They are mainly responsible for administrative tasks in general practice but provide basic clinical procedures ( 21 ) . Health care assistants are a potentially important re source for enhancing patient care in primary care setting s ( 20 ) . Our aim was to evaluate whether case management by a practice -based health care assistant can reduce depression symptoms and improve the process of care for patients with major depression in small primary care practice s. Methods We design ed a pragmatic , cluster r and omized , controlled trial that used practice as the unit of r and omization to avoid contamination ( 22 ) . The institutional review board of Goethe University Frankfurt am Main , Frankfurt am Main , Germany , approved the study protocol on 25 April 2005 ( 23 ) . We used written consent procedures for family physicians and patients . We recruited practice s between February 2005 and May 2005 and patients between May 2005 and July 2006 . We carried out the intervention between June 2005 and August 2007 . We completed the last follow-up for study patients in September 2007 . Setting and Participants After calculating the sample size ( 24 ) , we informed all 1600 family physicians registered with the medical association of the state of Hesse , Germany ( m and atory registration ) , about the trial and invited them by mail to participate in information meetings . As the registration list presents only names and addresses , we checked inclusion criteria only for those who participated in the meetings . We stopped recruiting when 74 practice s had enrolled , even though more practice s were interested in participating . Inclusion criteria for the practice s were acceptance of all major health plans ( 90 % of patients are covered by this type of insurance ) ( 25 ) ; provision of a primary care service , according to the definition of Starfield and colleagues ( 26 ) ; and management by a family physician . Patients were screened on special date s and referred to the trial by the family physician in the primary care practice . Inclusion criteria for patients were diagnosis of major depression with indication for any antidepressive treatment , age 18 to 80 years , access to a private telephone , ability to give informed consent , and ability to communicate in German . The diagnosis of major depression was based on a score of more than 9 points and a categorical diagnosis in the Patient Health Question naire-9 ( PHQ-9 ) ( 27 ) , and was confirmed by the family physician by using the checklists in the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , and International Classification of Diseases , Tenth Edition . New patients were double-screened with the same procedure within 2 weeks . Exclusion criteria were confirmed pregnancy , severe alcohol or illicit drug consumption , or acute suicidal ideation assessed by the family physician . R and omization and Interventions The data safety and monitoring board stratified the practice s according to the size of the city and performed computer-based r and omization . Patient r and om assignment status was nested within the practice status . The data safety and monitoring board was responsible for allocation concealment by keeping the r and omization results in a secure data base . Because of the practice staff training required for the behavioral intervention , patients , health care assistants , family physicians , and research ers were not blinded to assignment once the trial was started . We design ed our case management intervention in accordance with the Chronic Care Model ( 28 , 29 ) , which emphasizes proactive support for the patient by the entire practice team . We trained 1 health care assistant from each practice assigned to the intervention group in 2 workshops ( an 11-hour and a 6-hour workshop ) . This interactive training included information on depression , communication skills , telephone monitoring , and behavioral activation for the patient ( 3032 ) . The health care assistants contacted their patients by telephone twice a week in the first month and than once a month for the following 11 months . They monitored depression symptoms and adherence to medication by using the Depression Monitoring List ( 33 ) . Health care assistants also encouraged patients to follow self-management activities , such as medication adherence and activation for pleasant or social activities . The assistants provided this information to the family physician in a structured report that stratified the urgency of the contact by a robot scheme . Family physicians in both the intervention and control groups received training on evidence -based depression treatment guidelines ( 34 ) . During the trial , other forms of disease or case management programs were uncommon in Germany ( 35 ) . No study practice carried out case management for any other diseases . Outcomes and Follow-up Self-rating question naires were h and ed out to the patients at baseline and at 6 and 12 months after baseline . Patients filled in the question naires at home and sent them back to the practice . We collected the question naires in the practice s and collected data from patient records ( number of family physician and specialist contacts , hospitalization , and prescribed medication ) . Research staff carried out data input and management ( 36 ) . Serious adverse events were reported to the data safety and monitoring board . Clinical Outcomes The primary outcome was depression symptoms , which we assessed by using the primary carevali date d PHQ-9 ( 37 ) . Each item is scored from 0 ( not at all ) to 3 ( nearly every day ) , for a total score that ranges from 0 to 27 ( high scores indicate more severe depression ) . We assessed response ( 50 % improvement in PHQ-9 score ) and remission status ( PHQ-9 score<5 ) as secondary outcomes . We also report data for the following secondary outcomes : quality of life , patient assessment of chronic illness care , and medication adherence . We measured health-related quality of life by using the Medical Outcomes Study Short Form 36 ( SF-36 ) ( 38 , 39 ) and the EuroQol-5D ( 40 ) . The SF-36 allows the calculation of scores for physical health and mental health ( range , 0 to 100 ; higher scores indicate better status ) . The EuroQol-5D is a generic instrument that measures health-related quality of life with a visual analogue scale ( range , 0 to 100 ; higher ratings indicate higher quality of life ) . We determined the number of physical comorbid conditions by counting the documented diagnoses from different diagnostic groups listed in the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , and International Classification of Diseases , Tenth Edition , excluding all psychiatric diagnoses in the patient record . We assessed severity of chronic physical diseases by using the Chronic Disease Score , on the basis of prescription data from the patient record ( 41 ) . Process-of-Care Outcomes We assessed the number of family physician and mental health specialist contacts , as well as prescriptions for PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications , depression outcomes , and blood pressure control among older primary care patients . METHODS Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were r and omly assigned to an integrated care intervention or usual care . Outcomes were assessed at baseline , 2 , 4 , and 6 weeks using the Center for Epidemiologic Studies Depression Output:

Adherence improved most notably in studies that included sustainable system and patient-targeted changes . Primary care providers are often positioned to impact patients ' adherence ; however , practice constraints can limit their implementation

MS2_1shot183

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES The study aim ed to test two hypotheses . Firstly , that participants who relapsed during the 12-month follow-up period of our r and omized controlled trial , would show increased negative beliefs about their illness and reduced self-esteem , in comparison to the non-relapsed participants . Secondly , that cognitive behavioural therapy ( CBT ) for early signs of relapse would result in a reduction in negative beliefs about psychosis and an improvement in self-esteem at 12 months . DESIGN AND METHODS A total of 144 participants with schizophrenia or a related disorder were r and omized to receive either treatment as usual ( TAU ; N=72 ) or CBT ( N=72 ) . Participants completed the Personal Beliefs about Illness Question naire ( PBIQ ; Birchwood , Mason , MacMillan , & Healy , 1993 ) and the Rosenberg Self-Esteem Scale ( RSES ; Rosenberg , 1965 ) at entry , 3 months , 6 months , and 12 months . RESULTS At 12 months , relapsers showed greater increase in scores for PBIQ entrapment compared with non-relapsers . In addition , after controlling for baseline covariates ( treatment group and PBIQ self versus illness ) , relapsers also showed greater increase in scores for PBIQ self versus illness at 12 months . Furthermore , in comparison to treatment as usual , participants who received CBT showed greater improvement in PBIQ loss and in Rosenberg self-esteem . CONCLUSIONS The study provides evidence that relapse is associated with the development of negative appraisal s of entrapment and self-blame ( self vs. illness ) . In addition , this is the first study to show that CBT reduces negative appraisal s of loss arising from psychosis and improvements in self-esteem . Implication s for future research and treatment are discussed Background Mental disorders are more common in young adults than at any other life stage . Despite this , young people have low rates of seeking professional help for mental health problems . Young elite athletes have less positive attitudes toward seeking help than nonathletes and thus may be particularly unlikely to seek help . Interventions aim ed at increasing help-seeking in young elite athletes are warranted . Objective To test the feasibility and efficacy of three Internet-based interventions design ed to increase mental health help-seeking attitudes , intentions , and behavior in young elite athletes compared with a control condition . Methods We conducted a r and omized controlled trial ( RCT ) of three brief fully automated Internet-based mental health help-seeking interventions with 59 young elite athletes recruited online in a closed trial in Australia . The interventions consisted of a mental health literacy and destigmatization condition , a feedback condition providing symptom levels , and a minimal content condition comprising a list of help-seeking re sources , compared with a control condition ( no intervention ) . We measured help-seeking attitudes , intentions and behavior using self-assessed surveys . Participation was open to elite athletes regardless of their mental health status or risk of mental illness . Results Of 120 athletes initially agreeing to participate , 59 ( 49 % ) su bmi tted a preintervention or postintervention survey , or both , and were included in the present study . Adherence was satisfactory , with 48 ( 81 % ) participants visiting both weeks of assigned intervention material . None of the interventions yielded a significant increase in help-seeking attitudes , intentions , or behavior relative to control . However , at postintervention , there was a trend toward a greater increase in help-seeking behavior from formal sources for the mental health literacy/destigmatization condition compared with control ( P = .06 ) . This intervention was also associated with increased depression literacy ( P = .003 , P = .005 ) and anxiety literacy ( P = .002 , P = .001 ) relative to control at postintervention and 3-month follow-up , respectively , and a reduction in depression stigma relative to control at postintervention ( P = .01 , P = .12 ) and anxiety stigma at 3-month follow-up ( P = .18 , P = .02 ) . The feedback and help-seeking list interventions did not improve depression or anxiety literacy or decrease stigmatizing attitudes to these conditions . However , the study findings should be treated with caution . Due to recruitment challenges , the achieved sample size fell significantly short of the target size and the study was underpowered . Accordingly , the results should be considered as providing preliminary pilot data only . Conclusions This is the first RCT of an Internet-based mental health help-seeking intervention for young elite athletes . The results suggest that brief mental health literacy and destigmatization improves knowledge and may decrease stigma but does not increase help-seeking . However , since the trial was underpowered , a larger trial is warranted . Trial Registration 2009/373 ( www . clinical trials.gov ID : NCT00940732 ) , cited at http://www.webcitation.org/5ymsRLy9r Stigmatizing , or discriminatory , perspectives and behaviour , which target individuals on the basis of their mental health , are observed in even the youngest school children . We conducted a systematic review of the published and unpublished , scientific literature concerning the benefits and harms of school-based interventions , which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization . Forty relevant studies were identified , yet only a qualitative synthesis was deemed appropriate . Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions : poor reporting quality , a dearth of r and omized controlled trial evidence , poor methods quality for all research design s , considerable clinical heterogeneity , and inconsistent or null results . Nevertheless , certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development , implementation and evaluation of a curriculum , which fosters the development of empathy and , in turn , an orientation toward social inclusion and inclusiveness . These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct , structured contact with an infant , and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties . The possible value of using educational activities , material s and contents to enhance hypothesized benefits accruing to direct contact also requires investigation . Overall , the curriculum might serve as primary prevention for some students and as secondary prevention for others OBJECTIVES The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes , dangerousness , and desired social distance . METHODS Data were derived from a vignette experiment included in the 1996 General Social Survey . Respondents ( n = 1444 ) were r and omly assigned to 1 of 5 vignette conditions . Four vignettes described psychiatric disorders meeting diagnostic criteria , and the fifth depicted a " troubled person " with sub clinical problems and worries . RESULTS Results indicate that the majority of the public identifies schizophrenia ( 88 % ) and major depression ( 69 % ) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors . Results also show , however , that smaller proportions associate alcohol ( 49 % ) or drug ( 44 % ) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a desire for limited social interaction . CONCLUSIONS While there is reason for optimism in the public 's recognition of mental illness and causal attributions , a strong stereotype of dangerousness and desire for social distance persist . These latter conceptions are likely to negatively affect people with mental illness BACKGROUND Direct social contact interventions are known to reduce mental health stigma . Filmed social contact may be equally effective and have practical and cost advantages . AIMS To compare the effectiveness of a DVD , a live intervention and a lecture control , in reducing stigma , testing the hypotheses that : ( a ) DVD and live interventions will be equally effective ; and ( b ) the interventions with social contact ( DVD/live ) will be more effective than the lecture . Cost-effectiveness , process and acceptability are also assessed . METHOD Student nurses were r and omised to : ( a ) watch a DVD of service users/informal carers talking about their experiences , ( b ) watch a similar live presentation , or ( c ) attend a lecture . Primary outcomes were changes in attitudes ( using the Mental Illness : Clinicians Attitudes Scale , MICA ) , emotional reactions ( using the Emotional Reactions to Mental Illness Scale , ERMIS ) , intended proximity ( using the Reported and Intended Behaviour Scale , RIBS ) , and knowledge ( using the Social Contact Intended Learning Outcomes , SCILO ) , immediately after the intervention and at 4-month follow-up . RESULTS For the 216 participants , there were no differences between the DVD and live groups on MICA , ERMIS or RIBS scores . The DVD group had higher SCILO ( knowledge ) scores . The combined social contact group ( DVD/live ) had better MICA and RIBS scores than the lecture group , the latter difference maintained at 4 months . The DVD was the most cost-effective of the interventions , and the live session the most popular . CONCLUSIONS Our hypotheses were confirmed . This study supports the wider use of filmed social contact interventions to reduce stigma about mental illness Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Systematic review s provide the best evidence on the effectiveness of healthcare interventions including quality improvement strategies . The methods of systematic review of individual patient r and omised trials of healthcare interventions are well developed . We discuss method ological and practice issues that need to be considered when undertaking systematic review s of quality improvement strategies including developing a review protocol , identifying and screening evidence sources , quality assessment and data abstract ion , analytical methods , reporting systematic review s , and appraising systematic review s. This paper builds on our experiences within the Cochrane Effective Practice and Organisation of Care ( EPOC ) review group Background Mental disorders often have their first onset during adolescence . For this reason , high school teachers are in a good position to provide initial assistance to students who are developing mental health problems . To improve the skills of teachers in this area , a Mental Health First Aid training course was modified to be suitable for high school teachers and evaluated in a cluster r and omized trial . Methods The trial was carried out with teachers in South Australian high schools . Teachers at 7 schools received training and those at another 7 were wait-listed for future training . The effects of the training on teachers were evaluated using question naires pre- and post-training and at 6 months follow-up . The question naires assessed mental health knowledge , stigmatizing attitudes , confidence in providing help to others , help actually provided , school policy and procedures , and teacher mental health . The indirect effects on students were evaluated using question naires at pre-training and at follow-up which assessed any mental health help and information received from school staff , and also the mental health of the student . Results The training increased teachers ' knowledge , changed beliefs about treatment to be more like those of mental health professionals , reduced some aspects of stigma , and increased confidence in providing help to students and colleagues . There was an indirect effect on students , who reported receiving more mental health information from school staff . Most of the changes found were sustained 6 months after training . However , no effects were found on teachers ' individual support towards students with mental health problems or on student mental health . Conclusions Mental Health First Aid training has positive effects on teachers ' mental health knowledge , attitudes , confidence and some aspects of their behaviour . Trial registration The purpose of this school-based cluster-r and omized trial was to determine the initial acceptability , feasibility , and efficacy of an existing community-based intervention , In Our Own Voice , in a sample of US adolescent girls aged 13 - 17 years ( n = 156 ) . In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma . This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy . Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study . Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed . The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up . The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up . The intervention did improve mental health literacy at 4 and 8 weeks follow up . Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults ; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States . This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents BACKGROUND A school mental-health programme has been developed as a component of the community mental-health programme in Rawalpindi , Pakistan . It has the objective of improving the underst and ing of disorders of mental health in the rural community . We aim ed to assess the impact of a school mental-health programme on the awareness of schoolchildren , their parents , friends who were not attending school , and neighbours . METHODS We chose two secondary schools for boys and two for girls that were similar in terms of size , staff-pupil ratio , and drop-out rates . 100 children aged 12 - 16 years ( 25 girls and 25 boys in each of the study and control groups ) , 100 parents ( one for each child ) , 100 friends who did not attend school ( one for each child ) , and 100 neighbours ( one for each child ) were given a 19-item question naire before and after the study group had had a 4-month programme of mental-health education . The maximum score for the question naire was 16 points . FINDINGS Before the school mental Output:

Those containing social contact ( direct or indirect ) were not more effective than those without . There is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes . Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term .

MS2_1shot184

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: objective To assess whether there is a relationship between the effectiveness of alendronate treatment in postmenopausal women with osteoporosis and BsmI vitamin D receptor ( VDR ) genotypes CONTEXT Osteoporosis is a systemic disease with a strong genetic component . Vitamin D receptor ( VDR ) gene polymorphisms explain only a small part of the genetic influence on the level of bone mineral density ( BMD ) , whereas their effect on fracture remains uncertain . OBJECTIVE The objective of this study was to investigate the relationships between VDR genotypes and fracture risk . DESIGN A prospect i ve population -based cohort was studied . SUBJECTS A total of 589 postmenopausal women ( mean age , 62 yr ) were followed prospect ively during a median ( interquartile ) of 11 ( 1.1 ) yr . MAIN OUTCOME MEASURE The study measured incidents of vertebral and nonvertebral fractures . RESULTS VDR allele B was significantly and dose dependently overrepresented in women who fractured , including 34 and 86 women with first incident vertebral and nonvertebral fragility fractures , respectively . This corresponded to an odds ratio of 1.5 ( 95 % confidence interval , 0.95 - 2.40 ) for heterozygous carriers ( bB , n = 286 ) and 2.10 ( 95 % confidence interval , 1.16 - 3.79 ) for homozygous carriers ( BB , n = 90 ) of the B allele , compared with women with the bb genotype ( n = 213 ) . VDR genotype groups did not differ for demographics , physical activity , grip strength , personal and maternal history of fracture , and calcium intake . The association was independent of BMD of the spine , hip , and radius , and of the BMD loss at the radius . The relationship between VDR polymorphisms and fracture risk was not altered after adjustment for baseline circulating levels of bone turnover markers , estradiol , dehydroepi and rosterone sulfate , SHBG , IGF-I , intact PTH , and 25 hydroxyvitamin D. CONCLUSION VDR genotypes are associated with the risk of fracture in postmenopausal women independently of BMD , rate of postmenopausal forearm BMD loss , bone turnover , and endogenous hormones . The mechanisms by which VDR genotypes influence bone strength remain to be determined Vitamin D receptor ( VDR ) gene polymorphisms could be considered one of the factors influencing the efficacy of the anti-osteoporotic treatments . In this multicenter , prospect i ve , r and omized and controlled trial we evaluated whether BsmI vitamin D receptor ( VDR ) genotypes influence the efficacy of antiresorptive treatment regimes ( administered alone or in combination ) in postmenopausal osteoporotic women . Using restriction endonuclease , we identified the BsmI VDR polymorphism in 1,100 postmenopausal women with osteoporosis . The women were r and omized , taking account of genotype , into five treatment groups : ( 1 ) alendronate ( Aln , 10 mg/day ) plus raloxifene ( Rlx , 60 mg/day ) ; ( 2 ) Aln plus hormone replacement therapy ( HRT , 0.625 mg/day conjugated equine estrogens plus 2.5 mg/day medroxyprogesterone acetate ) ; ( 3 ) Aln alone ; ( 4 ) HRT alone ; and ( 5 ) Rlx alone . Lumbar-spine bone mineral density ( BMD ) and bone turnover markers were measured at study entry and after 1 year of treatment . Using the general linear model ( GLM ) repeated- measures procedure , the means of BMD and bone turnover markers significantly differed from baseline after a period of treatment . In particular , the mean change from baseline for BMD was −0.034 ( 95 % confidence interval [ CI ] : −0.037 to −0.031 , P < 0.001 ) ; for serum osteocalcin ( OC ) it was 1.369 ( 95 % CI : 1.289 to 1.448 , P < 0.001 ) ; and for urinary deoxypyridinoline ( DPD ) it was 1.322 ( 95 % CI : 1.242 to 1.401 , P < 0.001 ) , indicating a considerable variation before and after treatment of these indicators . In all three cases these effects appeared significantly influenced by treatments , genotypes , and the treatments*genotypes interaction term ( P < 0.001 each , except for the BMD and genotype effect with P = 0.02 ) , and not by the investigational centers involved in the study . In conclusion , in postmenopausal osteoporotic women , BsmI VDR genotypes influence the efficacy of antiresorptive drugs particularly when used in combination A novel T/C polymorphism ( ATG to ACG ) at the translation initiation site of the vitamin D receptor ( VDR ) gene , defined by FokI restriction endonuclease , has been recently associated with variation in bone mineral density ( BMD ) and rates of bone loss in a group of postmenopausal Mexican-American women . The presence of the restriction site , design ated as f , allows protein translation to initiate from the first ATG , while the allele lacking the site , indicated as F , initiates translation at a second ATG . In this study , we investigated the role of FokI polymorphism in a group of 400 postmenopausal women of Italian descent stratified for BMD into osteoporotic ( n = 164 ) , osteopenic ( n = 117 ) , and normal ( n = 119 ) groups . There were 159 ( 41 % ) FF homozygotes , 55 ( 14 % ) ff homozygotes , and 186 ( 45 % ) Ff heterozygotes . In the whole population , we observed a weak association between FokI polymorphism and lumbar BMD ( p = 0.06 , analysis of covariance [ ANCOVA ] ) but not with femoral neck BMD ( p = 0.5 , ANCOVA ) . Interestingly , the effect of FokI genotypes on lumbar BMD was influenced by the years since menopause such that differences in BMD related to different VDR allelic variants were greater among women in the first 5 years of menopause ( p = 0.04 , ANCOVA ) , progressively declining afterward . In addition , a significantly higher prevalence of ff genotype in osteoporotic than in osteopenic and normal women was observed ( p = 0.04 , Chi-square test ) . Finally , ff genotype result ed significantly over-represented in the group of women with a vertebral fracture as compared with controls ( p = 0.003 , Chi-square test ) , equivalent to a relative risk of 2.58 ( 95 % confidence intervals 1.36 - 4.91 ) . We conclude that in this population , FokI polymorphism at the VDR gene locus accounts for a part of the heritable component of BMD at the lumbar spine Output:

Overall , there were significant correlations between VDR ApaI , VDR FokI and PMOP susceptibility . Subgroup analysis showed that VDR ApaI polymorphism significantly decreased the osteoporosis risk in Caucasian postmenopausal women . In Asian population s , VDR BsmI and VDR FokI were associated with an increased risk of PMOP . As to the associations between VDR polymorphisms and BMD , Caucasian PMOP women carrying the ApaI aa genotype were at risk of high BMD in femoral neck , and low femoral neck BMD was observed in Caucasian PMOP women with FokI Ff genotype . PMOP women with the Cdx2 GA genotype had a lower lumbar spine BMD in overall and Caucasian population s compared with PMOP women with GG genotype . Different VDR gene polymorphisms have different impacts on PMOP risk and BMD

MS2_1shot185

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Falls in elderly people are a common presenting complaint to accident and emergency departments . Current practice commonly focuses on the injury , with little systematic assessment of the underlying cause , functional consequences , and possibilities for future prevention . We undertook a r and omised controlled study to assess the benefit of a structured inderdisciplinary assessment of people who have fallen in terms of further falls . METHODS Eligible patients were aged 65 years and older , lived in the community , and presented to an accident and emergency department with a fall . Patients assigned to the intervention group ( n=184 ) underwent a detailed medical and occupational-therapy assessment with referral to relevant services if indicated ; those assigned to the control group ( n=213 ) received usual care only . The analyses were by intention to treat . Follow-up data were collected every 4 months for 1 year . FINDINGS At 12-month follow-up , 77 % of both groups remained in the study . The total reported number of falls during this period was 183 in the intervention group compared with 510 in the control group ( p=0.0002 ) . The risk of falling was significantly reduced in the intervention group ( odds ratio 0.39 [ 95 % CI 0.23 - 0.66 ] ) as was the risk of recurrent falls ( 0.33 [ 0.16 - 0.68 ] ) . In addition , the odds of admission to hospital were lower in the intervention group ( 0.61 [ 0.35 - 1.05 ] ) whereas the decline in Barthel score with time was greater in the control group ( p<0.00001 ) . INTERPRETATION The study shows that an interdisciplinary approach to this high-risk population can significantly decrease the risk of further falls and limit functional impairment Background Falls are a major cause of morbidity and mortality in dementia , but there have been no prospect i ve studies of risk factors for falling specific to this patient population , and no successful falls intervention/prevention trials . This prospect i ve study aim ed to identify modifiable risk factors for falling in older people with mild to moderate dementia . Methods and Findings 179 participants aged over 65 years were recruited from outpatient clinics in the UK ( 38 Alzheimer 's disease ( AD ) , 32 Vascular dementia ( VAD ) , 30 Dementia with Lewy bodies ( DLB ) , 40 Parkinson 's disease with dementia ( PDD ) , 39 healthy controls ) . A multifactorial assessment of baseline risk factors was performed and fall diaries were completed prospect ively for 12 months . Dementia participants experienced nearly 8 times more incident falls ( 9118/1000 person-years ) than controls ( 1023/1000 person-years ; incidence density ratio : 7.58 , 3.11–18.5 ) . In dementia , significant univariate predictors of sustaining at least one fall included diagnosis of Lewy body disorder ( proportional hazard ratio ( HR ) adjusted for age and sex : 3.33 , 2.11–5.26 ) , and history of falls in the preceding 12 months ( HR : 2.52 , 1.52–4.17 ) . In multivariate analyses , significant potentially modifiable predictors were symptomatic orthostatic hypotension ( HR : 2.13 , 1.19–3.80 ) , autonomic symptom score ( HR per point 0–36 : 1.055 , 1.012–1.099 ) , and Cornell depression score ( HR per point 0–40 : 1.053 , 1.01–1.099 ) . Higher levels of physical activity were protective ( HR per point 0–9 : 0.827 , 0.716–0.956 ) . Conclusions The management of symptomatic orthostatic hypotension , autonomic symptoms and depression , and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia . R and omised controlled trials to assess such a strategy are a priority Objective : To evaluate the feasibility and safety of a home-based exercise programme for people with Alzheimer ’s disease , and to provide preliminary evidence of programme effectiveness in improving balance and mobility and reducing falls risk . Design : A r and omized controlled trial . Setting : Community . Participants : Forty people with mild to moderate Alzheimer ’s disease ( mean age 81.9 , SD 5.72 ; 62.5 % female ) . Interventions : Participants were r and omized to a six-month home-based individually tailored balance , strengthening and walking exercise programme ( physiotherapist ) or a six-month home-based education programme ( control ) ( occupational therapist ) . Both programmes provided six home-visits and five follow-up phone calls . Main measures : Balance , mobility , falls and falls risk were measured at baseline and programme completion . Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was performed to evaluate programme effectiveness . Feasibility and adverse events were systematic ally recorded at each contact . Results : Fifty-eight per cent of the exercise group finished the programme , completing an average of 83 % of prescribed sessions , with no adverse events reported . Functional Reach improved significantly ( P = 0.002 ) in the exercise group ( mean ( SD ) , 2.28 ( 4.36 ) ) compared to the control group ( –2.99 ( 4.87 ) ) . Significant improvement was also observed for the Falls Risk for Older People – Community score ( P = 0.008 ) and trends for improvement on several other balance , mobility , falls and falls risk measures for the exercise group compared to the control group . Conclusions : The exercise programme was feasible and safe and may help improve balance and mobility performance and reduce falls risk in people with Alzheimer ’s disease Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes , yet there is currently no evidence to guide falls prevention in this population . Methods A r and omised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program . The program was tailored to participant ’s individual cognitive levels and implemented as a carer-supported intervention . Feasibility of recruitment , retention and implementation of intervention were recorded through observation and documented in field notes . Adherence , carer burden and use of task simplification strategies were also monitored . Outcome measures , collected at 12 weeks included physiological , fear of falling , cognitive and functional measures . Results Recruitment was achievable but may be more challenging in a multisite trial . Twenty two dyads of persons with mild dementia and their carers were r and omised to intervention or usual care control group . Of 38 dyads referred to the study , there was a high rate of willingness to participate , with 6 ( 16 % ) declining and 10 ( 26 % ) not meeting inclusion criteria . The intervention was well received by participants and carers and adherence to both program components was very good . All participants implemented some home safety recommendations ( range 19 - 80 % ) with half implementing 50 % or more . At the end of 12 weeks , 72 % of the intervention group were exercising . Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant ( RR= 0.50 ( 95 % CI 0.11 - 2.19 ) . There were no differences in physiological outcome measures between the control and intervention groups . However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up . Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers . The lessons learnt included : recruitment for a larger trial will require multiple approaches ; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change ; strategies to ensure an adequate dosage of exercise should be further explored . We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication . A refined intervention should be tested in a r and omised trial with an adequately powered sample size . Trial registration Australia and New Zeal and Clinical Trials Registry The prevention of injury associated with falls in older people is a public health target in many countries around the world . Although there is good evidence that interventions such as multifactorial fall prevention and individually prescribed exercise are effective in reducing falls , the effect on serious injury rates is unclear . Historically , trials have not been adequately powered to detect injury endpoints , and variations in case definition across trials have hindered meta- analysis . It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in population s who are at a higher risk of injury . Further research is required to determine whether fall-prevention interventions can reduce serious injuries . Prevention of Falls Network Europe ( ProFaNE ) is a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice ( www.profane.eu.org ) . The European Commission funds the network , which links clinicians , members of the public , and research ers worldwide . The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity , including clinical trials , comparative research , and prospect i ve meta- analysis . Work is being undertaken in a 4-year program . As a first step , the development of a common set of outcome definitions and measures for future trials or meta- analysis was considered OBJECTIVE To compare the efficacy of seated exercises and weight-bearing ( WB ) exercises with social visits on fall risk factors in older people recently discharged from hospital . DESIGN Twelve-week r and omized , controlled trial . SETTING Home-based exercises . PARTICIPANTS Subjects ( N=180 ) aged 65 and older , recently discharged from hospital . INTERVENTIONS Seated exercises ( n=60 ) , WB exercises ( n=60 ) , and social visits ( n=60 ) . MAIN OUTCOME MEASURES Primary outcome factors were Physiological Profile Assessment ( PPA ) fall risk score , and balance while st and ing ( Coordinated Stability and Maximal Balance Range tests ) . Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures . RESULTS Subjects were tested at baseline and at completion of the intervention period . After 12 weeks of interventions , subjects in the WB exercise group had significantly better performance than the social visit group on the following : PPA score ( P=.048 ) , Coordinated Stability ( P<.001 ) , Maximal Balance Range ( P=.019 ) ; body sway on floor with eyes closed ( P=.017 ) ; and finger-press reaction time ( P=.007 ) tests . The seated exercise group performed better than the social visit group in PPA score ( P=.019 ) but for no other outcome factor . The seated exercise group had the highest rate of musculoskeletal soreness . CONCLUSIONS In older people recently discharged from the hospital , both exercise programs reduced fall risk score in older people . The WB exercises led to additional beneficial impacts for controlled leaning , reaction time , and caused less musculoskeletal soreness than the seated exercises CONTEXT Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease . OBJECTIVE To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease , conducted between June 1994 and April 1999 . INTERVENTIONS Patient-caregiver dyads were r and omly assigned to the combined exercise and caregiver training program , Reducing Disability in Alzheimer Disease ( RDAD ) , or to routine medical care ( RMC ) . The RDAD program was conducted in the patients ' home over 3 months . MAIN OUTCOME MEASURES Physical health and function ( 36-item Short-Form Health Survey 's [ SF-36 ] physical functioning and physical role functioning subscales and Sickness Impact Profile 's Mobility subscale ) , and affective status ( Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia ) . RESULTS At 3 months , in comparison with the routine care patients , more patients in the RDAD group exercised at least 60 min/wk ( odds ratio [ OR ] , 2.82 ; 95 % confidence interval [ CI ] , 1.25 - 6.39 ; P = .01 ) and had fewer days of restricted activity ( OR , 3.10 ; 95 % CI , 1.08 - 8.95 ; P<.001 ) . Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group ( mean difference , 19.29 ; 95 % CI , 8.75 - 29.83 ; P<.001 ) . Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores ( mean difference , -1.03 ; 95 % CI , -0 Output:

Conclusion Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community .

MS2_1shot186

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: To assess the efficacy of an adjunctive epineurotomy in carpal tunnel syndrome , 36 wrists in 33 patients were prospect ively r and omized into epineurotomy and non-epineurotomy treatment groups . The operating surgeons and evaluating therapist were double-blinded . Patients were evaluated preoperatively and at either 6 or 12 months postoperatively , with 15 patients examined at both postoperative time points . Evaluation consisted of five sensory and four motor tests : static and moving two-point discrimination , Semmes-Weinstein monofilament testing , vibratory ( 30 and 256 cps ) sensibility , and dynamometer testing of grip strength and lateral , three-jaw , and tip pinch strengths . Sensory testing showed overall improvement within both groups postoperatively , but there was no difference between the two groups at either 6 or 12 months postoperatively . Motor testing revealed no improvement in the grip strength or lateral , three-jaw , or tip pinch of either group at 12 months when compared to preoperative levels . Twenty-four of 26 epineurotomy patients and all 10 control patients were satisfied with their clinical outcome 30 months after surgery . The addition of an adjunctive epineurotomy , although safe , offered no clinical benefit in the surgical treatment of carpal tunnel syndrome in this series A 10-center r and omized prospect i ve multicenter study of endoscopic release of the carpal tunnel was carried out . Surgery was performed with a new device for transecting the transverse carpal ligament while control h and s were treated with conventional open surgery . There were 122 patients in the study ; 25 had carpal tunnel surgery on both h and s and 97 had surgery on one h and . Of the surgical procedures , 65 were in the control group and 82 were in the device group . The endoscopic device was coupled to a fiberoptic light and a video camera . A trigger-activated blade was used to incise the transverse carpal ligament . After surgery , the best predictors of return to work and to activities of daily living were strength and tenderness variables . For patients in the device group with one affected h and , the median time for return to work was 21 1/2 days less than that for the control group . Two patients treated with the endoscopic device required reoperation by open surgical decompression ; only one of these had incomplete release with the device . Two patients in the device group experienced transient ulnar neurapraxia AIM To compare a limited palmar incision for carpal tunnel release ( CTR ) with a traditional open technique , which is still considered the gold st and ard . METHODS Seventy-two patients with a carpal tunnel syndrome were individually r and omized into the trial ( limited incision CTR ) ( n=36 ) and control group ( traditional technique CTR ) ( n=36 ) . In the trial group , skin incision parallel to the thenar crease was made up to 2.5 cm in length , under an operating microscope and endoscopic transillumination . Skin incision in the control group began at the distal border of the carpal ligament , followed the longitudinal crease of the palm , and crossed the base of the palm in a zigzag fashion . Three months after surgery , the patients were asked about symptomatic relief and intervals between the operation and return to their daily activities and work , and examined for scar tenderness and esthetic outcome . Distal motor latency , conduction velocity , scar length , scar width , and operation time were measured . RESULTS There were no differences between the two groups in symptomatic relief and electrophysiological parameters . Intervals between the operation and return to daily activities ( median 5 days , range 2 - 15 ) were shorter in the trial group than in the control group ( median 10 days , range 2 - 21 ; p<0.001 ) , as well as the intervals between the operation and return to work ( median 15 days , range 5 - 45 vs median 30 days , range 10 - 60 ; p<0.001 ) . Scar/pillar tenderness , scar length and width , esthetic outcome , and operation time were significantly better in the trial group . CONCLUSION Limited palmar incision CTR is as effective and safe as traditional CTR technique , but with better postoperative recovery and cosmetic results & NA ; Endoscopic carpal tunnel release has been cl aim ed to offer improvement in recovery time and postoperative discomfort over open carpal tunnel release . Short‐incision open carpal tunnel release has been cl aim ed to offer recoveries comparable with endoscopic techniques . Patients receiving carpal tunnel surgery were r and omized to short‐incision open release or single‐portal endoscopic release . Preoperative and postoperative evaluation included grip and pinch strength measurements and patient completion of a question naire regarding symptoms and function . Thirty‐six operated h and s completed evaluation , including 22 endoscopic and 14 open releases . Early grip and pinch strength after endoscopic carpal tunnel release were improved significantly over short‐incision open release ( p < 0.05 ) . Subjective evaluation indicated a trend toward improved symptoms and function with endoscopic over short‐incision open carpal tunnel release . Endoscopic carpal tunnel release provides faster recovery of strength than short‐incision open carpal tunnel release and improves early postoperative comfort and function to a small degree . Mackenzie DJ , Hainer R , Wheatley MJ . Early recovery after endoscopic vs. short‐incision open carpal tunnel release . Ann Plast Surg Summary In a series of patients with clinical ly and neurophysiologically well defined carpal tunnel syndrome a r and omization has been made into two groups , one for operation with internal neurolysis and a microscopical technique , and the other group for cutting of the carpal ligament ( flexor retinaculum ) alone . The two groups have been compared postoperatively regarding clinical and neurophysiological parameters . All patients improved , 89 % in both groups considered themselves totally free of symptoms at follow-up examinations but there was no significant difference in any parameter between the two groups . As a conclusion the use of internal neurolysis can not be recommended as a routine procedure in carpal tunnel syndrome An operative technique of carpal tunnel release using intraoperative ultrasonography is described . In this technique , " safe line " is defined in the transverse carpal ligament and the adjacent deep forearm fascia midway between the ulnar margin of the median nerve and the radial margin of the ulnar artery . After ultrasonographic design of a 1.0 to 1.5-cm skin incision along the safe line at the distal carpal tunnel , the distal ligament is released under direct vision . Proximal release is performed along this line under ultrasonographic monitoring using a device that consists of a basket punch and an outer metal tube . In a prospect i ve r and omized study , the outcomes were compared for carpal tunnel release using either this technique in 50 h and s of 50 patients or conventional open release in 53 h and s of 53 patients . Follow-up assessment at 3 , 6 , 13 , 26 , 52 , and 104 weeks showed no significant difference with respect to numbness and paresthesias , static two-point discrimination , findings on Semmes-Weinstein monofilament testing , findings on manual muscle testing of the abductor pollicis brevis , and electrophysiologic findings . The ultrasonographic-release group had better outcomes regarding pain , tenderness of the scar , and key-pinch strength at 3 , 6 , and 13 weeks , and grip strength at 3 and 6 weeks after surgery . The scar was more aesthetic in this group . There were no complications with either technique The advantages and disadvantages of endoscopic compared with open carpal tunnel release are controversial . We have performed a prospect i ve , r and omised , blinded assessment in a district general hospital in order to determine if there was any demonstrable advantage in undertaking either technique . Twenty-five patients with confirmed bilateral idiopathic carpal tunnel syndrome were r and omised to undergo endoscopic release by the single portal Agee technique to one h and and open release to the other . Independent preoperative and postoperative assessment was undertaken by a h and therapist who was blinded to the type of treatment . Follow-up was for 12 months . The operating time was two minutes shorter for the open technique ( p < 0.005 ) . At all stages of postoperative assessment , the endoscopic technique had no significant advantages in terms of return of muscle strength and assessment of h and function , grip strength , manual dexterity or sensation . In comparison with open release , single-portal endoscopic carpal tunnel release has a similar incidence of complications and a similar return of h and function , but is a slightly slower technique to undertake This prospect i ve , r and omized study compares two treatment methods in patients with primary carpal tunnel syndrome . Decompression of the transverse carpal ligament was done in thirty-two h and s ( thirty patients ) and decompression of the transverse carpal ligament with the addition of an internal neurolysis of the median nerve was done in thirty-one h and s ( twenty-nine patients ) . Relief of symptoms was described in eighty-eight percent of the patients with carpal ligament release and eighty-one percent of patients with carpal ligament release plus internal neurolysis . Improvement in h and sensibility testing , in thenar muscle strength , and atrophy was noted in both treatment groups with no statistical difference between groups . The addition of an internal neurolysis to division of the transverse carpal ligament does not add significant improvement in the sensory or motor outcome of patients with primary carpal tunnel syndrome We conducted a prospect i ve , r and omized study to evaluate the effect of epineurotomy on the outcome of operative treatment of established median-nerve compression in the carpal canal . Fifty h and s ( forty-four patients ) were r and omized into two groups : one group had a release of the transverse carpal ligament alone , and the other had a release and adjuvant epineurotomy of the median nerve . The groups were similar with regard to age , gender , duration of symptoms , and preoperative physical findings . All patients had electrophysiological evidence of sensory delays and fibrillations on preoperative testing . All of the operative procedures were performed by the same surgeon . The patients were evaluated preoperatively and at one year postoperatively . The follow-up examination revealed no detectable differences between the two groups with regard to symptoms , objective findings , or electrophysiological findings . This suggests that epineurotomy of the median nerve offers no benefit compared with sectioning of the transverse carpal ligament alone A r and omized prospect i ve study was carried out to compare one-portal endoscopic carpal tunnel release with an open procedure . There were 47 patients ( mean age 52.6 years ) : 25 underwent an endoscopic and 22 an open release . The aim of the study was to evaluate the risks against the benefits for pain , grip , key-pinch strength and ability to return to work . The distribution of age , occupation , sex , neurographic findings and operated h and was similar in both groups . We detected no serious nerve complications . One “ open ” patient developed a hypertrophic scar , a second “ open ” patient a disabling reflex sympathetic dystrophy , one “ endo ” patient a transient neurapraxia . The remaining patients experienced complete relief of symptoms . Improvement of grip strength is significantly better after endoscopic release ( P=0.0001 at 3 months ) . In contrast , the key-pinch showed a similar pattern of improvement in both groups . The ability to use the operated h and as effectively as the contralateral one developed after 24 days for the endoscopic group versus 42 for the open approach ( P=0.0000 ) . The carpal arch alteration was less important for the endoscopic group ( P= 0.013 ) , but without any correlation with the grip strength . Agee 's one-portal technique only allows correct placement of a knife , not an inspection of the structures being operated upon . This is a major limitation , reducing the surgeon to a technician . Further development of this procedure dem and s a device that will enable a fruitful inspection of the carpal tunnel PURPOSE R and omized clinical trials can provide strong evidence regarding effective treatment options . The quality of reporting and the type of outcome measures used are important when judging whether results justify change in clinical practice . The aim of this study was to assess the quality of reporting of r and omized clinical trials related to treatment of upper-extremity disorders , published in 4 h and surgical and orthopedic journals during an 11-year period , and assess the type of outcome measures used in the trials . METHODS Eligible articles were identified by review ing all abstract s published in the 4 journals from 1992 through 2002 . The quality of reporting was assessed by a modified Jadad scale that consisted of 3 items ( r and omization , blinding , and withdrawals/dropouts ) . A higher score ( 0 - 5 ) indicated higher quality . The outcome measures were classified according to the International Classification of Functioning , Disability and Health into the levels of body function and structure , activity , and participation . RESULTS Of 92 articles reporting r and omized clinical trials , 40 articles described appropriate r and omization method that implied they were truly r and omized studies , 31 articles did not describe the r and omization method , and 21 articles ( 23 % ) described inappropriate r and omization methods . Double or single blinding was reported in 33 articles . Absence or description of withdrawals/dropouts was shown in 77 articles . The median quality score calculated for all 92 articles was 2 ( range , 0 - 5 ) points . The median score for the 28 articles published 1992 through 1996 was 1 ( range , 0 - 5 ) points and for the 64 articles published from 1997 through 2002 was 3 ( range , 0 - 5 ) points . All trials used outcome measures on body function and structure level ; 41 % used measures of activity and /or participation . CONCLUSIONS There is a need to improve the quality of reporting of upper-extremity r and omized clinical trials and Output:

The most frequently assessed outcomes were self-reported symptom resolution , grip or pinch strength and return to work .

MS2_1shot187

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Physical activity promotion is a priority , but contribution of physicians ' interventions is unclear . The effectiveness of the PEPAF ( " Experimental Program for Physical Activity Promotion " ) , which was implemented exclusively by physicians in routine primary care from October 2003 to December 2004 , was assessed . METHODS Fifty-six Spanish family physicians were r and omized to either the intervention ( n = 29 ) or st and ard care ( n = 27 ) arm of the trial . The physicians recruited 4317 physically inactive patients ( 2248 for intervention and 2069 for control protocol s ) from a systematic sample after assessing their physical activity in routine practice . Intervention physicians provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment ( 30 % ) . The main outcome measure was the change in physical activity measured by blinded nurses using the 7-Day Physical Activity Recall . Secondary outcomes included cardiorespiratory fitness and health-related quality of life . RESULTS At 6 months , intervention patients increased physical activity more than controls ( adjusted difference , 18 min/wk [ 95 % confidence interval , 6 - 31 min/wk ] ; metabolic equivalent tasks x hours per week , 1.3 [ 95 % CI , 0.4 - 2.2 ] ) . The proportion of the population achieving minimal physical activity recommendations was 3.9 % higher in the intervention group ( 1.2%-6.9 % ; number needed to treat , 26 ) . No differences were found in secondary outcomes . The effect of intervention was positively modified in subjects older than 50 years ( P < or = .01 ) and in the prescription subgroup ( P < .001 ) . CONCLUSIONS Family physicians were effective for increasing physical activity of primary care patients . Overall clinical effect was small but relevant for population public health . Within the intervention program , clinical ly relevant effects were seen in patients receiving a physical activity prescription . Trial Registration clinical trials.gov Identifier : NCT00131079 Background A recent HTA review concluded that there was a need for RCTs of exercise referral schemes ( ERS ) for people with a medical diagnosis who might benefit from exercise . Overall , there is still uncertainty as to the cost-effectiveness of ERS . Evaluation of public health interventions places challenges on conventional health economics approaches . This economic evaluation of a national public health intervention addresses this issue of where ERS may be most cost effective through subgroup analysis , particularly important at a time of financial constraint . Method This economic analysis included 798 individuals aged 16 and over ( 55 % of the r and omised controlled trial ( RCT ) sample ) with coronary heart disease risk factors and /or mild to moderate anxiety , depression or stress . Individuals were referred by health professionals in a primary care setting to a 16 week national exercise referral scheme ( NERS ) delivered by qualified exercise professionals in local leisure centres in Wales , UK . Health-related quality of life , health care services use , costs per participant in NERS , and willingness to pay for NERS were measured at 6 and 12 months . Results The base case analysis assumed a participation cost of £ 385 per person per year , with a mean difference in QALYs between the two groups of 0.027 . The incremental cost-effectiveness ratio was £ 12,111 per QALY gained . Probabilistic sensitivity analysis demonstrated an 89 % probability of NERS being cost-effective at a payer threshold of £ 30,000 per QALY . When participant payments of £ 1 and £ 2 per session were considered , the cost per QALY fell from £ 12,111 ( base case ) to £ 10,926 and £ 9,741 , respectively . Participants with a mental health risk factor alone or in combination with a risk of chronic heart disease generated a lower ICER ( £ 10,276 ) compared to participants at risk of chronic heart disease only ( £ 13,060 ) . Conclusions Results of cost-effectiveness analyses suggest that NERS is cost saving in fully adherent participants . Though full adherence to NERS ( 62 % ) was higher for the economics sample than the main sample ( 44 % ) , results still suggest that NERS can be cost-effective in Wales with respect to existing payer thresholds particularly for participants with mental health and CHD risk factors . Trial registration Current Controlled Trials IS RCT Background Over the past decade , practitioners in primary health care ( PHC ) setting s in many countries have issued written prescriptions to patients to promote increased physical activity or exercise . The aim of this study is to describe and analyse a comprehensive physical activity referral ( PAR ) scheme implemented in a routine PHC setting in Östergötl and County . The study examines characteristics of the PARs recipients and referral practitioners , identifies reasons why practitioners opted to use PARs with their clients , and discusses prescribed activities and prescriptions in relation to PHC registries . Methods Prospect i ve prescription data were obtained for 90 % of the primary health care centres in Östergötl and County , Sweden , in 2004 and 2005 . The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity , as assessed by PHC staff . Results During the two-year period , a total of 6,300 patients received PARs . Two-thirds of the patients were female and half of the patients were 45–64 years . Half of the patients ( 50.8 % ) who received PARs were recommended a home-based activity , such as walking . One third ( 33 % ) of the patients issued PARs were totally inactive , reporting no days of physical activity that lasted for 30 minutes , and 29 % stated that they reached this level 1–2 days per week . The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4 % in 2004 and 1.2 % in 2005 . Two-thirds of the combined prescriptions were issued by physicians ( 38 % ) and nurses ( 31 % ) . Physiotherapists and behavioural scientists issued the highest relative number of prescriptions . The most common reasons for issuing PARs were musculoskeletal disorders ( 39.1 % ) and overweight ( 35.4 % ) , followed by high blood pressure ( 23.3 % ) and diabetes ( 23.2 % ) . Conclusion Östergötl and County 's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons . PAR-related statistics , including PAR-rates by individual PHC centres and PAR- rates per health professional category , show differences in prescribing activities , both by patient categories , and by prescribing professionals Background The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials . Recent empirical evidence in health care and physical activity promotion context s provides a foundation for testing the feasibility and impact of a Self Determination Theory-based ( SDT ) exercise referral consultation . Methods An exploratory cluster r and omised controlled trial comparing st and ard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory . Individuals ( N = 347 ) referred to an exercise referral scheme were recruited into the trial from 13 centres . Outcomes and processes of change measured at baseline , 3 and 6-months : Minutes of self-reported moderate or vigorous physical activity ( PA ) per week ( primary outcome ) , health status , positive and negative indicators of emotional well-being , anxiety , depression , quality of life ( QOL ) , vitality , and perceptions of autonomy support from the advisor , need satisfaction ( 3 and 6 months only ) , intentions to be active , and motivational regulations for exercise . Blood pressure and weight were assessed at baseline and 6 months . Results Perceptions of the autonomy support provided by the health and fitness advisor ( HFA ) did not differ by arm . Between group changes over the 6-months revealed significant differences for reported anxiety only . Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months , which were not seen in the st and ard exercise referral group . A process model depicting hypothesized relationships between advisor autonomy support , need satisfaction and more autonomous motivation , enhanced well being and PA engagement at follow up was supported . Conclusions Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the st and ard provision exercise referral and the SDT-based intervention at programme end . At 6-months , observed between arm and within intervention arm differences for indicators of emotional health , and the results of the process model , were in line with SDT . The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed . Trial registration The trial is registered as Current Controlled trials IS RCT N07682833 Background Although the benefits of physical activity ( PA ) on to prevent and manage non-communicable diseases are well known , strategies to help increase the levels of PA among different population s are limited . Exercise-referral schemes have emerged as one effective approach to promote PA ; however , there is uncertainty about the feasibility and effectiveness of these schemes in setting s outside high-income countries . This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities ( PHCU ) of the Mexican social security institution to a group PA program offered in the same institution . Methods and design We will describe the methods of a cluster r and omized trial study design ed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme . Four PHCU were selected for the study ; the PHCU will take part as the unit of r and omization and sedentary hypertensive patients as the unit of assessment . 2 PHCU of control group ( GC ) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely . 2 PHCU of intervention group ( IG ) will refer patients to sports facilities at the same institution , to follow a group-based PA program developed to increase the PA levels with a design ed based on the Transtheoretical Model and Social Cognitive Theory . To evaluate the effects of the intervention as well as short-term maintenance of the intervention ’s effects , PA will be assessed at baseline , at 24 and 32 weeks of follow-up . The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups . PA will be measured through self-report and with objective measure by accelerometer . Discussion This study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system . Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical population s in Mexico and Latin America . Trial registration Clinical trials.gov Identifier : NCT01910935 . Date of registration : 07/05/2013 Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week OBJECTIVES To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme , an instructor-led walking programme and advice-only in patients referred for exercise by their GPs . DESIGN A single-centre , parallel-group , r and omised controlled trial , consisting of three arms , with the primary comparison at 6 months . SETTING Assessment s were carried out at Copthall Leisure Centre in Barnet , an outer London borough , and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough . PARTICIPANTS Participants were aged between 40 and 74 years , not currently physically active and with at least one cardiovascular risk factor . INTERVENTIONS The 943 patients who agreed to participate in the trial were assessed in cohorts and r and omised to one of the following three arms : a 10-week programme of supervised exercise classes , two to three times a week in a local leisure centre ; a 10-week instructor-led walking programme , two to three times a week ; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities . After 6 months the control group were rer and omised to one of the other trial arms . Assessment s took place before r and om Output:

Results from meta-analyses show that PARS had an effect on the adherence rate of physical activity , while the results from the meta-regressions show that programme characteristics such as type of chronic disease and the follow-up period influenced the adherence rate . CONCLUSIONS The effects of PARS on adherence and self-reported physical activity were influenced by programme characteristics and also by the design of the study .

MS2_1shot188

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND This study examines the importance of work in life of people with disability and then focuses on employer attitudes towards these people . In the light of Stone and Colella 's model , the study examines the employer attitudes and the role of variables such as type of disability , employer experience in the hiring of persons with disabilities , the description of hypothetical hirees with disabilities , the ways in which employers evaluate work performance and social acceptability , and the work tasks that they consider appropriate for workers with disability . METHOD Eighty employers were r and omly assigned to st and ard condition ( c and i date s with disability were presented by referring to the disability they presented ) or positive condition ( c and i date s were presented with reference to their strengths ) . RESULTS It was found that the type of disability and its presentation influence employer attitudes . In addition , realistic and conventional tasks were considered appropriate for hirees with disabilities . CONCLUSIONS Implication s were discussed Administrators , consumers , and policy makers are increasingly interested in supported employment as a way of helping persons with severe mental illness get and keep competitive jobs . However , in an atmosphere of increased expectations for performance and declining public financing , administrators want to know the costs and benefits of different approaches before they reallocate scarce treatment or rehabilitative dollars . This article discusses the net benefits of two approaches to supported employment that were compared in a r and omized trial : Individual Placement and Support ( IPS ) and Group Skills Training ( GST ) . The authors analyze costs and benefits from societal , government , and consumer perspectives . Although a previous analysis showed that IPS participants were significantly more likely to find work , worked more hours , and had higher earnings , net benefits of the two programs were not significantly different . The authors also discuss some of the strengths and weaknesses of cost-benefit analysis in mental health care and suggest future directions for policy and research Output:

Findings show that benefits of hiring people with disabilities included improvements in profitability ( e.g. , profits and cost-effectiveness , turnover and retention , reliability and punctuality , employee loyalty , company image ) , competitive advantage ( e.g. , diverse customers , customer loyalty and satisfaction , innovation , productivity , work ethic , safety ) , inclusive work culture , and ability awareness . Secondary benefits for people with disabilities included improved quality of life and income , enhanced self-confidence , exp and ed social network , and a sense of community . Conclusions There are several benefits to hiring people with disabilities .

MS2_1shot189

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain ( CLBP ) when managed in a hospital by either a regional pain clinic or a chiropractor . DESIGN The study was a pragmatic , r and omized , controlled trial . SETTING The trial was performed at a National Health Service ( NHS ) hospital outpatient clinic ( pain clinic ) in the United Kingdom . SUBJECTS AND INTERVENTIONS Patients with CLBP ( i.e. , symptom duration of > 12 weeks ) referred to a regional pain clinic ( outpatient hospital clinic ) were assessed and r and omized to either chiropractic or pain-clinic management for a period of 8 weeks . The study was pragmatic , allowing for normal treatment protocol s to be used . Treatment was administered in an NHS hospital setting . OUTCOME MEASURES The Rol and -Morris Disability Question naire ( RMDQ ) and Numerical Rating Scale were used to assess changes in perceived disability and pain . Mean values at weeks 0 , 2 , 4 , 6 , and 8 were calculated . The mean differences between week 0 and week 8 were compared across the two treatment groups using Student 's t-tests . Ninety-five percent ( 95 % ) confidence intervals ( CIs ) for the differences between groups were calculated . RESULTS R and omization placed 12 patients in the pain clinic and 18 in the chiropractic group , of which 11 and 16 , respectively , completed the trial . At 8 weeks , the mean improvement in RMDQ was 5.5 points greater for the chiropractic group ( decrease in disability by 5.9 ) than for the pain-clinic group ( 0.36 ) ( 95 % CI 2.0 points to 9.0 points ; p = 0.004 ) . Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group ( p = 0.023 ) . CONCLUSIONS This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a sub population of patients with CLBP Study Design . A r and omized trial . Objective . To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting . Summary and Background Data . Systematic review s have shown that there is strong evidence that intensive multidisciplinary treatment ( > 100 hours ) , which includes functional restoration , improves function among chronic patients with low back pain , and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability . However , there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy . Material s and Methods . A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers . The patients were r and omized into two intervention programs . Multidisciplinary rehabilitation ( n = 59 ) was conducted in groups and comprised of physical training , workplace interventions , back school , relaxation training , and cognitive-behavioral stress management methods for 70 hours . The individual physiotherapy ( n = 61 ) included physical exercise and passive treatment methods administered for 10 hours . Main outcome measures were : back pain and sciatic pain intensity , disability , sick leaves , healthcare consumption , symptoms of depression , and beliefs of working ability after 2 years . Results . There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation , at 6- , at 12- , or 24-month follow-up . In both intervention arms , however , the before- and -after comparison showed favorable effects , and the effects were still maintained at 2 years follow-up . Conclusions . The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment Abstract Objective To estimate the effect of adding exercise classes , spinal manipulation delivered in NHS or private premises , or manipulation followed by exercise to “ best care ” in general practice for patients consulting with back pain . Fig 1 Progress of the UK BEAM trial Design Pragmatic r and omised trial with factorial design . Setting 181 general practice s in Medical Research Council General Practice Research Framework ; 63 community setting s around 14 centres across the United Kingdom . Participants 1334 patients consulting their general practice s about low back pain . Main outcome measures Scores on the Rol and Morris disability question naire at three and 12 months , adjusted for centre and baseline scores . Results All groups improved over time . Exercise improved mean disability question naire scores at three months by 1.4 ( 95 % confidence interval 0.6 to 2.1 ) more than “ best care . ” For manipulation the additional improvement was 1.6 ( 0.8 to 2.3 ) at three months and 1.0 ( 0.2 to 1.8 ) at 12 months . For manipulation followed by exercise the additional improvement was 1.9 ( 1.2 to 2.6 ) at three months and 1.3 ( 0.5 to 2.1 ) at 12 months . No significant differences in outcome occurred between manipulation in NHS premises and in private premises . No serious adverse events occurred . Conclusions Relative to “ best care ” in general practice , manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months ; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months ; and exercise achieved a small benefit at three months but not 12 months OBJECTIVE For long-term treatment effects , patients with subacute back pain need to adhere to treatment recommendations beyond the prescribed exercise treatment . Adherence rates are as low as 30 % , so we developed a cognitive-behavioural training programme to enhance patients ' self-efficacy , maximise severity perceptions and reduce barrier perceptions . METHOD A 2 x 4 ( group x time ) repeated measurement design was applied . Forty-seven patients with non-specific , subacute back pain were r and omly assigned to a training group ( exercise treatment plus cognitive-behavioural training programme ) or a control group ( exercise treatment only ) . RESULTS Repeated measures ANOVA revealed significant main and interaction effects ; the training group reported enhanced self-efficacy and severity perceptions , reduced barrier perceptions , and self-reported that they exercised more often than the control group over time . However , no group differences regarding pain intensity emerged . CONCLUSION Our findings demonstrate that a short and inexpensive cognitive-behavioural training programme is an effective tool to enable back pain patients to follow treatment recommendations on a regular basis . PRACTICE IMPLICATION S The short and simple intervention can easily be conducted by personnel , other than psychologists , i.e. , physiotherapists Objectives The aim of this r and omized controlled study was to investigate whether additional psychologic interventions in the context of multidisciplinary inpatient pain treatment increases treatment efficacy compared with normal orthopedic rehabilitation . In addition , we aim ed to demonstrate the additional benefit of a subsequent maintenance program in further stabilizing treatment successes . Methods We r and omly assigned 363 chronic back pain patients to 1 of 3 treatment conditions : traditional orthopedic rehabilitation , multidisciplinary ( behavioral-medical ) rehabilitation alone , and multidisciplinary rehabilitation with subsequent booster sessions . Pain disability , depression , self-efficacy , health status , life satisfaction , and coping strategies were assessed at admission , discharge , and 12 months follow-up . The completion rate was 94 % . Results All 3 treatment conditions were effective in improving core outcome measures in chronic back pain patients in the short term . The results were almost maintained at follow-up ( small-to-medium within-group effect sizes ) . Significant advantages in favor of behavioral-medical interventions were found on almost all pain coping strategies and depression compared with traditional orthopedic rehabilitation . We found only slight advantages for the behavioral-medical treatment with subsequent booster sessions compared with the condition without a further maintenance program . Discussion The results concerning the efficacy of the multidisciplinary treatment are in accordance with former meta-analyses . Surprisingly , the findings suggest that the presented traditional orthopedic treatment was inherently very effective . The implication s of these findings are discussed with respect to the benefit of additional psychologic interventions and the benefit of aftercare approaches for chronic pain patients This study examined the supplemental value of a cognitive coping skills training when added to an operant-behavioral treatment for chronic low-back pain patients . The complete treatment package ( OPCO ) was compared with an operant program + group discussion ( OPDI ) and a waiting-list control ( WLC ) . After the WL period , the WLC patients received a less protocol ized operant program usually provided in Dutch rehabilitation centers ( OPUS ) . Regression analyses showed that , compared with WLC , both OPCO and OPDI led to less negative affect , higher activity tolerance , less pain behavior , and higher pain coping and pain control . At posttreatment , OPCO led to better pain coping and pain control than OPDI . Calculation of improvement rates revealed that OPCO and OPDI had significantly more improved patients than OPUS on all the dependent variables . The discussion includes findings regarding treatment credibility , compliance , and contamination bias Study Design . Single blind r and omized study . Objectives . To compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration . Summary of Background Data . To the authors ’ best knowledge , only one r and omized study has evaluated the effectiveness of lumbar fusion . The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician . Patients and Methods . Sixty-four patients aged 25–60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4–L5 and /or L5–S1 at radiographic examination were r and omized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy , or cognitive intervention and exercises . The cognitive intervention consisted of a lecture to give the patient an underst and ing that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it . This was reinforced by three daily physical exercise sessions for 3 weeks . The main outcome measure was the Oswestry Disability Index . Results . At the 1-year follow-up visit , 97 % of the patients , including 6 patients who had either not attended treatment or changed groups , were examined . The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery , compared with 42 to 30 after cognitive intervention and exercises . The mean difference between groups was 2.3 ( −6.7 to 11.4 ) ( P = 0.33 ) . Improvements inback pain , use of analgesics , emotional distress , life satisfaction , and return to work were not different . Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment , and lower limb pain was reduced more after surgery . The success rateaccording to an independent observer was 70 % after surgery and 76 % after cognitive intervention and exercises . The early complication rate in the surgical group was 18 % . Conclusion . The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration r and omized to cognitive intervention and exercises , or lumbar fusion OBJECTIVE To evaluate the effectiveness of the addition of back school to exercise and physical treatment modalities in relieving pain and improving the functional status of patients with chronic low back pain . DESIGN A r and omized controlled trial . PATIENTS A total of 146 patients with chronic low back pain were enrolled in the study . METHODS Subjects were divided into 2 groups : the back school group received exercise , physical treatment modalities and a back school programme ; and the control group received exercise and physical treatment modalities . Treatment efficacy was evaluated at the end of treatment and 3 months post-treatment , in terms of pain , measured with the Visual Analogue Scale , and functional status , measured with the Oswestry Low Back Pain Disability Question naire . RESULTS In both groups , Visual Analogue Scale and Oswestry Low Back Pain Disability Question naire were significantly reduced after therapy ( p < 0.01 ) , but the difference between the scores at the end of treatment and 3 months post-treatment was not significant . There was a significant improvement in Visual Analogue Scale and Oswestry Low Back Pain Disability Question naire in the back school group compared with the control group at the end of therapy and 3 months post-treatment ( p < 0.05 ) . CONCLUSION The addition of back school was more effective than exercise and physical treatment modalities alone in the treatment of patients with chronic low back pain Background Effective strategies for the primary prevention of low back pain ( LBP ) remain elusive with few large-scale clinical trials investigating exercise and education approaches . The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise . Methods The Prevention of Low Back Pain in the Military study was a cluster r and omized clinical study with four intervention arms and a two-year follow-up . Participants were recruited from a military training setting from 2007 to 2008 . Soldiers in 20 consecutive companies were considered for eligibility ( n = 7,616 ) . Of those , 1,741 were ineligible and 1,550 were eligible but refused participation . For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years ( SD = 4.2 ) and there were 3,082 males ( 71.3 Output:

There was insufficient evidence to assess whether MBR interventions were associated with more adverse events than usual care or physical interventions .Sensitivity analyses did not suggest that the pooled estimates were unduly influenced by the results from low quality studies . Subgroup analyses were inconclusive regarding the influence of baseline symptom severity and intervention intensity . Patients with chronic LBP receiving MBR are likely to experience less pain and disability than those receiving usual care or a physical treatment . MBR also has a positive influence on work status compared to physical treatment . Effects are of a modest magnitude and should be balanced against the time and re source requirements of MBR programs . More intensive interventions were not responsible for effects that were substantially different to those of less intensive interventions .

MS2_1shot190

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To compare the effectiveness of annual topical application of silver diamine fluoride ( SDF ) solution , semi-annual topical application of SDF solution , and annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth . METHODS A total of 212 children , aged 3 - 4 years , were r and omly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth : Gp1-annual application of SDF , Gp2-semi-annual application of SDF , and Gp3-annual application of glass ionomer . Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested . RESULTS After 24 months , 181 ( 85 % ) children remained in the study . The caries arrest rates were 79 % , 91 % and 82 % for Gp1 , Gp2 and Gp3 , respectively ( p=0.007 ) . In the logistic regression model using GEE to adjust for clustering effect , higher caries arrest rates were found in lesions treated in Gp2 ( OR=2.98 , p=0.007 ) , those in anterior teeth ( OR=5.55 , p<0.001 ) , and those in buccal/lingual smooth surfaces ( OR=15.6 , p=0.004 ) . CONCLUSION Annual application of either SDF solution or high fluoride-releasing glass ionomer can arrest active dentine caries . Increasing the frequency of application to every 6 months can increase the caries arrest rate of SDF application . CLINICAL SIGNIFICANCE Arrest of active dentine caries in primary teeth by topical application of SDF solution can be enhanced by increasing the frequency of application from annually to every 6 months , whereas annual paint-on of a flowable glass ionomer can also arrest active dentine caries and may provide a more aesthetic outcome Arresting Caries Treatment ( ACT ) has been proposed to manage untreated dental caries in children . This prospect i ve r and omized clinical trial investigated the caries-arresting effectiveness of a single spot application of : ( 1 ) 38 % silver diamine fluoride ( SDF ) with tannic acid as a reducing agent ; ( 2 ) 38 % SDF alone ; ( 3 ) 12 % SDF alone ; and ( 4 ) no SDF application in primary teeth of 976 Nepalese schoolchildren . The a priori null hypothesis was that the different treatments have no effect in arresting active cavitated caries . Only the single application of 38 % SDF with or without tannic acid was effective in arresting caries after 6 months ( 4.5 and 4.2 mean number of arrested surfaces ; p < 0.001 ) , after 1 year ( 4.1 and 3.4 ; p < 0.001 ) , and after 2 years ( 2.2 and 2.1 ; p < 0.01 ) . Tannic acid conferred no additional benefit . ACT with 38 % SDF provides an alternative when restorative treatment for primary teeth is not an option Background There is growing interest in the use of diammine silver fluoride ( DSF ) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world . While DSF has been available in various formulations for many years , most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized . Methods This preliminary study determined the applied doses ( 3 teeth treated ) , maximum serum concentrations , and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode , and silver was determined using inductively coupled plasma-mass spectrometry . The mean amount of DSF solution applied to the 3 teeth was 7.57 mg ( 6.04 μL ) . Results Over the 4 hour observation period , the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver . These maximums were reached 3.0 h and 2.5 h for fluoride and silver , respectively . Conclusions Fluoride exposure was below the U.S. Environmental Protection Agency ( EPA ) oral reference dose . Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime , but for occasional use was well below concentrations associated with toxicity . This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults . Clinical trials registration NCT01664871 BACKGROUND Silver diamine fluoride ( SDF ) is an effective agent for the arrest of caries in children , is easy to apply and can be used outside the clinical environment . Interim restorative treatment ( IRT ) using glass ionomer cement has also been cl aim ed to be a simple and effective method to arrest caries in deciduous teeth . OBJECTIVE To examine whether , for underprivileged schoolchildren with cavities , treatment with 30 % SDF gives better results than IRT for carries arrest . METHOD This r and omised controlled study compares the effect of IRT ( FUJI IX ) with 30 % SDF in 91 children aged 5 - 6 years . RESULTS After 1 year , treatment with SDF was more effective [ relative risk ( RR ) = 66.9 % ] than IRT ( RR = 38.6 % ) for the arrest of caries ; this was statistically significant ( P < 0.05 ) . CONCLUSION The SDF technique showed better results than IRT for the arrest of cavities in deciduous teeth , indicating that its use for underprivileged communities may justify a paradigm shift in paediatric dentistry We hypothesized that the six-monthly application of silver diamine fluoride ( SDF ) can arrest the development of caries in the deciduous dentition of six-year-old schoolchildren and prevent caries in their first permanent molars . A prospect i ve controlled clinical trial was conducted on the efficacy of a 38 % SDF solution for caries reduction . Four hundred and twenty-five six-year-old children were divided into two groups : One group received SDF solution in primary canines and molars and first permanent molars every 6 mos for 36 mos . The second group served as controls . The 36-month follow-up was completed by 373 children . The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls . The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls . The SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren The aim of this in vitro study was to investigate the effect of the cariostatic and preventive agent silver diamine fluoride ( SDF ) on the microtensile bond strength of resin composite to dentin . Forty-two caries-free , extracted molars were flattened occlusally and apically using a diamond saw , and the exposed occlusal dentin was polished with a series of silicon carbide papers , all under water irrigation . The teeth were then r and omly divided into six groups of seven teeth each that were treated as follows : 1 ) Peak SE self-etch bonding agent ; 2 ) 12 % SDF + Peak SE ; 3 ) 38 % SDF + Peak SE ; 4 ) Peak LC etch- and -rinse bonding agent ; 5 ) 12 % SDF + Peak LC ; and 6 ) 38 % SDF + Peak LC . Four-millimeter buildups of Amelogen Plus were incrementally placed on all teeth ; after a 24-hour storage period in distilled water , the specimens were sectioned perpendicular to the adhesive interface to produce beams of cross-sectional surface area measuring approximately 1 mm(2 ) . The beams were placed on a microtensile testing machine , which utilized a single-speed pump motor and force gauge at 20 kgf × 0.01 second to record maximum tensile force before failure occurred . Two-way analysis of variance and post hoc Tukey tests were performed to compare the effects of the SDF on microtensile bond strength , with statistical significance set at α = 0.05 . None of the experimental groups treated with different concentrations of SDF showed a significant difference in bond strength compared to the control groups , and there was no significant difference in bond strength between self-etch and etch- and -rinse groups . However , the effect of SDF on self-etch bonded teeth compared to etch- and -rinse bonded teeth was statistically significant ( p=0.0363 ) , specifically at the 12 % concentration . SDF does not adversely affect the bond strength of resin composite to noncarious dentin Different regimens of silver diamine fluoride ( SDF ) have been used to manage early childhood caries . So far , there is limited information regarding the concentrations and frequency of applications for effective caries control in primary teeth . This study aim ed to compare the efficacy of 2 commercially available SDF solutions at preprepared concentrations of 38 % and 12 % when applied annually or biannually over 18 mo in arresting dentine caries in primary teeth . This r and omized double-blinded clinical trial recruited kindergarten children aged 3 to 4 y who had at least 1 tooth with dentine caries . The children were r and omly allocated to receive 4 treatment protocol s : group 1 , annual application of 12 % SDF ; group 2 , biannual application of 12 % SDF ; group 3 , annual application of 38 % SDF ; and group 4 , biannual application of 38 % SDF . Clinical examinations at 6-mo intervals were conducted to assess whether active carious lesions became arrested . Information on the children ’s background and oral hygiene habits was collected through a parental question naire at baseline and follow-up examinations . A total of 888 children with 4,220 dentine carious tooth surfaces received treatment at baseline . After 18 mo , 831 children ( 94 % ) were examined . The caries arrest rates were 50 % , 55 % , 64 % , and 74 % for groups 1 , 2 , 3 , and 4 , respectively ( P < 0.001 ) . Lesions treated with SDF biannual application had a higher chance of becoming arrested compared with those receiving SDF annual application ( odds ratio , 1.33 ; 95 % confidence interval , 1.04–1.71 ; P = 0.025 ) . The interaction between concentration and lesion site was statistically significant ( P < 0.001 ) . Compared with 12 % SDF , the use of 38 % SDF increased a chance of becoming arrested ( P < 0.05 ) , except lesions on occlusal surfaces . Based on the 18-mo results , SDF is more effective in arresting dentin caries in the primary teeth of preschool children at 38 % concentration than 12 % concentration and when applied biannually rather than annually . Knowledge Transfer Statement : The results of this study can be used by clinicians and dental public health professionals when deciding which concentrations and frequency of application of silver diamine fluoride solution should be adopted for arresting dentine caries . With consideration of caries arrest treatment with silver diamine fluoride , which is painless , simple , and low cost , this information could lead to more appropriate therapeutic decisions for caries control in young children or those who lack access to affordable conventional dental care OBJECTIVES This study aim ed to compare the effectiveness of three topical fluoride application protocol s in arresting dentine caries in primary teeth of preschool children in a fluori date d area . METHODS Children aged 3 - 4 years who had at least one active dentine caries lesion were r and omly allocated into three intervention groups : Group 1-application of 30 % silver diammine fluoride ( SDF ) solution every 12 months ; Group 2-three applications of 30 % SDF solution at weekly interval at baseline ; and Group 3-three applications of 5 % sodium fluoride ( NaF ) varnish at weekly interval at baseline . A masked examiner carried out follow-up examinations every 6 months to assess whether the treated lesions had become arrested . RESULTS A total of 304 children with 1670 tooth surfaces with dentine caries received treatment at baseline . After 18 months , 275 children ( 91 % ) remained in the study . The caries arrest rates at tooth surface level were 40 % , 35 % and 27 % for Groups 1 , 2 and 3 , respectively ( p<0.001 ) . Result of the multi-level survival analysis showed that the two SDF application protocol s could shorten the time to arrest of dentine caries compared with the NaF application protocol . Presence of plaque on lesion surface , tooth type and tooth surface all had significant effects on caries arrest rates . CONCLUSIONS Annual or three consecutive weekly applications of SDF solution is more effective in arresting dentine caries in primary teeth than three consecutive weekly applications of NaF varnish . CLINICAL SIGNIFICANCE In a water fluori date d area , application of SDF solution , either three weekly applications at baseline or annually , can arrest active dentine caries lesions in primary teeth faster than three weekly applications of NaF varnish at baseline Dental caries in Chinese pre-school children is common , and restorative treatment is not readily available . This prospect i ve controlled clinical trial investigated the effectiveness of topical fluoride applications in arresting dentin caries . We divided 375 children ( aged 3 - 5 yrs ) with carious upper anterior teeth into five groups . Children in the first and second groups received annual applications of silver diamine fluoride solution ( 44,800 ppm F ) . NaF varnish ( 22,600 ppm F ) was applied every three Output:

RESULTS The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program . After taking into consideration the low cost of the treatment and the disease burden of caries , panel members were confident that the benefits of SDF application in the target population s outweigh its possible undesirable effects . Per GRADE , this is a conditional recommendation based on low- quality evidence .

MS2_1shot191

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: INTRODUCTION The efficacy of contingency-management ( CM ) and motivational enhancement therapy ( MET ) for college student smoking cessation was examined . METHODS Nontreatment-seeking daily smokers ( N = 110 ) were r and omly assigned to 3 weeks of CM versus noncontingent reinforcement ( NR ) and to three individual sessions of MET versus a relaxation control in a 2 x 2 experimental design . Expired carbon monoxide ( CO ) sample s were collected twice daily for 3 weeks . Participants earned 5 US dollars for providing each sample ; additionally , those r and omized to CM earned escalating monetary rewards based on CO reductions ( Week 1 ) and smoking abstinence ( Weeks 2 - 3 ) . RESULTS Compared with NR , CM result ed in significantly lower CO levels and greater total and consecutive abstinence during the intervention . Those in the CM and MET groups reported greater interest in quitting smoking posttreatment , but rates of confirmed abstinence at follow-up were very low ( 4 % at 6-month follow-up ) and did not differ by group . DISCUSSION Findings support the short-term efficacy of CM for reducing smoking among college students . Future research should explore enhancements to CM in this population , including a longer intervention period and the recruitment of smokers who are motivated to quit Chronic Obstructive Pulmonary Disease ( COPD ) usually results from tobacco smoking . Smoking cessation slows COPD 's progression , but few have studied anti-smoking treatments in COPD . In 3-month trials we paid lottery tickets during daily home visits to still-smoking COPD patients for reductions in breath carbon monoxide ( CO ) , a measure of smoke intake . In our first protocol experimental patients received 0 - 3 tickets per day , depending upon the extent of CO reduction below pre-treatment baselines ; yoked controls received the same number of tickets , but not contingent on CO . The protocol produced no change . In a second study patients were assigned a post-baseline quit- date , received nicotine gum , and were paid up to 5 tickets per night , but only for CO less than 10 parts per million ( ppm ) . CO fell sharply as the intervention began , but gradually rose again . A third protocol added special reinforcement schedules for those who did not quit or relapsed ( up to 20 tickets per night for CO less than 10 ppm ) . Daily CO concentrations fell from 27.1 parts per million ( baseline mean ) to 12.7 ( intervention mean ) , but rapid increases followed the intervention . Few patients stopped smoking , but CO and cigarettes used per day significantly fell during Studies 2 and 3 . Post-hoc analysis suggested only a small effect from gum Rationale Sustaining smoking abstinence during the initial weeks of a cessation effort is highly correlated with long-term smoking abstinence . However , experimental research is needed to establish a direct causal relationship between achieving early abstinence and lowered relapse risk . Objective In the present study , we tested whether a period of sustained abstinence directly decreases the relative reinforcing effects of cigarette smoking . Methods Participants were 63 adult smokers who were r and omized into one of three conditions : 14-day ( 14C ) , 7-day ( 7C ) , and 1-day ( 1C ) contingent payment for smoking abstinence . Smoking status was assessed three times per day for 14 consecutive days using breath carbon monoxide monitoring and an abstinence criterion of ≤4 ppm . In the 14C condition , monetary payment was contingent on abstinence for all 14 days ; in the 7C condition , payment was noncontingent for days 1–7 and contingent for days 8–14 ; in the 1C condition , payment was noncontingent for days 1–13 and contingent for day 14 . On day 14 , all participants completed a 3-h preference session under controlled laboratory conditions wherein they could make a maximum of 20 exclusive choices between options to smoke ( two puffs/choice ) or earn money ( $ 0.25/choice ) . Preference was deemed an index of the relative reinforcing effects of smoking and money . Results A significantly lower proportion of participants in the 14C condition ever chose the smoking option ( 19 % ) compared to those in the 7C ( 57 % ) or 1C ( 62 % ) conditions . Conclusions These results provide experimental evidence that sustained abstinence can decrease the relative reinforcing effects of smoking , an effect that may be related to the commonly observed decrease in relapse risk among those who are able to sustain smoking abstinence during the initial weeks of a cessation effort Medication noncompliance with smoking cessation pharmacotherapies is a significant problem in both research and clinical setting s. This r and omized , controlled , single-blind study compared three single-session psychological interventions to increase use of nicotine gum during a 15-day treatment period . A total of 97 adult smokers were r and omized to receive st and ard treatment ( ST , n = 31 ) , brief feedback ( BF , n = 32 ) plus ST , or contingency management ( CM ; i.e. , payment for chewing at least 12 pieces/day on 10 of 15 intervention days , n = 34 ) plus ST and BF . Only the CM condition led to significantly greater average daily gum use ( pieces/day : ST , 6.17 ; BF , 7.81 ; CM , 10.17 [ p values < .05 ] ) and higher rates of compliance ( ST , 13.6 % ; BF , 25.2 % ; CM , 65.6 % [ p values < .001 ] ) . No differences were observed in smoking abstinence , nicotine withdrawal , or urinary cotinine as a function of treatment . Implication s of the present findings are discussed , including application to clinical trials and extension to real-world use of nicotine gum Background . There have been few reports of the process of implementing ongoing worksite health promotion programs . This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers . Methods . Issues discussed include : forming a partnership with organizations , design of the multicomponent incentive intervention , program promotion , maintaining participation , and the need to modify program components over time . Results . The program produced high participation rates ( 29 % of smokers joined the program ) and moderate cessation rates among participants ( during the last half of the program , monthly cessation rates averaged 20 % ) . There was marked variability across worksites on both participation and cessation , and qualitative features of organizations associated with outcome are discussed . Discussion . The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed . The article concludes with recommendations for implementation of similar programs Purpose . To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition . Design . A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs , each assigned to separate worksites . Setting . The study was conducted from 1990 to 1991 at three aerospace industry worksites in California . Subjects . All employees who were current , regular tobacco users were eligible to participate in the program offered at their site . Intervention . The multicomponent program included a self-help package , telephone counseling , and other elements . The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program . The traditional program offered a st and ard smoking cessation program . Measures . Self-reported question naires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period . Results . The incentive-competition program had an abstinence rate of 41 % at 6 months ( n = 68 ) , which was significantly better than the multicomponent program ( 23 % , n = 81 ) or the traditional program ( 8 % , n = 36 ) . At 12 months , the quit rates for the incentive and multicomponent programs were statistically indistinguishable ( 37 % vs. 30 % ) , but remained higher than the traditional program ( 11 % ) . Chi-square tests , t-tests , and logistic regression were used to compare smoking abstinence across the three programs . Conclusions . Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition , and more effective than a traditional program Biochemical validation of smoking status has long been considered essential , but recent reports have question ed its utility in certain kinds of field trials . We describe efforts to biochemically vali date self-reports of smoking cessation from participants in four large-scale r and omized trials in outpatient clinics , hospitals , worksites , and dental clinics . These studies included over 5,000 adults smokers who participated in the population -based low-intensity intervention evaluations . At a 1-year follow-up , 798 subjects reported no tobacco use . We attempted to verify these reports using saliva continine/carbon monoxide validation procedures . Overall , there was a moderately high nonparticipation rate ( 27 % ) , a low disconfirmation rate ( 4 % ) , and a high self-reported relapse rate ( 12 % ) in the interval between survey and biochemical validation . There were no differences between intervention and control conditions on any of the above variables . Longer duration s of self-reported abstinence were strongly related to increased probability of biochemical confirmation . Differences in results across projects were related to how biochemical validation was conducted . These results , as well as statistical power considerations , raise questions about whether biochemical validation procedures are practical , informative , or cost-effective in such population -based , low-intensity intervention research This study determined the effects on smoking behavior of providing contingent reinforcement for nonsmoking versus reduced smoking afternoon breath carbon monoxide ( CO ) target levels . Twenty-eight hired chronic smoker volunteers were r and omly assigned to one of three experimental conditions during a 10-day intervention : ( a ) 8 ppm target CO , $ 5 per day incentive ( n = 11 ) ; ( b ) 16 ppm target CO , $ 4 per day incentive ( n = 8) ; or ( c ) 8 ppm target CO , no incentive ( n = 9 ) . Both payment groups showed significantly lower CO levels and greater amounts of daytime smoking reduction than the no-pay group . A specific effect of CO target was also seen ; 45 % of subjects in the 8 ppm group compared with 0 % of subjects in the 16 ppm target and no-pay groups produced average afternoon CO levels of 8.5 ppm or lower during the intervention . Average levels of CO and smoking reduction did not differ for the two paid groups , however , because some subjects in the 8 ppm group failed to reduce CO sufficiently to contact the reinforcer . Contingent reinforcement based on expired air CO levels can exercise powerful and precise ( target-specific ) control over smoking behavior , but there may be individual differences in ability to meet reinforcement contingencies if difficult targets are introduced abruptly The relationship between reinforcer amount and daytime smoking reduction in smokers offered money for reduced afternoon breath carbon monoxide ( CO ) levels was examined . Twenty-three hired regular smokers with average baseline CO levels of about 30 ppm were exposed in r and om order to five sliding scale payment schedules that changed daily or weekly . Money was available for afternoon CO readings between 0 and 21 ppm with pay amount inversely related to the absolute CO reading obtained . Maximum pay amount for readings below 7 ppm varied among $ 0 , $ 1.50 , $ 3 , $ 6 , and $ 12 per day . Contingent reinforcement promoted CO and daytime cigarette reduction within individuals with the amount of behavior change related to the amount of payment available . Average CO levels decreased from 30 to 15 ppm as a function of pay amount whereas self-reported daytime cigarettes decreased from 12 to 5 per day . Average minutes of cigarette abstinence prior to the afternoon study contact increased from 62 to 319 minutes as a function of pay amount , whereas the percentage of available money earned increased from 22 % to 48 % . Nontargeted evening cigarette use also decreased during periods of daytime smoking reduction . The orderly effects of this contingent reinforcement intervention on daytime smoking of regular smoker volunteers suggest that this is a sensitive model for continued evaluation of factors that influence smoking reduction and cessation BACKGROUND Smoking is the leading preventable cause of premature death in the United States . Previous studies of financial incentives for smoking cessation in work setting s have not shown that such incentives have significant effects on cessation rates , but these studies have had limited power , and the incentives used may have been insufficient . METHODS We r and omly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs ( 442 employees ) or to receive information about programs plus financial incentives ( 436 employees ) . The financial incentives were $ 100 for completion of a smoking-cessation program , $ 250 for cessation of smoking within 6 months after study enrollment , as confirmed by a biochemical test , and $ 400 for abstinence for an additional 6 months after the initial cessation , as confirmed by a biochemical test . Individual participants were stratified according to work site , heavy or nonheavy smoking , and income . The primary end point was smoking cessation 9 or 12 months after enrollment , depending on whether initial cessation was reported at 3 or 6 months . Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cess Output:

In the remaining trials , there was no clear evidence that participants who committed their own money to the programme did better than those who did not , or that contingent rewards enhanced success rates over fixed payment schedules . There is some evidence that recruitment rates can be improved by rewarding participation , which may be expected to deliver higher absolute numbers of successful quitters . With the exception of one recent trial , incentives and competitions have not been shown to enhance long-term cessation rates . Early success tended to dissipate when the rewards were no longer offered . Rewarding participation and compliance in contests and cessation programmes may have potential to deliver higher absolute numbers of quitters .

MS2_1shot192

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: IMPORTANCE Sauna bathing is a health habit associated with better hemodynamic function ; however , the association of sauna bathing with cardiovascular and all-cause mortality is not known . OBJECTIVE To investigate the association of frequency and duration of sauna bathing with the risk of sudden cardiac death ( SCD ) , fatal coronary heart disease ( CHD ) , fatal cardiovascular disease ( CVD ) , and all-cause mortality . DESIGN , SETTING , AND PARTICIPANTS We performed a prospect i ve cohort study ( Finnish Kuopio Ischemic Heart Disease Risk Factor Study ) of a population -based sample of 2315 middle-aged ( age range , 42 - 60 years ) men from Eastern Finl and . Baseline examinations were conducted from March 1 , 1984 , through December 31 , 1989 . EXPOSURES Frequency and duration of sauna bathing assessed at baseline . RESULTS During a median follow-up of 20.7 years ( interquartile range , 18.1 - 22.6 years ) , 190 SCDs , 281 fatal CHDs , 407 fatal CVDs , and 929 all-cause mortality events occurred . A total of 601 , 1513 , and 201 participants reported having a sauna bathing session 1 time per week , 2 to 3 times per week , and 4 to 7 times per week , respectively . The numbers ( percentages ) of SCDs were 61 ( 10.1 % ) , 119 ( 7.8 % ) , and 10 ( 5.0 % ) in the 3 groups of the frequency of sauna bathing . The respective numbers were 89 ( 14.9 % ) , 175 ( 11.5 % ) , and 17 ( 8.5 % ) for fatal CHDs ; 134 ( 22.3 % ) , 249 ( 16.4 % ) , and 24 ( 12.0 % ) for fatal CVDs ; and 295 ( 49.1 % ) , 572 ( 37.8 % ) , and 62 ( 30.8 % ) for all-cause mortality events . After adjustment for CVD risk factors , compared with men with 1 sauna bathing session per week , the hazard ratio of SCD was 0.78 ( 95 % CI , 0.57 - 1.07 ) for 2 to 3 sauna bathing sessions per week and 0.37 ( 95 % CI , 0.18 - 0.75 ) for 4 to 7 sauna bathing sessions per week ( P for trend = .005 ) . Similar associations were found with CHD , CVD , and all-cause mortality ( P for trend ≤.005 ) . Compared with men having a sauna bathing session of less than 11 minutes , the adjusted hazard ratio for SCD was 0.93 ( 95 % CI , 0.67 - 1.28 ) for sauna bathing sessions of 11 to 19 minutes and 0.48 ( 95 % CI , 0.31 - 0.75 ) for sessions lasting more than 19 minutes ( P for trend = .002 ) ; significant inverse associations were also observed for fatal CHDs and fatal CVDs ( P for trend ≤.03 ) but not for all-cause mortality events . CONCLUSIONS AND RELEVANCE Increased frequency of sauna bathing is associated with a reduced risk of SCD , CHD , CVD , and all-cause mortality . Further studies are warranted to establish the potential mechanism that links sauna bathing and cardiovascular health The effect of the Finnish sauna on insulin absorption from a subcutaneous injection site was examined in eight insulin-dependent diabetic patients by measuring externally the disappearance rate of 125I-labelled rapid-acting insulin . The sauna ( twice for 25 minutes at 85 degrees C ) accelerated insulin absorption by 110 % as compared with room temperature ( p < 0.01 ) . After the sauna blood glucose concentrations were 3.0 - 3.3 mmol/1 ( 54.1 - 59.5 mg/100 ml ) lower than on the control day ( p < 0.05 ) . The fall in blood glucose values was proportional to the increased rate of insulin absorption ( r = 0.30 ; p < 0.01 ) . The hypoglycaemic effect of a sauna in insulin-treated diabetics is clearly at least partly due to enhanced insulin absorption from the injection site . Such an effect might be prevented by taking a snack or reducing the insulin dose We have reported that repeated sauna therapy improves impaired vascular endothelial function in a patient with coronary risk factors . We hypothesized that sauna therapy decreases urinary 8-epi-prostagl and in F(2alpha ) ( PGF(2alpha ) ) levels as a marker of oxidative stress and conducted a r and omized , controlled study . Twenty-eight patients with at least one coronary risk factor were divided into a sauna group ( n = 14 ) and non-sauna group ( n = 14 ) . Sauna therapy was performed with a 60 degrees C far infrared-ray dry sauna for 15 minutes and then bed rest with a blanket for 30 minutes once a day for two weeks . Systolic blood pressure and increased urinary 8-epi-PGF(2alpha ) levels in the sauna group were significantly lower than those in the non-sauna group at two weeks after admission ( 110 + /- 15 mmHg vs 122 + /- 13 mmHg , P < 0.05 , 230 + /- 67 pg/mg x creatinine vs 380 + /- 101 pg/mg x creatinine , P < 0.0001 , respectively ) . These results suggest that repeated sauna therapy may protect against oxidative stress , which leads to the prevention of atherosclerosis KEY POINTS A recent 30 year prospect i ve study showed that lifelong sauna use reduces cardiovascular-related and all-cause mortality ; however , the specific cardiovascular adaptations that cause this chronic protection are currently unknown . We investigated the effects of 8 weeks of repeated hot water immersion ( ' heat therapy ' ) on various biomarkers of cardiovascular health in young , sedentary humans . We showed that , relative to a sham group which participated in thermoneutral water immersion , heat therapy increased flow-mediated dilatation , reduced arterial stiffness , reduced mean arterial and diastolic blood pressure , and reduced carotid intima media thickness , with changes all on par or greater than what is typically observed in sedentary subjects with exercise training . Our results show for the first time that heat therapy has widespread and robust effects on vascular function , and as such , could be a viable treatment option for improving cardiovascular health in a variety of patient population s , particularly those with limited exercise tolerance and /or capabilities . ABSTRACT The majority of cardiovascular diseases are characterized by disorders of the arteries , predominantly caused by endothelial dysfunction and arterial stiffening . Intermittent hot water immersion ( ' heat therapy ' ) results in elevations in core temperature and changes in cardiovascular haemodynamics , such as cardiac output and vascular shear stress , that are similar to exercise , and thus may provide an alternative means of improving health which could be utilized by patients with low exercise tolerance and /or capabilities . We sought to comprehensively assess the effects of 8 weeks of heat therapy on biomarkers of vascular function in young , sedentary subjects . Twenty young , sedentary subjects were assigned to participate in 8 weeks ( 4 - 5 times per week ) of heat therapy ( n = 10 ; immersion in a 40.5 ° C bath sufficient to maintain rectal temperature ≥ 38.5 ° C for 60 min per session ) or thermoneutral water immersion ( n = 10 ; sham ) . Eight weeks of heat therapy increased flow-mediated dilatation from 5.6 ± 0.3 to 10.9 ± 1.0 % ( P < 0.01 ) and superficial femoral dynamic arterial compliance from 0.06 ± 0.01 to 0.09 ±0.01 mm(2 ) mmHg(-1 ) ( P = 0.03 ) , and reduced ( i.e. improved ) aortic pulse wave velocity from 7.1 ± 0.3 to 6.1 ± 0.3 m s(-1 ) ( P = 0.03 ) , carotid intima media thickness from 0.43 ± 0.01 to 0.37 ± 0.01 mm ( P < 0.001 ) , and mean arterial blood pressure from 83 ± 1 to 78 ± 2 mmHg ( P = 0.02 ) . No changes were observed in the sham group or for carotid arterial compliance , superficial femoral intima media thickness or endothelium-independent dilatation . Heat therapy improved endothelium-dependent dilatation , arterial stiffness , intima media thickness and blood pressure , indicating improved cardiovascular health . These data suggest heat therapy may provide a simple and effective tool for improving cardiovascular health in various population Background there are no previous studies linking repeated heat exposure of sauna and the risk of memory diseases . We aim ed to investigate whether frequency of sauna bathing is associated with risk of dementia and Alzheimer 's disease . Setting prospect i ve population -based study . Methods the frequency of sauna bathing was assessed at baseline in the Kuopio Ischaemic Heart Disease population -based prospect i ve cohort study of 2,315 apparently healthy men aged 42 - 60 years at baseline , with baseline examinations conducted between 1984 and 1989 . Hazard ratios ( HRs ) with 95 % confidence intervals ( CIs ) for dementia and Alzheimer 's disease were ascertained using Cox-regression modelling with adjustment for potential confounders . Results during a median follow-up of 20.7 ( interquartile range 18.1 - 22.6 ) years , a total of 204 and 123 diagnosed cases of dementia and Alzheimer 's disease were respectively recorded . In analysis adjusted for age , alcohol consumption , body mass index , systolic blood pressure , smoking status , Type 2 diabetes , previous myocardial infa rct ion , resting heart rate and serum low-density lipoprotein cholesterol , compared with men with only 1 sauna bathing session per week , the HR for dementia was 0.78 ( 95 % CI : 0.57 - 1.06 ) for 2 - 3 sauna bathing sessions per week and 0.34 ( 95 % CI : 0.16 - 0.71 ) for 4 - 7 sauna bathing sessions per week . The corresponding HRs for Alzheimer 's disease were 0.80 ( 95 % CI : 0.53 - 1.20 ) and 0.35 ( 95 % CI : 0.14 - 0.90 ) . Conclusion in this male population , moderate to high frequency of sauna bathing was associated with lowered risks of dementia and Alzheimer 's disease . Further studies are warranted to establish the potential mechanisms linking sauna bathing and memory diseases BACKGROUND Sauna bathing is associated with reduced cardiovascular risk , but the mechanisms underlying this beneficial effect are not entirely understood . We aim ed to assess the relationship between sauna bathing and risk of incident hypertension . METHODS Frequency of sauna bathing was ascertained using question naires in the Kuopio Ischemic Heart Disease Study , a prospect i ve cohort study conducted in Eastern Finl and that comprised a population -based sample of 1,621 men aged 42 to 60 years without hypertension at baseline . The incidence of hypertension was defined as a physician diagnosis of hypertension , systolic blood pressure ( SBP ) > 140 mm Hg , diastolic blood pressure > 90 mm Hg , or use of antihypertensive medication . RESULTS During a median follow-up of 24.7 years , 251 incident cases ( 15.5 % ) were recorded . In Cox regression analysis adjusted for baseline age , smoking , body mass index , and SBP ; compared to participants reporting 1 sauna session per week , the hazard ratio for incident hypertension in participants reporting 2 to 3 sessions and 4 to 7 sessions was 0.76 ( 95 % confidence interval : 0.57 - 1.02 ) and 0.54 ( 0.32 - 0.91 ) , respectively . The corresponding hazard ratios were similar after further adjustment for glucose , creatinine , alcohol consumption , heart rate , family history of hypertension , socioeconomic status , and cardiorespiratory fitness : 0.83 ( 95 % confidence interval : 0.59 - 1.18 ) and 0.53 ( 0.28 - 0.98 ) , respectively . CONCLUSIONS Regular sauna bathing is associated with reduced risk of hypertension , which may be a mechanism underlying the decreased cardiovascular risk associated with sauna use . Further epidemiological and experimental studies could help eluci date the effects of sauna bathing on cardiovascular function There have been a few reports in Caucasians that glucose tolerance is worse at higher environmental temperatures . In investigating these observations in a tropical African population , we performed st and ard oral gl Output:

CONCLUSION PH preceded by a glucose load results in acute glucose intolerance in non-diabetic and diabetic individuals . However , heating a non-diabetic individual without a glucose load appears not to affect glycaemic control . Likewise , a glucose challenge given within 24 hours of a single-bout of heating does not affect glucose tolerance in non-diabetic individuals . Despite the promise PH may hold , no short-term benefit to glucose tolerance is observed in non-diabetic individuals .

MS2_1shot193

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract The use of systemic prophylactic antibiotics in third molar surgery is still a controversial issue . A double-blind study has been conducted with 75 selected patients r and omized into two groups . After exclusions , 68 patients requiring removal of 133 bone impacted m and ibular third molars remained . Surgery was carried out under general anesthesia and a St and ard operative technique used . Postoperative raorbidity was assessed by recording trismus , swelling , pain , and the incidence of infection . In the group given an antibiotic 15.1 % of patients and 7.8 % of sockets became infected ; in the control group the incidence was 14.3 % and 8.7 % , respectively . Difficult extraction s were more likely to give rise to postoperative infection , but neither the state of eruption nor the occurrence of previous pericoronitis appeared to predispose to dry socket . Trismus and swelling were associated with increased difficulty of extraction , but increased pain did not usually occur unless a socket became infected , Differences of overall morbidity between the groups were slight and not statistically significant . The main conclusion from the study is that the use of prophylactic antibiotics in third molar surgery is unnecessary unless specific systemic factors are present Treatment of osteitis after surgical removal of the third molar of the m and ible is still a clinical problem . A total of 140 patients undergoing operations for removal of an impacted third molar of the m and ible , were included in a double-blind study . Placebo or antibiotics - azidocillin , erythromycin , clindamycin and doxycycline - were given to the patients preoperatively and for the following 7 days . The concentrations in serum , alveolar serum and m and ibular bone were measured and the postoperative courses - pain , trismus , swelling and wound-healing - were recorded . No correlation was obtained between the antibiotic concentration and the postoperative complaints , except in the azidocillin group on day 2 , in which fewer complaints were noticed in patients with high concentrations of the drug at the time of operations . The 80 patients in the antibiotic groups responded significantly better with respect to wound-healing than the 60 patients in the placebo groups . Only 15 operations lasted more than 15 min and the three of them which subsequently result ed in alveolitis were in the placebo groups . Antibiotics significantly reduced pain on day 7 postoperatively . In general , no statistically significant differences in trismus and swelling could be demonstrated between the patient groups . However , there was a significant difference between the placebo and doxycycline groups with respect to swelling ( day 2 postoperative , P < 0.01 ; day 5 postoperative , P < 0.05 ) . Thus systemically administered antibiotics offered only slight advantages in routine operations of impacted third m and ibular molars , but could decrease the rate of infections after traumatic operations PURPOSE This study evaluated the influence of antibiotic prophylaxis on postoperative complications after inferior third molar removal in young patients . PATIENTS AND METHODS We extracted 59 m and ibular third molars from 59 patients with a mean age of 15 years ( range , 12 - 19 years ) . The patients were included in the study when radiographs at the time of surgery showed that only the crown of the tooth germ was formed . Patients were r and omized into 2 groups , the test group and the control group . The test group received 2-g amoxicillin tablets 1 hour before surgery , and the control group received no antibiotic therapy . The test group included 32 patients , 20 of whom were female and 12 were male ; the mean age was 15 years . The control group included 27 patients , 12 of whom were female and 15 were male ; the mean age was 15 years . Postoperative complications such as pain , swelling , wound infection , and fever were recorded by use of a question naire completed by the patient for the week after the extraction . Suture removal and question naire evaluation were performed by a surgeon who did not know the preoperative regimen . RESULTS The mean operating time was 34 minutes in the control group and 31 minutes in the test group . This difference was not significant . In the test group there was a statistically significant reduction of postoperative pain in the 7 days after the extraction , and the patients had a consistent minor consumption of analgesics . Swelling was always present in the control and test groups in the postoperative week , but in the test group it was a minor sequela and was absent in 2 patients . Wound infection was a sequela reported in 4 patients in the control group and in 1 patient in the test group ; this difference was statistically significant ( P < .01 ) . Fever was present in 2 patients in the control group and in 1 patient in the test group ; this difference was not statistically significant . CONCLUSIONS A statistically significant difference was found between patients receiving preoperative amoxicillin and the control group in the incidence of postoperative pain , fever , and wound infection . Another important finding was the statistically minor consumption of analgesics in the test group in the postoperative week AIM To test the efficacy of two dosing regimens of antimicrobial prophylaxis during the removal of impacted lower third molars . DESIGN Double blind , prospect i ve , placebo-controlled trial . SETTING Teaching hospital , India . SUBJECTS 151 patients aged 19 - 36 having impacted lower third molars removed . METHODS R and om allocation into three groups : placebo ( n= 34 ) , metronidazole 1 g orally , 1 hour preoperatively ( n= 44 ) , or metronidazole 400 mg orally eight hourly for 5 days postoperatively ( n= 47 ) . Patients were recalled on the sixth postoperative day for assessment of pain scores on the second and sixth days , swelling , differences in mouth opening between preoperative and the sixth postoperative day , and the state of the wound . RESULTS There were no significant differences in the outcome between the three groups ( P= 0.09 ) . CONCLUSION Antimicrobial prophylaxis does not seem to reduce morbidity after removal of lower third molars PURPOSE We sought to compare recovery for clinical and health-related quality of life ( HRQOL ) outcomes after third molar surgery in patients treated with or without intravenous antibiotics at surgery . PATIENTS AND METHODS Fifty-six patients at least 18 years of age and with all 4 third molars below the occlusal plane , treated at 3 clinical centers , were given intravenous antibiotics just before third molar surgery . Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group ( n = 60 patients ) who did not receive antibiotics . The control group was selected using the same criteria and treated under the same surgical protocol as the antibiotic group . Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics . RESULTS The incidence of delayed clinical recovery defined as a postsurgery visit with treatment was higher in the control group compared with the antibiotic group . In the antibiotic group , 4 % had 1 postsurgery visit with treatment ; no patient had 2 visits . In the control group without antibiotics , 28 % had at least 1 postsurgery visit with treatment ( P < .0001 ) and 13 % had at least 2 postsurgery visits with treatment . No statistically significant differences in HRQOL outcomes were found between the 2 groups . CONCLUSIONS Administration of intravenous antibiotics before third molar surgery may improve clinical recovery in healthy adult patients with all 4 third molars below the occlusal plane , a presenting characteristic that has been suggested as a risk factor for delayed recovery . The findings from this exploratory trial indicate that evaluation of the effectiveness of systemic antibiotic administration with third molar surgery in a r and omized , multi-intervention , explanatory clinical trial is warranted A double blind trial , was design ed , in which 118 patients undergoing the removal of impacted wisdom teeth were r and omly divided into the following groups ; 41 patients received Metronidazole , 39 patients received Arnica Montana , 38 patients received the placebo . Metronidazole was more effective in pain control than Arnica ( p less than 0.001 ) and placebo ( p less than 0.01 ) . It prevented swelling better than Arnica ( p less than 0.01 ) and placebo ( p less than 0.05 ) and was more effective in promoting healing than Arnica ( p less than 0.01 ) and placebo ( p greater than 0.02 ) . Arnica Montana appeared to give rise to greater pain than placebo ( p less than 0.05 ) and caused more swelling than the placebo ( p less than 0.01 ) Objective The purpose of the study was to determine if the intra-alveolar application of topical metronidazole gel could reduce the incidence of alveolar osteitis ( dry socket ) following routine tooth extraction in molar and premolar extraction sites . Design This was a multicentre , double blind , r and omised , placebo-controlled clinical trial . A total of 302 patients took part , of which 23 returned with alveolar osteitis . Of these , eight had received the metronidazole gel and 15 the placebo . Setting The study was carried out in three general dental practice s by general dental practitioners working in Engl and over the period 2000 - 2003.Main outcome measures Following extraction of either a molar or premolar tooth , either a 25 % metronidazole gel or KY Jelly was syringed gently into the socket . A painful post operative complication was recorded if either a dry socket was present or the patient returned with pain . Results and conclusions The difference in the incidence of alveolar osteitis between the placebo and the active gel groups was not significant and it was concluded that 25 % topical metronidazole gel was not effective in reducing the incidence of alveolar osteitis . It was found that the incidence of alveolar osteitis reduced with increasing age and was more likely to occur in a patient with a previous history of the condition OBJECTIVES The purpose of this study was to examine the relationships between patient characteristics and reasons for extraction of permanent teeth . METHODS 5131 dentists were selected from the list of the membership directory of the Japan Dental Association by systematic r and om selection . The dentists were asked to record the reason for each extraction of permanent teeth during a period from February 1 to 7 , 2005 . Reasons for tooth extraction were assigned to five groups : caries , fracture of teeth weakened by caries or endodontics , periodontal diseases , orthodontics and other reasons . We used cross tabulation and multiple logistic regression analysis to estimate the relationships between patient characteristics and reasons for tooth extraction . RESULTS 2001 dentists ( response rate of 39.0 % ) returned the forms , and complete information on 7333 patients was obtained . A total of 3,196 ( 43.6 % ) patients underwent tooth extraction due to caries and its sequela , and 2721 ( 37.1 % ) patients underwent tooth extraction due to periodontal disease . Multiple logistic regression analysis showed that denture wearers were more likely to undergo tooth extraction due to periodontal disease in all age groups ( p < 0.05 ) . Males tended to undergo tooth extraction due to periodontal disease than did females in all age groups ( p < 0.05 ) except for age group 30 - 49 . Subjects with 19 or less teeth were more likely to undergo tooth extraction due to periodontal disease in the age groups 30 - 49 ( p < 0.001 ) and 50 - 69 ( p < 0.001 ) . In the age group of 50 years or older , female ( p<0.01 ) and the possession of 20 or more natural teeth ( p < 0.05 ) were related to caries extraction . However , there was no clear relationship between caries extraction and patient characteristics under 50 years old . CONCLUSION There was a significant relationship between denture wearing and periodontal extraction . In the middle aged population , patients with 19 or less teeth lost their teeth mainly due to periodontal disease The most common complications after surgical extraction of the third m and ibular molar are trismus , oedema or swelling , local pain , dysphagia and infection . The aim of this comparative , double-blind , r and omized clinical trial was to evaluate the efficacy of two sustained release amoxicillin/clavulanate regimens in the reduction of infection after third molar extractive surgery . A total of 225 patients were r and omized into three equal groups : placebo , prophylaxis with single pre-surgical dose of two tablets amoxicillin/clavulanate 1000/62.5 mg , and pre-emptive post-surgery therapy with two tablets amoxicillin/clavulanate 1000/62.5 mg BID for 5 days . A higher rate of infection ( P=0.006 ) was found among patients receiving placebo ( 16 % ) than those receiving single-dose prophylaxis ( 5.3 % ) or 5-day pre-emptive therapy ( 2.7 % ) . A relationship between both the duration ( 13.8 % for long versus 7.4 % for medium versus 1.6 % for short ) and difficulty ( 12.7 % with ostectomy versus 3.5 % without ostectomy ; P=0.011 ) of surgical procedure and incidence of subsequent infection was also observed . Both prophylactic and therapeutic regimens versus placebo achieved greater reduction of pain after surgery on day 3 ( P=0.001 ) . Logistic regression analysis Output:

There is evidence that prophylactic antibiotics reduce the risk of infection , dry socket and pain following third molar extraction and result in an increase in mild and transient adverse effects . However , patients at a higher risk of infection are more likely to benefit from prophylactic antibiotics , because infections in this group are likely to be more frequent , associated with complications and be more difficult to treat . Due to the increasing prevalence of bacteria which are resistant to treatment by currently available antibiotics , clinicians should consider carefully whether treating 12 healthy patients with antibiotics to prevent one infection is likely to do more harm than good

MS2_1shot194

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The objective of our study was to investigate the relationship between sonographic findings and the occurrence of abortion in pregnancies complicated by first-trimester bleeding in which fetal cardiac activity was documented upon admission . A prospect i ve study of transvaginal sonography was performed in 270 pregnant patients with bleeding between 5 and 12 weeks ' gestation . The study group included 149 cases in which a singleton fetus with cardiac activity was initially documented . The outcome variable was pregnancy loss prior to 20 weeks . The influence of sonographic findings on admission was studied by univariate analysis and logistic regression . The prevalence of abortion was 23/149 ( 15 % ) . A significant relationship ( p < 0.05 ) was found between the occurrence of abortion and the following : fetal bradycardia ( heart rate less than -1.2 SD from the mean ) , a discrepancy between the diameter of the gestational sac and crown-rump length less than -0.5 SD from the mean , and a discrepancy between menstrual and sonographic age of more than 1 week . According to the logistic regression equation that was obtained , the probability of abortion in first-trimester bleeding with documented fetal cardiac activity upon admission varied between a minimum of 6 % when none of the above risk factors were present and a maximum of 84 % when all were present . The presence of any of the above factors identified 84 % of all subsequent abortions Between 1983 and 1984 a double-blind r and omized study with progesterone substitution in threatened abortion was carried out . Fifty-six patients with vaginal bleeding during the first trimester of pregnancy , the internal cervical os being closed , were referred to the hospital . Twenty-five women ( 5th and 6th week of gestation ) with positive serum concentrations of beta-hCG were admitted to the study without regard to sonogram results . In other 25 women ( 7th-10th week of pregnancy ) and 6 women ( greater than or equal to 11th week of pregnancy ) fetal heart action and movement could be demonstrated by ultrasound . The patients were prescribed bed rest and vaginal suppositories twice daily , containing either 25 mg progesterone or only polyethylene glycol . The code was not broken until after completion of the study . Serial serum determinations of beta-hCG , estradiol-17 beta ( E2 ) , progesterone , and ultrasound were performed . Four patients had to be omitted from final analysis ( two tubal pregnancies , one intrauterine infection , one sectio parva ) . Three of 26 patients progesterone ( 11 % ) and five of 26 patients with placebo ( 19 % ) had an abortion , which represented no significant difference . Frequency of abortion was increased in women more than 30 years old , in women with previous abortions and after ovulation induction . Progesterone treatment result ed in a significant elevation of serum progesterone concentrations ( p less than 0.01 ) , while beta-hCG and E2 were unchanged . The results of this study confirm that pregnancy outcome is favorable in women with bleeding and normal hormone concentrations without hormonal treatment and unfavorable in women with reduced beta-hCG and E2-concentrations . ( ABSTRACT TRUNCATED AT 250 WORDS In a prospect i ve study 265 patients with threatened abortions were divided into 2 groups . One group of 134 patients received treatment with Oestradiol benzoat and hydroxyprogesterone capronat . The other group of 131 patients received no hormonal treatment . Of the group treated with hormones 40.7 % of the women had an abortion . Of the group treated with placebos 39.7 % of the patients had an abortion . There was therefore no difference in the success rate of the treatment of threatened abortion irrespective of the administration of hormones or placebos . The value of hormonal therapy in the treatment of threatened abortion is therefore question able The purpose of this study was to investigate the effect of vaginal progesterone on endocervical cytokine concentration in women at risk of threatened abortion . One hundred and sixty pregnant women with clinical symptoms of threatened abortion before the 20th week of pregnancy were r and omly assigned to receive vaginal progesterone or placebo . Cervical fluids were collected and endocervical concentrations of different cytokines ( IFNγ , TNFα , IL-8 , IL-10 and IL-12 ) were analyzed before and one week after progesterone or placebo treatment . A significant decrease in IFNγ and increase in IL-10 in endocervical fluid was seen when the values were compared before and after progesterone treatment . However , there were no significant differences in pregnancy outcomes between the placebo and progesterone groups . We conclude that despite the failure of vaginal progesterone treatment to improve pregnancy outcomes , progesterone can induce a shift in the concentration of cytokines in endocervical secretions BACKGROUND Midtrimester amniocentesis to investigate fetal karyotype carries a small risk of fetal loss . AIM To test the hypothesis that progesterone prophylaxis may reduce this . STUDY DESIGN A r and omised controlled trial comparing a short prophylactic treatment with progesterone after amniocentesis with untreated controls . RESULTS There were no differences in frequency of miscarriage , preterm delivery or neonatal outcome . CONCLUSION Prophylactic progesterone treatment after amniocentesis does not improve obstetric outcome Presented herein is a r and omized prospect i ve study performed to evaluate the efficacy of the addition of lymphocyte immunotherapy ( LI ) to progesterone ( P ) therapy ( LI/P ) for the prevention of spontaneous abortion ( SAB ) in primary aborters with a history of three SABs . The incidence of intrauterine pregnancies in four cycles was 23 of 35 ( 65.7 % ) patients for LI/P vs. 14 of 31 ( 45.1 % ) patients treated with progesterone alone . SABs occurred in 6 of 23 ( 26.0 % ) LI/P-treated patients compared to 8 of 14 ( 57.1 % ) given progesterone alone . The mean number of previous abortions in both groups was 3.9 . The mean age of the LI/P group was 34.1 vs. 33.6 years for the group treated with progesterone alone . These data could be interpreted to show that progesterone therapy and LI independently inhibit SAB or that LI/P acts synergistically to inhibit immune destruction . LI/P therapy was found to be more effective than progesterone therapy alone One hundred cases of threatened abortion were r and omly allocated to four lines of treatment namely , long acting progesterone , antispasmodic , indomethacin and placebo . The lowest success rate was encountered in the indomethacin treated group ; symptoms of intolerance were common and three cases out of sixteen turned into missed abortion . Indomethacin does not offer any advantage over other lines of treatment in threatened abortion BACKGROUND The aim was to study whether prolongation of luteal support during early pregnancy influences the delivery rate after IVF . METHODS Dual centre study including 303 women who achieved pregnancy after IVF or ICSI was used . All were treated with the long protocol using GnRH agonists and given luteal support with 200 mg vaginal progesterone three times daily during 14 days from the day of transfer until the day of a positive HCG test . The study group ( n = 150 ) withdrew vaginal progesterone from the day of positive HCG . The control group ( n = 153 ) continued administration of vaginal progesterone during the next 3 weeks of pregnancy . RESULTS The number of miscarriages prior to and after week 7 of gestation was seven ( 4.6 % ) and 15 ( 10.0 % ) in the study group and five ( 3.3 % ) and 13 ( 8.5 % ) in the control group respectively . The number of deliveries was 118 ( 78.7 % ) in the study group and 126 ( 82.4 % ) in the control group . The differences were not significant . CONCLUSIONS Prolongation of progesterone supplementation in early pregnancy has no influence on the miscarriage rate , and thus no effect on the delivery rate . Progesterone supplementation can safely be withdrawn at the time of a positive HCG test BACKGROUND Women who have had a spontaneous preterm delivery are at greatly increased risk for preterm delivery in subsequent pregnancies . The results of several small trials have suggested that 17 alpha-hydroxyprogesterone caproate ( 17P ) may reduce the risk of preterm delivery . METHODS We conducted a double-blind , placebo-controlled trial involving pregnant women with a documented history of spontaneous preterm delivery . Women were enrolled at 19 clinical centers at 16 to 20 weeks of gestation and r and omly assigned by a central data center , in a 2:1 ratio , to receive either weekly injections of 250 mg of 17P or weekly injections of an inert oil placebo ; injections were continued until delivery or to 36 weeks of gestation . The primary outcome was preterm delivery before 37 weeks of gestation . Analysis was performed according to the intention-to-treat principle . RESULTS Base-line characteristics of the 310 women in the progesterone group and the 153 women in the placebo group were similar . Treatment with 17P significantly reduced the risk of delivery at less than 37 weeks of gestation ( incidence , 36.3 percent in the progesterone group vs. 54.9 percent in the placebo group ; relative risk , 0.66 [ 95 percent confidence interval , 0.54 to 0.81 ] ) , delivery at less than 35 weeks of gestation ( incidence , 20.6 percent vs. 30.7 percent ; relative risk , 0.67 [ 95 percent confidence interval , 0.48 to 0.93 ] ) , and delivery at less than 32 weeks of gestation ( 11.4 percent vs. 19.6 percent ; relative risk , 0.58 [ 95 percent confidence interval , 0.37 to 0.91 ] ) . Infants of women treated with 17P had significantly lower rates of necrotizing enterocolitis , intraventricular hemorrhage , and need for supplemental oxygen . CONCLUSIONS Weekly injections of 17P result ed in a substantial reduction in the rate of recurrent preterm delivery among women who were at particularly high risk for preterm delivery and reduced the likelihood of several complications in their infants Deficiency in the luteal phase has been shown during stimulated cycles using a protocol involving a GnRH agonist . The authors undertook a r and omised prospect i ve trial of supplementation by progesterone of the luteal phase and of early pregnancy in two hundred and seventy two patients requiring fertilisation in vitro ( FIV ) , gamete inter-fallopian transfer ( GIFT ) or zygote inter-fallopian transfer ( ZIFT ) . Either progesterone in solution in oil ( 50 mg/day ) administered by intramuscular injection or micronized progesterone administered intra-vaginally ( 600 mg/d ) were used as support for the luteal phase . Administration of progesterone in association with estradiol valerate was started on the day prior to oocyte puncture and was continued until the 12th week of pregnancy . The implantation rate was very close to the threshold of significance ( P = 0.07 ) in favour of the patients given vaginal progesterone . There was a higher rate of clinical pregnancies ( 33.6 versus 26.7 p. cent ) in the latter group , though this was not significant . While plasma progesterone ( Pg ) levels were lower in patients using vaginal progesterone , the abortion rate during the first three months was lower in this group ( P < 0.05 ) . Micronized progesterone administered vaginally was well tolerated by all patients . During stimulated cycles , notably by GnRHa , it thus proved to be more effective than Pg administered by intramuscular injection with regard to implantation and abortion rates Summary . The clinical and endocrine effects of progestogen therapy in early pregnancy were investigated using a double‐blind r and omized trial in 64 patients who had a viable fetus at 6 weeks gestation and had an increased risk of miscarriage . The patients were r and omly allocated to receive either 17 alpha‐hydroxyprogesterone caproate or a placebo between 7 and 12 weeks gestation . Four fetal ultrasonographic variables and 17 maternal endocrine variables were studied in each woman . Only four maternal serum variables ( 17 alpha‐hydroxyprogesterone , prolactin , thyroxin and thyroxin binding globulin ) rose significantly . The serum progesterone levels in the hormone supplemented group were on average 20 % higher than in the placebo group but the difference was not statistically significant . However , the relation between the progesterone levels and the fetal outcome was not clear . Therefore it is not advisable to prescribe 17‐OHP‐C during early pregnancy to prevent a miscarriage BACKGROUND A combination of mifepristone and misoprostol provides an effective method of medical abortion for early pregnancy . This is the first r and omized trial comparing the use of sublingual misoprostol with vaginal misoprostol in combination with mifepristone for termination of early pregnancies up to 63 days . METHODS A total of 224 women who requested legal termination of pregnancy up to 63 days were r and omized by computer- generated list into two groups and given 200 mg of oral mifepristone followed 48 Output:

Based on scarce data from two method ologically poor trials , there is no evidence to support the routine use of progestogens for the treatment of threatened miscarriage .

MS2_1shot195

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objectives To assess the completeness and representativeness of body mass index ( BMI ) data in the Clinical Practice Research Data link ( CPRD ) , and determine an optimal strategy for their use . Design Descriptive study . Setting Electronic healthcare records from primary care . Participants A million patient r and om sample from the UK CPRD primary care data base , aged ≥16 years . Primary and secondary outcome measures BMI completeness in CPRD was evaluated by age , sex and calendar period . CPRD-based summary BMI statistics for each calendar year ( 2003–2010 ) were age-st and ardised and sex-st and ardised and compared with equivalent statistics from the Health Survey for Engl and ( HSE ) . Results BMI completeness increased over calendar time from 37 % in 1990–1994 to 77 % in 2005–2011 , was higher among females and increased with age . When BMI at specific time points was assigned based on the most recent record , calendar – year-specific mean BMI statistics underestimated equivalent HSE statistics by 0.75–1.1 kg/m2 . Restriction to those with a recent ( ≤3 years ) BMI result ed in mean BMI estimates closer to HSE ( ≤0.28 kg/m2 underestimation ) , but excluded up to 47 % of patients . An alternative strategy of imputing up-to- date BMI based on modelled changes in BMI over time since the last available record also led to mean BMI estimates that were close to HSE ( ≤0.37 kg/m2 underestimation ) . Conclusions Completeness of BMI in CPRD increased over time and varied by age and sex . At a given point in time , a large proportion of the most recent BMI s are unlikely to reflect current BMI ; consequent BMI misclassification might be reduced by employing model-based imputation of current BMI Background Asthma is a chronic lung disease in which recurrent asthma symptoms create a substantial burden to individuals and their families . At the same time the economic burden associated with asthma is considerable . Methods The cost-effectiveness study was part of a single centre prospect i ve r and omised controlled trial comparing a nurse-led telemonitoring programme to usual care in a population of asthmatic out patients . The study included 109 asthmatic out patients ( 56 children ; 53 adults ) . The duration of follow-up was 12 months , and measurements were performed at baseline , 4 , 8 , and 12 months . Patients were asked to transfer their monitor data at least twice daily and by judging the received data and following a stepwise intervention protocol a nurse was able to act as the main caregiver in the intervention group . In both groups the EQ-5D and the SF-6D were used to obtain estimates of health state utilities . One year health care costs , patient and family costs , and productivity losses were calculated . The mean incremental costs were weighted against the mean incremental effect in terms of QALY . Results The study population generally represented mild to moderate asthmatics . No significant differences were found between the groups with regard to the generic quality of life . Overall , the mean health care costs per patient were higher in the intervention group than in the control group . The intervention costs mainly caused the cost difference between the groups . The intervention costs the society € 31,035/QALY gained with regard to adults and with regard to children € 59,071/QALY gained . Conclusion If the outcome is measured by generic quality of life the nurse-led telemonitoring programme is of limited cost-effectiveness in the study population . From the societal perspective the probability of the programme being cost-effective compared to regular care was 85 % at a ceiling ratio of € 80,000/QALY gained among the adults and 68 % among the children . A decrease in the price of the asthma monitor will substantial increase the probability of the programme to be cost-effective . Trial registration Number : What to prescribe for a patient in general practice when the choice of treatments has a limited evidence base ? Tjeerd-Pieter van Staa and colleagues argue that using electronic health records to enter patients into r and omised trials of treatments in real time could provide the The aim of the present study was to quantify the healthcare utilization of a child population according to level of respiratory illness . A stratified r and om sample of 713 children was selected from respondents to a postal respiratory question naire , carried out in two general practice population s in 1993 . Children were stratified into four groups according to the number of positive responses to five key questions . These groups were used as indicators of likelihood of asthma diagnosis . A search was made of these childrens ' practice records covering a 2-yr period , to include both primary and secondary healthcare . There was a significant increase across positive response groups in the proportion of children having primary and secondary care based consultations , particularly for respiratory conditions ( p = 0.001 ) . There was also a significant increase in prescribing . Of those children considered to be " likely asthmatics " from their question naire responses , 8.1 % ( n = 31 ) did not receive any primary or secondary care for a respiratory problem over the 2-yr period . As the likelihood of respiratory illness increased in this population , more dem and was made upon re sources for the treatment of respiratory illness . Quantification of this dem and enables evidence based re source allocation decisions to be made . This method of quantification could be applied in other population Objective To determine the completeness and diagnostic validity of myocardial infa rct ion recording across four national health record sources in primary care , hospital care , a disease registry , and mortality register . Design Cohort study . Participants 21 482 patients with acute myocardial infa rct ion in Engl and between January 2003 and March 2009 , identified in four prospect ively collected , linked electronic health record sources : Clinical Practice Research Data link ( primary care data ) , Hospital Episode Statistics ( hospital admissions ) , the disease registry MINAP ( Myocardial Ischaemia National Audit Project ) , and the Office for National Statistics mortality register ( cause specific mortality data ) . Setting One country ( Engl and ) with one health system ( the National Health Service ) . Main outcome measures Recording of acute myocardial infa rct ion , incidence , all cause mortality within one year of acute myocardial infa rct ion , and diagnostic validity of acute myocardial infa rct ion compared with electrocardiographic and troponin findings in the disease registry ( gold st and ard ) . Results Risk factors and non-cardiovascular coexisting conditions were similar across patients identified in primary care , hospital admission , and registry sources . Immediate all cause mortality was highest among patients with acute myocardial infa rct ion recorded in primary care , which ( unlike hospital admission and disease registry sources ) included patients who did not reach hospital , but at one year mortality rates in cohorts from each source were similar . 5561 ( 31.0 % ) patients with non-fatal acute myocardial infa rct ion were recorded in all three sources and 11 482 ( 63.9 % ) in at least two sources . The crude incidence of acute myocardial infa rct ion was underestimated by 25 - 50 % using one source compared with using all three sources . Compared with acute myocardial infa rct ion defined in the disease registry , the positive predictive value of acute myocardial infa rct ion recorded in primary care was 92.2 % ( 95 % confidence interval 91.6 % to 92.8 % ) and in hospital admissions was 91.5 % ( 90.8 % to 92.1 % ) . Conclusion Each data source missed a substantial proportion ( 25 - 50 % ) of myocardial infa rct ion events . Failure to use linked electronic health records from primary care , hospital care , disease registry , and death certificates may lead to biased estimates of the incidence and outcome of myocardial infa rct ion . Trial registration NCT01569139 clinical trials.gov BACKGROUND acute medical units allow for those who need admission to be correctly identified , and for those who could be managed in ambulatory setting s to be discharged . However , re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs . OBJECTIVE identifying patient-level health and social care costs for older people discharged from acute medical units in Engl and . DESIGN a prospect i ve cohort study of health and social care re source use . SETTING an acute medical unit in Nottingham , Engl and . PARTICIPANTS four hundred and fifty-six people aged over 70 who were discharged from an acute medical unit within 72 h of admission . METHODS hospitalisation and social care data were collected for 3 months post-recruitment . In Nottingham , further approvals were gained to obtain data from general practice s , ambulance services , intermediate care and mental healthcare . Re source use was combined with national unit costs . RESULTS costs from all sectors were available for 250 participants . The mean ( 95 % CI , median , range ) total cost was £ 1926 ( 1579 - 2383 , 659 , 0 - 23,612 ) . Contribution was : secondary care ( 76.1 % ) , primary care ( 10.9 % ) , ambulance service ( 0.7 % ) , intermediate care ( 0.2 % ) , mental healthcare ( 2.1 % ) and social care ( 10.0 % ) . The costliest 10 % of participants accounted for 50 % of the cost . CONCLUSIONS this study highlights the costs accrued by older people discharged from acute medical units ( AMUs ) : they are mainly ( 76 % ) in secondary care and half of all costs were incurred by a minority of participants ( 10 % ) Objectives The Hospital Episode Statistics ( HES ) data set is a source of administrative ‘ big data ’ with potential for costing purpose s in economic evaluations alongside clinical trials . This study assesses the validity of coverage in the HES outpatient data set . Methods Men who died of , or with , prostate cancer were selected from a prostate-cancer screening trial ( CAP , Cluster r and omised triAl of PSA testing for Prostate cancer ) . Details of visits that took place after 1/4/2003 to hospital outpatient departments for conditions related to prostate cancer were extracted from medical records ( MR ) ; these appointments were sought in the HES outpatient data set based on date . The matching procedure was repeated for periods before and after 1/4/2008 , when the HES outpatient data set was accredited as a national statistic . Results 4922 outpatient appointments were extracted from MR for 370 men . 4088 appointments recorded in MR were identified in the HES outpatient data set ( 83.1 % ; 95 % confidence interval [ CI ] 82.0–84.1 ) . For appointments occurring prior to 1/4/2008 , 2195/2755 ( 79.7 % ; 95 % CI 78.2–81.2 ) matches were observed , while 1893/2167 ( 87.4 % ; 95 % CI 86.0–88.9 ) appointments occurring after 1/4/2008 were identified ( p for difference < 0.001 ) . 215/370 men ( 58.1 % ) had at least one appointment in the MR review that was unmatched in HES , 155 men ( 41.9 % ) had all their appointments identified , and 20 men ( 5.4 % ) had no appointments identified in HES . Conclusions The HES outpatient data set appears reasonably valid for research , particularly following accreditation . The data set may be a suitable alternative to collecting MR data from hospital notes within a trial , although caution should be exercised with data collected prior to accreditation Background Poor outcomes and high re source -use are observed for frail older people discharged from acute medical units . A specialist geriatric medical intervention , to facilitate Comprehensive Geriatric Assessment , was developed to reduce the incidence of adverse outcomes and associated high re source -use in this group in the post-discharge period . Objective To examine the costs and cost-effectiveness of a specialist geriatric medical intervention for frail older people in the 90 days following discharge from an acute medical unit , compared with st and ard care . Methods Economic evaluation was conducted alongside a two-centre r and omised controlled trial ( AMIGOS ) . 433 patients ( aged 70 or over ) at risk of future health problems , discharged from acute medical units within 72 hours of attending hospital , were recruited in two general hospitals in Nottingham and Leicester , UK . Participants were r and omised to the intervention , comprising geriatrician assessment in acute units and further specialist management , or to control where patients received no additional intervention over and above st and ard care . Primary outcome was incremental cost per quality adjusted life year ( QALY ) gained . Results We undertook cost-effectiveness analysis for 417 patients ( intervention : 205 ) . The difference in mean adjusted QALYs gained between groups at 3 months was -0.001 ( 95 % confidence interval [ CI ] : -0.009 , 0.007 ) . Total adjusted secondary and social care costs , including direct costs of the intervention , at 3 months were £ 4412 ( € 5624 , $ 6878 ) and £ 4110 ( € 5239 , $ 6408 ) for the intervention and st and ard care groups , the incremental cost was £ 302 ( 95 % CI : 193 , 410 ) [ € 385 , $ 471 ] . The intervention was dominated by st and ard care with probability of 62 % , and with 0 % probability of cost-effectiveness ( at £ 20,000/QALY threshold ) . Conclusions The specialist ger Output:

Conclusion Economic evaluations using data from a large observational data base without any primary data collection is feasible , informative and potentially efficient .

MS2_1shot196

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Sixty-nine women with a convincing complaint of menorrhagia took part in a double-blind treatment trial . Menstrual blood loss was measured and the subject 's own perception was carefully recorded . Only 38 % had objective menorrhagia with a measured loss greater than 80 ml although 59 % would qualify with an upper limit of normal of 60 ml . Overall the measured loss in the " heaviest " periods ( 69.6 + /- 7.3 ml ; mean + /- SEM ) were significantly greater than that of the " lightest " periods ( 42.7 + /- 4.7 ml ; p less than 0.001 ) , but there were many major errors in perception by individuals . Perceived daily blood loss volume on a 4-point rating scale gave the following group means and ranges : spotting , 2.5 ml ( 0.1 to 15.5 ) ; light , 5.7 ml ( 0.1 to 63.1 ) ; moderate , 16.1 ml ( 0.5 to 108.6 ) ; very heavy , 22.0 ml ( 1.4 to 215.8 ) ; very wide individual ranges of assessment are illustrated . As a whole the group was also able to distinguish between a day-to-day volume increase or decrease , but again there were many major errors . Some subjects who experienced a reduction in measured blood loss from one day to the next actually perceived this as a large increase . Menstrual pain and duration of bleeding were not found to influence perception of blood loss volume , whereas younger subjects ( 26 and under ) were significantly more likely than older women ( 37 and over ) to regard a moderate loss as very heavy . There was no significant correlation between the number of pads/tampons used and the measured menstrual loss , and some individuals showed extreme variations between blood loss and pad usage . This study suggests that the only reliable assessment of menstrual blood loss volume and changes in volume in women complaining of menorrhagia is obtained by objective measurement of blood loss by a technique such as alkaline hematin extraction OBJECTIVE To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates . DESIGN Prospect i ve observational study . SETTING 11 general practice s from the Somerset Morbidity Project . SUBJECTS 885 women consulting their general practitioner with menorrhagia over four years . MAIN OUTCOME MEASURES Proportions of these women investigated and treated with drugs in primary care , referred to a gynaecologist and undergoing operative procedures . The relation between investigation and prescribing in primary care and referral to and surgery in secondary care . RESULTS Less than half of women had a vaginal examination ( 42 % , 95 % CI 39 % to 45 % ) , or a full blood count ( 39 % , 95 % CI 36 % to 43 % ) . Almost a quarter of women , 23 % ( 95 % CI 20 % to 26 % ) , received no drugs and 37 % ( 95 % CI 34 % to 40 % ) received norethisterone . Over a third , 38 % ( 95 % CI 34 % to 40 % ) , of women were referred , and once referred 43 % ( 95 % CI 38 % to 48 % ) of women were operated on . Women referred to a gynaecologist were significantly more likely to have received tranexamic acid and /or mefenamic acid in primary care ( chi(2)=16.4 , df=1 , p<0.001 ) . There were substantial between practice variations in management , for example in prescribing of tranexamic acid and /or mefenamic acid ( range 16 % to 72 % ) and referral to gynaecology ( range 24 % to 52 % ) . There was a significant association between high referral and high operative rates ( Spearman 's correlation coefficient=0.86 , p=0.001 ) . CONCLUSIONS Substantial differences in management exist between practice s when investigating and prescribing for menorrhagia in primary care . Rates of prescribing of effective medical treatment remain low . The decision to refer a woman impacts markedly on her chances of subsequently being operated on . Effective management in primary care may not reduce referral or hysterectomy rates 44 women with heavy menstrual bleeding participated in a six months r and omised , double blind , cross over clinical trial . The objective was to use simple methods to study whether treatment of menorrhagia with tranexamic acid has an effect that can be detected by the women themselves . The effect was evaluated by means of diaries and a visual analog scale . The bleeding during each period of treatment was compared with the bleeding during untreated periods . Bleeding during the different periods of treatment was also compared directly . The results indicate that tranexamic acid was more effective than placebo . This difference was not disclosed , however , in the laboratory data . After the study , 75 % of the women wished to continue treatment with tranexamic acid 22 patients complaining of primary menorrhagia or menorrhagia associated with an intrauterine device ( I.U.C.D. ) were studied in a double blind trial with crossover of ethamsylate and placebo . Acutal menstrual blood-losses were calculated from the iron content of used sanitary material during one pre-trail menstrual period and four trial menstrual periods , during which patients received ethamsylate ( " Dicynene " ) treatment during two menstrual cycles and placebo during two cycles . During ethamsylate treatment the mean menstrual blood-loss was reduced by 50 % in patients with primary menorrhagia and by 19 % in patients with an I.U.C.D. This difference between the two groups is probably accounted for by the differing values of initial blood-loss which was significantly higher in the group with primary menorrhagia . Tampon usage and the duration of bleeding were not significantly altered by ethamsylate treatment . Reported side-effects , which were not serious , were equally common during ethamsylate and placebo treatment Abstract Objective : To determine whether an educational package could influence the management of menorrhagia , increase the appropriateness of choice of non-hormonal treatment , and reduce referral rates from primary to secondary care . Design : R and omised controlled trial . Setting : General practice s in East Anglia . Subjects : 100 practice s ( 348 doctors ) in primary care were recruited and r and omised to intervention ( 54 ) and control ( 46 ) . Interventions : An educational package based on principles of “ academic detailing ” with independent academics was given in small practice based interactive groups with a visual presentation , a printed evidence based summary , a graphic management flow chart , and a follow up meeting at 6 months . Outcome measures : All practice s recorded consultation details , treatments offered , and outcomes for women with regular heavy menstrual loss ( menorrhagia ) over 1 year . Results : 1001 consultation data sheets for menorrhagia were returned . There were significantly fewer referrals ( 20 % v 29 % ; odds ratio 0.64 ; 95 % confidence interval 0.41 to 0.99 ) and a significantly higher use of tranexamic acid ( odds ratio 2.38 ; 1.61 to 3.49 ) in the intervention group but no overall difference in norethisterone treatment compared with controls . There were more referrals when tranexamic acid was given with norethisterone than when it was given alone . Those practice s reporting fewer than 10 cases showed the highest increase in prescribing of tranexamic acid . Conclusions : The educational package positively influenced referral for menorrhagia and treatment with appropriate non-hormonal drugs Abstract Objective : To compare the efficacy and acceptability of ethamsylate , mefenamic acid , and tranexamic acid for treating menorrhagia . Design : R and omised controlled trial . Setting : A university department of obstetrics and gynaecology . Subjects : 76 women with dysfunctional uterine bleeding . Interventions : Treatment for five days from day 1 of menses during three consecutive menstrual periods . 27 patients were r and omised to take ethamsylate 500 mg six hourly , 23 patients to take mefenamic acid 500 mg eight hourly , and 26 patients to take tranexamic acid 1 g six hourly . Main outcome measures : Menstrual loss measured by the alkaline haematin method in three control menstrual periods and three menstrual periods during treatment ; duration of bleeding ; patient 's estimation of blood loss ; sanitary towel usage ; the occurrence of dysmenorrhoea ; and unwanted events . Results : Ethamsylate did not reduce mean menstrual blood loss whereas mefenamic acid reduced blood loss by 20 % ( mean blood loss 186 ml before treatment , 148 ml during treatment ) and tranexamic acid reduced blood loss by 54 % ( mean blood loss 164 ml before treatment , 75 ml during treatment ) . Sanitary towel usage was significantly reduced in patients treated with mefenamic acid and tranexamic acid . Conclusions : Tranexamic acid given during menstruation is a safe and highly effective treatment for excessive bleeding . Patients with dysfunctional uterine bleeding should be offered medical treatment with tranexamic acid before a decision is made about surgery . Key messages In any year around 5 % of women aged 30 - 49 years visit their general practitioners with menor-rhagia Every year in the United Kingdom around 45 000 hysterectomies and a further 10 000 endometrial ablations are performed for menorrhagia The commonest drug prescribed in the British Isles for menorrhagia ( norethisterone ) has little or no effect in reducing menstrual bleeding Tranexamic acid ( an antifibrinolytic ) 1 g six to eight hourly reduces menstrual blood loss by over half and should be offered to women with dysfunctional bleeding before a decision is made about Objective To compare the effect of Kabi 2161 ( a prodrug of tranexamic acid ) and placebo on the reduction of menstrual blood loss in women suffering from idiopathic menorrhagia and to evaluate tolerance and effectiveness in a two‐dose regimen In a double-blind trial tranexamic acid ( Cyclokapron ) 1 g. four times a day for the first four days of menstruation , significantly decreased menstrual blood loss in women with menorrhagia for which no organic cause had been found . No difference in side-effects was noted between the active and placebo treatment Objective To compare the efficacy and safety of tranexamic acid and norethisterone in the treatment of ovulatory menorrhagia A double-blind study of 65 women , aged 15 - 44 , was performed to determine if IUD use caused menorrhagia , and if so , if the menorrhagia could be prevented with Cyclocaprone . IUDs were inserted and the women were given pills to take during their menstrual periods . The pills were given at r and om ; 34 received Cyclocaprone and 31 received placebos . The volume of menstrual bleeding was measured during 1 menstrual period before the experiment , which served as a control , and for up to 4 menstrual periods after the insertion of the IUD and administration of the pills . The average volume of blood loss during the control period was about 35.75 ml ; during the following menstrual periods this increased 11.5 % among the women who had received Cyclocaprone and 82.7 % among those who had received placebos . The difference between the 2 groups was statistically significant ( p less than .001 ) . The majority of the women subjectively reported an increase in menstrual bleeding . The cyclocaprone users may have experienced an abnormally heavy bleeding during the menstrual period which caused them to report an increase in menstrual bleeding . In 13 of the menstrual cycles , blood loss exceeded 100 ml ; all of these cases were among women who had received placebos . The greatest increase in blood loss occurred in the menstrual cycle after the insertion of the IUD ; blood loss decreased in each subsequent menstrual period . 3 women who had received placebos had a hemoglobin concentration of less than 10.5 gm% . There were 5 cases of side effects among the women using Cyclocaprone and 2 among the women taking placebos . The results suggest that the IUD causes an activation of plasminogen in the endometrium early in the menstrual cycle ; cyclocaprone prevents this activation and the result ing menorrhagia abnormality in the giant platelet syndrome of Bernard-Soulierl 8 and also in von Willebr and 's disease , in which the abnormality is probably secondary to a deficiency or defect of a plasma protein related to factor VIIII-the factor VII I-related protein . ' 9 In our patient the defective ristocetin platelet aggregation seemed to be due to a plasma defect rather than to a primary platelet abnormality because aggregation was corrected partially or completely by the addition of normal plasma , cryoprecipitate , or a plasma fraction rich in factor VIII-related in protein . On the other h and the level of factor VIII-related protein in the infant 's plasma was normal , which suggested that either there was a functional abnormality of this protein or the patient lacked another substance necessary for ristocetin platelet aggregation . This did not seem to be fibrinogen , which , it has been suggested , is a co-factor for ristocetin aggregation,20 because the thrombin clotting times and fibrinogen levels were normal . The small volumes of blood obtainable from the infant precluded more detailed in-vitro studies , and it is possible that the vitamin E deficiency was directly responsible for the defective platelet ristocetin aggregation or that the deficiency result ed in the synthesis of an abnormal factor VIII-related protein . The normal bleeding time , the lack of family history , and the results of treatment , however , did not suggest that the infant was suffering from von Willebr and 's disease . The role of iron or folate deficiency in the pathogenesis of the patient 's haematological status is difficult to assess . It has been suggested that folate deficiency Output:

AUTHORS ' CONCLUSIONS Antifibrinolytic treatment ( such as TXA ) appears effective for treating HMB compared to placebo , NSAIDs , oral luteal progestogens , ethamsylate , or herbal remedies , but may be less effective than LIUS . There were too few data for most comparisons to determine whether antifibrinolytics were associated with increased risk of adverse events , and most studies did not specifically include thromboembolism as an outcome

MS2_1shot197

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction . Patients either had a recent myocardial infa rct ion ( with or without clinical heart failure ) or symptomatic heart failure ( without a recent MI ) . Patients were with and without treatment with the class III antiarrhythmic drug dofetilide over 36 months . Methods The Danish Investigations of Arrhythmia and Mortality ON Dofetilide ( DIAMOND ) studies included 2627 patients without atrial fibrillation at baseline , who were r and omised to treatment with either dofetilide or placebo . Results The competing risk analyses estimated the cumulative incidences of atrial fibrillation during the 42 months of follow-up to be 9.6 % in the placebo-treated heart failure-group , and 2.9 % in the placebo-treated myocardial infa rct ion-group . Cox proportional hazard regression found a 42 % significant reduction in the incidence of new-onset AF when assigned to dofetilide compared to placebo ( hazard ratio 0.58 , 95 % confidence interval 0.40 - 0.82 ) and there was no interaction with study ( p = 0.89).In the heart failure-group , the incidence of atrial fibrillation was significantly reduced to 5.6 % in the dofetilide-treated patients ( hazard ratio 0.57 , 95 % confidence interval 0.38 - 0.86).In the myocardial infa rct ion-group the incidence of atrial fibrillation was reduced to 1.7 % with the administration of dofetilide . This reduction was however not significant ( hazard ratio 0.61 , 95 % confidence interval 0.30 - 1.24 ) . Conclusion In patients with left ventricular dysfunction the incidence of AF in 42 months was 9.6 % in patients with heart failure and 2.9 % in patients with a recent MI . Dofetilide significantly reduced the risk of developing atrial fibrillation compared to placebo in the entire study group and in the subgroup of patients with heart failure . The reduction in the subgroup with recent MI was not statistically significant , but the hazard ratio was similar to the hazard ratio for the heart failure patients , and there was no difference between the effect in the two studies ( p = 0.89 for interaction ) BACKGROUND Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infa rct ion . Recent advances in pharmacological treatment of myocardial infa rct ion may have changed the impact of this arrhythmia . OBJECTIVE To assess the incidence and prognosis of atrial fibrillation complicating myocardial infa rct ion in a large population of patients receiving optimal treatment , including angiotensin converting enzyme ( ACE ) inhibitors . METHODS Data were derived from the GISSI-3 trial , which included 17 944 patients within the first 24 hours after acute myocardial infa rct ion . Atrial fibrillation was recorded during the hospital stay , and follow up visits were planned at six weeks and six months . Survival of the patients at four years was assessed through census offices . RESULTS The incidence of in-hospital atrial fibrillation or flutter was 7.8 % . Atrial fibrillation was associated with indicators of a worse prognosis ( age > 70 years , female sex , higher Killip class , previous myocardial infa rct ion , treated hypertension , high systolic blood pressure at entry , insulin dependent diabetes , signs or symptoms of heart failure ) and with some adverse clinical events ( reinfa rct ion , sustained ventricular tachycardia , ventricular fibrillation ) . After adjustment for other prognostic factors , atrial fibrillation remained an independent predictor of increased in-hospital mortality : 12.6%v 5 % , adjusted relative risk ( RR ) 1.98 , 95 % confidence interval ( CI ) 1.67 to 2.34 . Data on long term mortality ( four years after acute myocardial infa rct ion ) confirmed the persistent negative influence of atrial fibrillation ( RR 1.78 , 95 % CI 1.60 to 1.99 ) . CONCLUSIONS Atrial fibrillation is an indicator of worse prognosis after acute myocardial infa rct ion , both in the short term and in the long term , even in an unselected population BACKGROUND Paroxysmal atrial fibrillation ( PAF ) is considered a frequent complication of acute myocardial infa rct ion ( AMI ) , associated with increased in-hospital and long-term mortality rates . This notion is based on data collected before thrombolysis and additional modern methods of treatment became widely available , and no information is available on the significance of PAF in the general population with AMI in the thrombolytic era . The aim of the present study was to define the incidence , associated clinical parameters , and short- and long-term prognostic significance of PAF in patients with AMI in the thrombolytic era . METHODS AND RESULTS A prospect i ve , nationwide survey was conducted of 2866 consecutive patients admitted with AMI in all 25 coronary care units in Israel during January/February 1992 , 1994 , and 1996 ( thrombolytic era [ TE ] ) . The data were compared with a previous Israeli study of 5803 patients with AMI hospitalized in 1981 through 1983 ( prethrombolytic era [ PTE ] ) . Patients in the TE with PAF were older and had a worse risk profile than those without PAF . PAF in the TE was independently associated with increased 30-day ( odds ratio , 1.32 ; 95 % confidence interval , 0.92 to 1.87 ) and 1-year ( relative risk , 1.33 ; 95 % confidence interval , 1.05 to 1.68 ) mortality rates . The incidence of PAF ( 8.9 % and 9.9 % ) and the 30-day ( 25.1 % and 27.6 % ) and 1-year ( 38.4 % and 42.5 % ) mortality rates of patients with PAF were similar in the TE and PTE , although PAF in the TE occurred in older and sicker patients than those in the PTE . After adjustment for conventional risk factors , PAF was associated with significantly lower 30-day ( odds ratio , 0.64 ; 95 % confidence interval , 0.44 to 0.94 ) and 1-year ( relative risk , 0.69 ; 95 % confidence interval , 0.54 to 0.88 ) mortality rates compared with the PTE . CONCLUSIONS Patients with AMI who develop PAF in the TE have significantly worse short- and long-term prognoses than patients without PAF , mostly due to their worse risk profile . After adjustment for confounding factors , patients with PAF in the TE have a better overall outcome than counterparts in the PTE , probably reflecting the better management of patients with AMI in the TE OBJECTIVES We examined the clinical predictors and angiographic and clinical outcomes associated with atrial fibrillation in the setting of acute myocardial infa rct ion ( MI ) . BACKGROUND This condition has been studied primarily in prethrombolytic era small trials . METHODS We compared baseline clinical characteristics , short-term clinical and angiographic outcomes and 1-year mortality of patients enrolled in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries ( GUSTO-I ) trial with atrial fibrillation on admission electrocardiography ( n = 1,026 [ 2.5 % ] ) or after enrollment ( n = 3,254 [ 7.9 % ] ) and those without atrial fibrillation ( n = 36,611 [ 89.6 % ] ) . Univariable and multivariable analyses were used to assess relations between baseline factors and the development of atrial fibrillation . RESULTS Patients with any atrial fibrillation more often had three-vessel coronary artery disease and initial Thrombolysis in Myocardial Infa rct ion ( TIMI ) grade < 3 flow than those without the arrhythmia . In-hospital stroke was increased in patients with atrial fibrillation ( 3.1 % vs. 1.3 % , p = 0.0001 ) , mainly ischemic stroke ( 1.8 % vs. 0.5 % , p = 0.0001 ) . Significant multivariable predictors of later atrial fibrillation included advanced age , higher peak creatine kinase levels , worse Killip class and increased heart rate . The unadjusted mortality rate was significantly higher at 30 days ( 14.3 % vs. 6.2 % , p = 0.0001 ) and at 1 year ( 21.5 % vs. 8.6 % , p < 0.0001 ) in patients with atrial fibrillation . The adjusted 30-day mortality rate remained significantly higher with any ( odds ratio [ OR ] 1.3 , 95 % confidence interval [ CI ] 1.2 to 1.4 ) or later ( OR 1.4 , 95 % CI 1.3 to 1.5 ) atrial fibrillation but not with baseline atrial fibrillation ( OR 1.1 , 95 % CI 0.88 to 1.3 ) . CONCLUSIONS Atrial fibrillation in the setting of acute MI independently predicts stroke and 30-day mortality . More aggressive treatment strategies in this subgroup may be warranted and deserve further study AIMS Atrial fibrillation ( AF ) is a common complication in patients with acute myocardial infa rct ion and is associated with an increase in the risk of death . The excess mortality associated with AF complicating acute myocardial infa rct ion has not been studied in detail . Observations indicate that AF facilitates induction of ventricular arrhythmias , which may increase the risk of sudden cardiovascular death ( SCD ) . A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments . METHODS AND RESULTS We analysed the relation between AF/atrial flutter ( AFL ) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infa rct ion screened in the TR And olapril Cardiac Evaluation registry . This cohort of patients with an enzyme-verified acute myocardial infa rct ion was admitted to 27 centres in 1990 - 92 . Survival status was obtained 2 years after screening of the last patient . An independent endpoint committee assessed the modes of death . Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospect ively collected . Sustained or paroxysmal AF/AFL was observed in 1149 patients ( 19 % ) during hospitalization . During follow-up , 1659 patients ( 34 % ) died : 482 ( 50 % ) patients with AF/AFL and 1177 ( 30 % ) patients without AF/AFL , P<0.001 . SCD occurred in 536 , non-SCD occurred in 725 , and 398 died of non-cardiovascular causes ( includes 142 unclassifiable cases ) . The adjusted risk ratio of AF/AFL for total mortality was 1.33 ( 95 % CI : 1.19 - 1.49 ; P<0.0001 ) and the risk ratio for SCD was 1.31 ( 95 % CI : 1.07 - 1.60 ; P<0.009 ) . The adjusted risk ratio of AF/AFL for non-SCD was 1.43 ( 95 % CI : 1.21 - 1.70 ; P<0.0001 ) . CONCLUSION The excess mortality observed in patients with AF/AFL following acute myocardial infa rct ion is due to a significant increase in both SCD and non-SCD Background : Atrial fibrillation ( AF ) is a common complication of acute myocardial infa rct ion ( AMI ) with a reported incidence of 7–18 % . Recently , P‐wave signal‐averaged electrocardiogram ( P‐SAECG ) has been used to assess the risk of paroxysmal AF attacks in some diseases . The aim of this study was to determine prospect ively whether patients with AMI at risk for paroxysmal AF would be identified by P‐SAECG and other clinical variables Atrial fibrillation ( AF ) is common during the course of acute myocardial infa rct ion and is associated with left atrial ( LA ) dilatation . However , the role of LA depolarization abnormality on the electrocardiogram ( ECG ) in the setting of LA dilatation was not studied in this context . Patients admitted with non-ST-segment elevation myocardial infa rct ion ( NSTEMI ) who developed new-onset AF ( International Classification of Diseases , Ninth Revision code 427.31 ) were prospect ively identified . Baseline ECGs and echocardiograms before the admission event were review ed . Follow-up was directed toward pertinent cardiovascular events , atrial tachyarrhythmias , and death as end points . Of 101 patients with NSTEMI who had new-onset AF , 88 had current echocardiograms and 69 had LA dilatation ( 78 % ) . Total follow-up was 24 months ( mean 21.4 ) . Prolonged P-wave duration ( > or = 110 ms ) and decre Output:

Conclusions Our meta- analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI

MS2_1shot198

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract . Rationale : A large proportion of patients with major depression do not respond sufficiently to any first-line treatment . Objectives : The aim of this study was to compare a strategy of sertraline dose increase with a strategy of adding mianserin in patients with major depression insufficiently responding to 6 weeks of open treatment with sertraline , controlling for the effect of an extended duration of treatment . Methods : One thous and six hundred and twenty-nine patients , 18–65 years of age , with major depression scoring at least 18 on the 17-item Hamilton depression scale ( HDS ) were treated openly with 50 mg/day sertraline , and patients who after 4 weeks had not responded ( achieving at least a 50 % reduction in score on the HDS ) were treated with 100 mg/day sertraline for an additional 2-week period . The patients who had still not responded were then r and omised to double-blind treatment for an additional 5 weeks with either 100 mg/day sertraline plus placebo , 200 mg/day sertraline plus placebo or 100 mg/day sertraline plus 30 mg/day mianserin . Results : After 6 weeks of open treatment , 60 % had responded and 22 % had dropped out , leaving 295 non-responding patients ( 18 % ) for r and omisation . In the intention-to-treat- analysis , continuing the treatment with 100 mg/day sertraline result ed in response in 70 % of the non-responders , similar to the response rate ( 67 % ) obtained in the patients who had mianserin added . However , increasing the sertraline dose to 200 mg/day result ed in a lower response rate at 56 % ( P<0.05 ) . Similar results were seen in the completers . A substantial increase in the accumulated response rate from week 6 to week 8 was seen . There was no influence of baseline variables , including the presence of melancholic features on the overall post-r and omisation response rate . Conclusion : After 6 weeks of insufficient antidepressant treatment with 50–100 mg/day sertraline , a continued treatment with 100 mg/day sertraline can be considered until at least week 8 before considering changing strategy , unless the condition deteriorates Treatment effects are often evaluated by comparing change over time in outcome measures . However , valid analyses of longitudinal data can be problematic , particularly when some data are missing for reasons related to the outcome . In choosing the primary analysis for confirmatory clinical trials , regulatory agencies have for decades favored the last observation carried forward ( LOCF ) approach for imputing missing values . Many advances in statistical methodology , and also in our ability to implement those methods , have been made in recent years . The characteristics of data from acute phase clinical trials can be exploited to develop an appropriate analysis for assessing response profiles in a regulatory setting . These data characteristics and regulatory considerations will be review ed . Approaches for h and ling missing data are compared along with options for modeling time effects and correlations between repeated measurements . Theory and empirical evidence are utilized to support the proposal that likelihood-based mixed-effects model repeated measures ( MMRM ) approaches , based on the missing at r and om assumption , provide superior control of Type I and Type II errors when compared with the traditional LOCF approach , which is based on the more restrictive missing completely at r and om assumption . It is further reasoned that in acute phase clinical trials , unstructured modeling of time trends and within-subject error correlations may be preferred BACKGROUND There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor . AIMS To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response . METHOD A partially r and omised preference trial , with patients r and omised to either antidepressants or counselling or given their choice of either treatment . The treatment and follow-up were identical in the r and omised and patient preference arms . RESULTS There were 103 r and omised and 220 preference patients in the trial . We found : no differences in the baseline characteristics of the r and omised and preference groups ; that the two treatments were equally effective at 8 weeks , both for the r and omised group and when the r and omised and patient preference groups for a particular treatment were combined ; and that expressing a preference for either treatment conferred no additional benefit on outcome . CONCLUSIONS These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting CONTEXT Extracts of St John 's wort are widely used to treat depression . Although more than 2 dozen clinical trials have been conducted with St John 's wort , most have significant flaws in design and do not enable meaningful interpretation . OBJECTIVE To compare the efficacy and safety of a st and ardized extract of St John 's wort with placebo in out patients with major depression . DESIGN AND SETTING R and omized , double-blind , placebo-controlled clinical trial conducted between November 1998 and January 2000 in 11 academic medical centers in the United States . PARTICIPANTS Two hundred adult out patients ( mean age , 42.4 years ; 67.0 % female ; 85.9 % white ) diagnosed as having major depression and having a baseline Hamilton Rating Scale for Depression ( HAM-D ) score of at least 20 . INTERVENTION Participants completed a 1-week , single-blind run-in of placebo , then were r and omly assigned to receive either St John 's wort extract ( n = 98 ; 900 mg/d for 4 weeks , increased to 1200 mg/d in the absence of an adequate response thereafter ) or placebo ( n = 102 ) for 8 weeks . MAIN OUTCOME MEASURES The primary outcome measure was rate of change on the HAM-D over the treatment period . Secondary measures included the Beck Depression Inventory ( BDI ) , Hamilton Rating Scale for Anxiety ( HAM-A ) , the Global Assessment of Function ( GAF ) scale , and the Clinical Global Impression-Severity and -Improvement scales ( CGI-S and CGI-I ) . RESULTS The r and om coefficient analyses for the HAM-D , HAM-A , CGI-S , and CGI-I all showed significant effects for time but not for treatment or time-by-treatment interaction ( for HAM-D scores , P<.001 , P = .16 , and P = .58 , respectively ) . Analysis of covariance showed nonsignificant effects for BDI and GAF scores . The proportion of participants achieving an a priori definition of response did not differ between groups . The number reaching remission of illness was significantly higher with St John 's wort than with placebo ( P = .02 ) , but the rates were very low in the full intention-to-treat analysis ( 14/98 [ 14.3 % ] vs 5/102 [ 4.9 % ] , respectively ) . St John 's wort was safe and well tolerated . Headache was the only adverse event that occurred with greater frequency with St John 's wort than placebo ( 39/95 [ 41 % ] vs 25/100 [ 25 % ] , respectively ) . CONCLUSION In this study , St John 's wort was not effective for treatment of major depression This study examined cross-sectional and prospect i ve associations of exercise with depressed mood in a community-based sample of older men and women ( aged 50 - -89 years in 1984 - -1987 ) in southern California . Regular strenuous exercise and exercise > or =3 times per week were reported ; depressed mood was assessed by using the Beck Depression Inventory ( BDI ) . After exclusion of persons with categorical depression and those rating themselves largely or extremely physically limited during the previous month , data on 932 men and 1,097 women were available for cross-sectional analysis . Exercise and depressed mood were reassessed for 404 men and 540 women in 1992 - -1995 ; these data were the focus of prospect i ve analyses . In 1984 - -1987 , exercise rates were high ( > 80 % ) , and average BDI scores were low . Cross-sectional analyses indicated that before and after adjustment for covariates , exercise was significantly associated with less depressed mood . However , prospect i ve analyses of the 944 persons who attended both clinic visits indicated no association between baseline exercise and either follow-up BDI score ( p > 0.10 ) or change in BDI score between baseline and follow-up ( p > 0.10 ) . Results confirm that exercisers have less depressed mood . However , exercise does not protect against future depressed mood for those not clinical ly depressed at baseline CONTEXT Extracts of Hypericum perforatum ( St John 's wort ) are widely used for the treatment of depression of varying severity . Their efficacy in major depressive disorder , however , has not been conclusively demonstrated . OBJECTIVE To test the efficacy and safety of a well-characterized H perforatum extract ( LI-160 ) in major depressive disorder . DESIGN AND SETTING Double-blind , r and omized , placebo-controlled trial conducted in 12 academic and community psychiatric research clinics in the United States . PARTICIPANTS Adult out patients ( n = 340 ) recruited between December 1998 and June 2000 with major depression and a baseline total score on the Hamilton Depression Scale ( HAM-D ) of at least 20 . INTERVENTIONS Patients were r and omly assigned to receive H perforatum , placebo , or sertraline ( as an active comparator ) for 8 weeks . Based on clinical response , the daily dose of H perforatum could range from 900 to 1500 mg and that of sertraline from 50 to 100 mg . Responders at week 8 could continue blinded treatment for another 18 weeks . MAIN OUTCOME MEASURES Change in the HAM-D total score from baseline to 8 weeks ; rates of full response , determined by the HAM-D and Clinical Global Impressions ( CGI ) scores . RESULTS On the 2 primary outcome measures , neither sertraline nor H perforatum was significantly different from placebo . The r and om regression parameter estimate for mean ( SE ) change in HAM-D total score from baseline to week 8 ( with a greater decline indicating more improvement ) was -9.20 ( 0.67 ) ( 95 % confidence interval [ CI ] , -10.51 to -7.89 ) for placebo vs -8.68 ( 0.68 ) ( 95 % CI , -10.01 to -7.35 ) for H perforatum ( P = .59 ) and -10.53 ( 0.72 ) ( 95 % CI , -11.94 to -9.12 ) for sertraline ( P = .18 ) . Full response occurred in 31.9 % of the placebo-treated patients vs 23.9 % of the H perforatum-treated patients ( P = .21 ) and 24.8 % of sertraline-treated patients ( P = .26 ) . Sertraline was better than placebo on the CGI improvement scale ( P = .02 ) , which was a secondary measure in this study . Adverse-effect profiles for H perforatum and sertraline differed relative to placebo . CONCLUSION This study fails to support the efficacy of H perforatum in moderately severe major depression . The result may be due to low assay sensitivity of the trial , but the complete absence of trends suggestive of efficacy for H perforatum is noteworthy BACKGROUND The necessity of antidepressant continuation-phase therapy following acute-phase response has result ed in the need to characterize the longer-term efficacy and safety of all new medications . Previous studies using " extension " protocol s suggest that mirtazapine has sustained antidepressant effects . The current study was performed to evaluate the efficacy and safety of up to 1 year of mirtazapine therapy , using a more rigorous , r and omized , placebo-controlled discontinuation design . METHOD An intent-to-treat sample of 410 patients meeting DSM-IV criteria for moderate-to-severe recurrent or chronic major depressive episodes began 8 to 12 weeks of open-label therapy with mirtazapine ( flexibly titrated , 15 - 45 mg/day ) . Thereafter , 156 fully remitted patients ( according to Hamilton Rating Scale for Depression and Clinical Global Impressions-Improvement scores ) were r and omly assigned to receive 40 weeks of double-blind continuation-phase therapy with either mirtazapine or placebo . RESULTS Mirtazapine therapy reduced the rate of depressive relapse by more than half , with 43.8 % of patients relapsing on treatment with placebo as compared with 19.7 % of the mirtazapine-treated patients . The discontinuation rate due to adverse events was 11.8 % for active mirtazapine therapy versus 2.5 % for placebo . Although weight gain was significantly greater in the group receiving active medication during the double-blind phase ( p = .001 ) , patients taking mirtazapine gained only 1.4 kg ( 3.1 lb ) across the 40 weeks of continuation therapy , and there was no difference in the rates of weight gain as a newonset adverse event . CONCLUSION Continuation-phase therapy with mirtazapine is effective and well tolerated BACKGROUND This was the first controlled continuation phase study ( up to 1-year total treatment ) to evaluate the safety and efficacy of bupropion SR for decreasing the risk for relapse of depression in patients who responded to bupropion SR . METHODS Patients with recurrent major depression were treated with bupropion SR 300 m Output:

For patients who do not respond to initial medication treatment , treatments such as psychotherapy , exercise , light therapy , alternative medicines , and counselling have demonstrated benefits over placebo and may enhance remission rates when used in combination with antidepressants . R and omized controlled clinical trials conducted in the last 5 years provide very good evidence to show that achieving and sustaining the fully remitted state is an attainable goal in the management of patients with depression

MS2_1shot199

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The current study was design ed to investigate the changes that occur in depression , anxiety , obsessive — compulsive symptoms and health-related quality of life during methylpheni date ( MPH ) treatment in children with attention-deficit hyperactivity disorder ( ADHD ) . Forty-five treatment naive children with ADHD , aged 8—14 , were assessed based on self , parent and teacher reports at the baseline and at the end of the first and third month of MPH treatment regarding changes in inattention , hyperactivity , impulsivity , depression , anxiety and obsessive — compulsive symptoms . Changes in the quality of life were also noted . Repeated measures of analysis of variance ( ANOVA ) tests with Bonferroni corrections were conducted in order to evaluate the data . Symptoms of inattention , hyperactivity and impulsivity were significantly reduced ( p < 0.017 ) following a three-month MPH treatment . There were significant decreases in depression ( p = 0.004 ) , trait anxiety ( p = 0.000 ) and checking compulsion symptom scores ( p = 0.001 ) . Moreover , parents reported significant improvements in psychosocial ( p = 0.001 ) and total scores ( p = 0.009 ) of quality of life , despite no change in physical health scores ( p > 0.05 ) . Children ’s ratings of quality of life measures showed no significant changes in physical health and psychosocial scores ( p > 0.05 ) , while total scores significantly improved ( p = 0.001 ) after the treatment . Over a three-month MPH treatment , depression , trait anxiety and checking compulsion symptoms decreased and quality of life seemed to improve along with those of inattention , hyperactivity and impulsivity The psychiatric outcome is reported for a large sample of hyperactive children ( N = 123 ) , meeting research diagnostic criteria , and normal control children ( N = 66 ) followed prospect ively over an 8-year period into adolescence . Over 80 % of the hyperactives were attention deficit hyperactivity disorder ( ADHD ) and 60 % had either oppositional defiant disorder and /or conduct disorder at outcome . Rates of antisocial acts were considerably higher among hyperactives than normals , as were cigarette and marijuana use and negative academic outcomes . The presence of conduct disorder accounted for much though not all of these outcomes . Family status of hyperactives was much less stable over time than in the normal subjects . The use of research criteria for diagnosing children as hyperactive identifies a pattern of behavioral symptoms that is highly stable over time and associated with considerably greater risk for family disturbance and negative academic and social outcomes in adolescence than has been previously reported Measurement of health-related quality of life ( HRQOL ) in attention-deficit-hyperactivity disorder ( ADHD ) gives a more complete picture of day-to-day functioning and treatment effects than behavioural rating alone . The aim of this pilot study was to investigate the impact of the combined diagnoses of developmental coordination disorder ( DCD ) and ADHD on HRQOL , and the effectiveness of methylpheni date ( MPH ) on HRQOL . HRQOL was established using the Dutch-Child-AZL-TNO- Quality -of-Life ( DUX-25 ) and the TNO-AZL-Child- Quality -of-Life ( TACQOL ) question naires , completed by children and parents . HRQOL of these children was compared with that of 23 age- and sex-matched healthy controls . Twenty-three children ( 21 males , two females ; mean age 8 y 6 mo , [ SD 3 mo ] range 7 y-10 y 8 mo ) with ADHD/DCD entered a 4-week , open-label MPH study , after MPH-sensitivity was established , in a double-blind , placebo-controlled trial . In these children 's self- and proxy reports , impact of both DCD and ADHD was reflected in lower general well-being ( self and proxy report p=0.001 ) due to lower functioning in motor ( selfp=0.026 ; proxy 0.001 ) , autonomic ( self p<0.001 ; proxy p=0.047 ) , cognitive ( self p=0.001 ; proxy p=0.01 ) , and social ( self and proxy p<0.001 ) domains . HRQOL scores improved in 18 children receiving MPH ( p=0.001 ) versus controls . The ADHD /DCD group also demonstrated a significant improvement in ADHD symptoms ( p<0.001 ) and motor functioning ( p<0.001 ) . Additional motor therapy will still be needed in about half of the children with ADHD/DCD receiving MPH , within multimodal treatment including educational and psychosocial assistance Editor 's Note : In order to encourage dissemination of the STROBE Statement , this article is being published simultaneously in Annals of Internal Medicine , Epidemiology , and PLoS Medicine . It is freely accessible on the Annals of Internal Medicine Web site ( www.annals.org ) and will also be published on the Web sites of Epidemiology and PLoS Medicine . The authors jointly hold the copyright of this article . For details on further use , see the STROBE Web site ( www.strobe-statement.org ) . Rational health care practice s require knowledge about the etiology and pathogenesis , diagnosis , prognosis , and treatment of diseases . R and omized trials provide valuable evidence about treatments and other interventions . However , much of clinical or public health knowledge comes from observational research ( 1 ) . About 9 of 10 research papers published in clinical specialty journals describe observational research ( 2 , 3 ) . The STROBE Statement Reporting of observational research is often not detailed and clear enough to assess the strengths and weaknesses of the investigation ( 4 , 5 ) . To improve the reporting of observational research , we developed a checklist of items that should be addressed : the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) Statement ( Appendix Table ) . Items relate to the title , abstract , introduction , methods , results , and discussion sections of articles . The STROBE Statement has recently been published in several journals ( 6 ) . Our aim is to ensure clear presentation of what was planned , done , and found in an observational study . We stress that the recommendations are not prescriptions for setting up or conducting studies , nor do they dictate methodology or m and ate a uniform presentation . Appendix Table . The Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) Statement : Checklist of Items That Should Be Addressed in Reports of Observational Studies STROBE provides general reporting recommendations for descriptive observational studies and studies that investigate associations between exposures and health outcomes . STROBE addresses the 3 main types of observational studies : cohort , casecontrol , and cross-sectional studies . Authors use diverse terminology to describe these study design s. For instance , follow-up study and longitudinal study are used as synonyms for cohort study , and prevalence study as a synonym for cross-sectional study . We chose the present terminology because it is in common use . Unfortunately , terminology is often used incorrectly ( 7 ) or imprecisely ( 8) . In Box 1 , we describe the hallmarks of the 3 study design s. Box 1 . Main Study Design s Covered by STROBE The Scope of Observational Research Observational studies serve a wide range of purpose s , from reporting a first hint of a potential cause of a disease to verifying the magnitude of previously reported associations . Ideas for studies may arise from clinical observations or from biological insight . Ideas may also arise from informal looks at data that lead to further explorations . Like a clinician who has seen thous and s of patients and notes 1 that strikes her attention , the research er may note something special in the data . Adjusting for multiple looks at the data may not be possible or desirable ( 9 ) , but further studies to confirm or refute initial observations are often needed ( 10 ) . Existing data may be used to examine new ideas about potential causal factors , and may be sufficient for rejection or confirmation . In other instances , studies follow that are specifically design ed to overcome potential problems with previous reports . The latter studies will gather new data and will be planned for that purpose , in contrast to analyses of existing data . This leads to diverse viewpoints , for example , on the merits of looking at subgroups or the importance of a predetermined sample size . STROBE tries to accommo date these diverse uses of observational research from discovery to refutation or confirmation . Where necessary , we will indicate in what circumstances specific recommendations apply . How to Use this Paper This paper is linked to the shorter STROBE paper that introduced the items of the checklist in several journals ( 6 ) , and forms an integral part of the STROBE Statement . Our intention is to explain how to report research well , not how research should be done . We offer a detailed explanation for each checklist item . Each explanation is preceded by an example of what we consider transparent reporting . This does not mean that the study from which the example was taken was uniformly well reported or well done ; nor does it mean that its findings were reliable , in the sense that they were later confirmed by others : It only means that this particular item was well reported in that study . In addition to explanations and examples , we included boxes with supplementary information . These are intended for readers who want to refresh their memories about some theoretical points or be quickly informed about technical background details . A full underst and ing of these points may require study ing the textbooks or method ological papers that are cited . STROBE recommendations do not specifically address topics , such as genetic linkage studies , infectious disease modeling , or case reports and case series ( 11 , 12 ) . As many of the key elements in STROBE apply to these design s , authors who report such studies may nevertheless find our recommendations useful . For authors of observational studies that specifically address diagnostic tests , tumor markers , and genetic associations , STARD ( 13 ) , REMARK ( 14 ) , and STREGA ( 15 ) recommendations may be particularly useful . The Items in the STROBE Checklist We now discuss and explain the 22 items in the STROBE checklist ( Appendix Table ) and give published examples for each item . Some examples have been edited by removing citations or spelling out abbreviations . Eighteen items apply to all 3 study design s , whereas 4 are design -specific . Starred items ( for example , item 8) indicate that the information should be given separately for cases and controls in casecontrol studies , or exposed and unexposed groups in cohort and cross-sectional studies . We advise authors to address all items somewhere in their paper , but we do not prescribe a precise location or order . For instance , we discuss the reporting of results under a number of separate items , while recognizing that authors might address several items within a single section of text or in a table . Title and Abstract 1(a ) Indicate the study 's design with a commonly used term in the title or the abstract . Example Leukaemia incidence among workers in the shoe and boot manufacturing industry : a casecontrol study ( 18 ) . Explanation Readers should be able to easily identify the design that was used from the title or abstract . An explicit , commonly used term for the study design also helps ensure correct indexing of articles in electronic data bases ( 19 , 20 ) . 1(b ) Provide in the abstract an informative and balanced summary of what was done and what was found . Example Background : The expected survival of HIV-infected patients is of major public health interest . Objective : To estimate survival time and age-specific mortality rates of an HIV-infected population compared with that of the general population . Design : Population -based cohort study . Setting : All HIV-infected persons receiving care in Denmark from 1995 to 2005 . Patients : Each member of the nationwide Danish HIV Cohort Study was matched with as many as 99 persons from the general population according to sex , date of birth , and municipality of residence . Measurements : The authors computed KaplanMeier life tables with age as the time scale to estimate survival from age 25 years . Patients with HIV infection and corresponding persons from the general population were observed from the date of the patient 's HIV diagnosis until death , emigration , or 1 May 2005 . Results : 3990 HIV-infected patients and 379 872 persons from the general population were included in the study , yielding 22 744 ( median , 5.8 y/person ) and 2 689 287 ( median , 8.4 y/person ) person-years of observation . Three percent of participants were lost to follow-up . From age 25 years , the median survival was 19.9 years ( 95 % CI , 18.5 to 21.3 ) among patients with HIV infection and 51.1 years ( CI , 50.9 to 51.5 ) among the general population . For HIV-infected patients , survival increased to 32.5 years ( CI , 29.4 to 34.7 ) during the 2000 to 2005 period . In the subgroup that excluded persons with known hepatitis C coinfection ( 16 % ) , median survival was 38.9 years ( CI , 35.4 to 40.1 ) during this same period . The relative mortality rates for patients with HIV infection compared with those for the general population decreased with increasing age , whereas the excess mortality rate increased with increasing age . Limitations : The observed mortality rates are assumed to apply beyond the current maximum observation time of 10 years . Conclusions : The estimated median survival is more than 35 years for a young person diagnosed with HIV infection in the late highly active antiretroviral therapy era . However , an ongoing effort is still needed to further reduce mortality rates for these persons compared with the general population ( 21 ) . Explanation The abstract provides key information that enables readers to underst and a study and decide whether to read the article . Typical components include a statement of the research question , a short description of methods and results , and a conclusion ( 22 ) . Abstract s should summarize key details of studies and should only present information that is provided in the article . We advise presenting key results in a numerical form that includes numbers of participants , estimates of associations , and appropriate measures of variability and uncertainty ( for example , odds ratios with confidence intervals ) . We regard it insufficient to state only that an exposure is or is not significantly associated with an Output:

In the majority of studies review ed , children rated their QoL more highly than their parents . There was some evidence for greater agreement on the physical health domain than psychosocial domains