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1.
Neuropathology ; 2024 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-39391989

RESUMEN

Hereditary spastic paraplegia (HSP) with thin corpus callosum can be due to a variety of genetic causes, the most common of which are biallelic variants in SPG11 (HSP11). Only six cases of neuropathologic examination of HSP11 have been reported. Here we present neuropathological findings in another case of HSP11 with novel mutation (homozygous c.6439_6442del) and clinical features of three additional cases of HSP11. These four cases of HSP11 had similar disease courses with prominent lower extremity weakness and spasticity but varied cognitive symptoms and brain magnetic resonance imaging (MRI) findings. Neuropathological examination of one case included ex vivo MRI of the cerebrum, histologic and immunohistochemical evaluation, and Western blot for SPG11. The case was notable for a small cerebrum with decreased volume of cortex, white matter, and deep gray nuclei. The corpus callosum was thin, and the substantia nigra showed marked pallor. Microscopically, the cortex had normal lamination and mild loss of neurons with mild gliosis, the corpus callosum was thin with limited gliosis, and the substantia nigra had marked decrease in neurons and pigment, with minimal gliosis. In contrast, the basal ganglia, thalamus, and spinal cord (anterior horns, corticospinal, and spinocerebellar tracts) had prominent neuron loss and gliosis. Myelin-laden macrophages were found in multiple sites but were most common in the corpus callosum. No hyperphosphorylated tau or TDP-43 aggregates, Lewy bodies, or amyloid ß plaques were found. Compared to control, SPG11 was absent in HSP11 brain and markers of autophagy were elevated by Western blot. Comparison with prior reports of HSP with thin corpus callosum and HSP11 demonstrates a disease with a broad range of structural changes of the brain, including features of abnormal development and degeneration.

2.
Pediatr Transplant ; 25(3): e13897, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33131128

RESUMEN

BACKGROUND: Pediatric patients undergoing heart transplant have a number of factors predisposing them to become fluid-overloaded, including capillary leak syndrome. Capillary leak and FO are associated with organ injury and may influence both short- and long-term outcomes. This study aimed to 1) determine the extent, timing, and predictors of post-operative FO and 2) investigate the association of FO with clinically important outcomes. METHODS: Between 2000 and 2012, 70 children less than 6 years old had a heart transplant at our institution. This was a secondary analysis of data from an ongoing prospective cohort study. RESULTS: FO, defined as cumulative fluid balance greater than 10% of body weight in the first 5 post-operative days, occurred in 16/70 patients (23%); 7 of these had more than 20% FO. Shorter donor ischemic time and longer cardiopulmonary bypass time were independently associated with increased risk of FO. FO >20% was a statistically significant independent predictor of mortality (P = .005), ventilation time, and PICU length of stay. There was no statistically significant association between identified neurodevelopment domains and FO. CONCLUSIONS: Our single-center experience demonstrates that FO was common after pediatric heart transplant and was associated with worse clinical outcomes. FO is a potentially modifiable factor, and research is needed to better determine risk factors and whether intervention to reduce FO can improve outcomes in pediatric heart transplant patients.


Asunto(s)
Trasplante de Corazón , Hospitalización/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Desequilibrio Hidroelectrolítico/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pronóstico , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento
3.
Brain ; 138(Pt 9): 2608-18, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26115676

RESUMEN

The great majority of acute brain injury results from trauma or from disorders of the cerebrovasculature, i.e. ischaemic stroke or haemorrhage. These injuries are characterized by an initial insult that triggers a cascade of injurious cellular processes. The nature of these processes in spontaneous intracranial haemorrhage is poorly understood. Subarachnoid haemorrhage, a particularly deadly form of intracranial haemorrhage, shares key pathophysiological features with traumatic brain injury including exposure to a sudden pressure pulse. Here we provide evidence that axonal injury, a signature characteristic of traumatic brain injury, is also a prominent feature of experimental subarachnoid haemorrhage. Using histological markers of membrane disruption and cytoskeletal injury validated in analyses of traumatic brain injury, we show that axonal injury also occurs following subarachnoid haemorrhage in an animal model. Consistent with the higher prevalence of global as opposed to focal deficits after subarachnoid haemorrhage and traumatic brain injury in humans, axonal injury in this model is observed in a multifocal pattern not limited to the immediate vicinity of the ruptured artery. Ultrastructural analysis further reveals characteristic axonal membrane and cytoskeletal changes similar to those associated with traumatic axonal injury. Diffusion tensor imaging, a translational imaging technique previously validated in traumatic axonal injury, from these same specimens demonstrates decrements in anisotropy that correlate with histological axonal injury and functional outcomes. These radiological indicators identify a fibre orientation-dependent gradient of axonal injury consistent with a barotraumatic mechanism. Although traumatic and haemorrhagic acute brain injury are generally considered separately, these data suggest that a signature pathology of traumatic brain injury-axonal injury-is also a functionally significant feature of subarachnoid haemorrhage, raising the prospect of common diagnostic, prognostic, and therapeutic approaches to these conditions.


Asunto(s)
Axones/patología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/etiología , Hemorragia Subaracnoidea/complicaciones , Péptidos beta-Amiloides/metabolismo , Animales , Axones/diagnóstico por imagen , Encéfalo/metabolismo , Encéfalo/patología , Imagen de Difusión Tensora , Modelos Animales de Enfermedad , Imagen por Resonancia Magnética , Masculino , Trastornos Mentales/etiología , Ratones , Ratones Endogámicos C57BL , Microscopía Electrónica de Transmisión , Proteínas de Neurofilamentos/metabolismo , Estadística como Asunto , Hemorragia Subaracnoidea/patología , Factores de Tiempo , Ultrasonografía
4.
Pediatr Nephrol ; 31(4): 671-8, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26559064

RESUMEN

BACKGROUND: Critical illness following heart transplantation can include acute kidney injury (AKI). Study objectives were to define the epidemiology of, risk factors for, or impact on outcomes of AKI after pediatric heart transplant. METHODS: Using data from a prospective study of 66 young children, we evaluated: (1) post-operative AKI rate (by pediatric modified RIFLE criteria); (2) pre, intra, and early post-operative AKI risk factors using stepwise logistic regression (3) effect of AKI on short-term outcomes (ventilation and length of pediatric intensive care unit (PICU) stay) using stepwise multiple regression. RESULTS: AKI occurred in 73 % of children. Pre-transplant ventilation and higher baseline estimated creatinine clearance (eCCl) were independent risk factors for AKI. Pre-operative inotrope use was associated with reduced risk of AKI. Tacrolimus level emerged as important in multivariable risk prediction. Children with AKI had a longer duration of ventilation and length of pediatric intensive care unit (PICU) stay, with AKI being an independent predictor. CONCLUSIONS: AKI was common after heart transplant and associated with more complicated early post-transplant course. Lower baseline eCCl was associated with lower incidence of AKI; this merits further investigation. The association of pre-operative inotropes with less AKI may reflect a pathophysiological mechanism or be a surrogate for clinical factors and management prior to transplant. Avoiding high tacrolimus levels may be a modifiable risk factor for AKI.


Asunto(s)
Lesión Renal Aguda/epidemiología , Trasplante de Corazón/efectos adversos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/terapia , Factores de Edad , Canadá/epidemiología , Preescolar , Enfermedad Crítica , Femenino , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación , Modelos Logísticos , Masculino , Análisis Multivariante , Estudios Prospectivos , Sistema de Registros , Respiración Artificial , Factores de Riesgo , Tacrolimus/uso terapéutico , Resultado del Tratamiento
5.
Elife ; 122024 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-38896568

RESUMEN

We present open-source tools for three-dimensional (3D) analysis of photographs of dissected slices of human brains, which are routinely acquired in brain banks but seldom used for quantitative analysis. Our tools can: (1) 3D reconstruct a volume from the photographs and, optionally, a surface scan; and (2) produce a high-resolution 3D segmentation into 11 brain regions per hemisphere (22 in total), independently of the slice thickness. Our tools can be used as a substitute for ex vivo magnetic resonance imaging (MRI), which requires access to an MRI scanner, ex vivo scanning expertise, and considerable financial resources. We tested our tools on synthetic and real data from two NIH Alzheimer's Disease Research Centers. The results show that our methodology yields accurate 3D reconstructions, segmentations, and volumetric measurements that are highly correlated to those from MRI. Our method also detects expected differences between post mortem confirmed Alzheimer's disease cases and controls. The tools are available in our widespread neuroimaging suite 'FreeSurfer' (https://surfer.nmr.mgh.harvard.edu/fswiki/PhotoTools).


Every year, thousands of human brains are donated to science. These brains are used to study normal aging, as well as neurological diseases like Alzheimer's or Parkinson's. Donated brains usually go to 'brain banks', institutions where the brains are dissected to extract tissues relevant to different diseases. During this process, it is routine to take photographs of brain slices for archiving purposes. Often, studies of dead brains rely on qualitative observations, such as 'the hippocampus displays some atrophy', rather than concrete 'numerical' measurements. This is because the gold standard to take three-dimensional measurements of the brain is magnetic resonance imaging (MRI), which is an expensive technique that requires high expertise ­ especially with dead brains. The lack of quantitative data means it is not always straightforward to study certain conditions. To bridge this gap, Gazula et al. have developed an openly available software that can build three-dimensional reconstructions of dead brains based on photographs of brain slices. The software can also use machine learning methods to automatically extract different brain regions from the three-dimensional reconstructions and measure their size. These data can be used to take precise quantitative measurements that can be used to better describe how different conditions lead to changes in the brain, such as atrophy (reduced volume of one or more brain regions). The researchers assessed the accuracy of the method in two ways. First, they digitally sliced MRI-scanned brains and used the software to compute the sizes of different structures based on these synthetic data, comparing the results to the known sizes. Second, they used brains for which both MRI data and dissection photographs existed and compared the measurements taken by the software to the measurements obtained with MRI images. Gazula et al. show that, as long as the photographs satisfy some basic conditions, they can provide good estimates of the sizes of many brain structures. The tools developed by Gazula et al. are publicly available as part of FreeSurfer, a widespread neuroimaging software that can be used by any researcher working at a brain bank. This will allow brain banks to obtain accurate measurements of dead brains, allowing them to cheaply perform quantitative studies of brain structures, which could lead to new findings relating to neurodegenerative diseases.


Asunto(s)
Enfermedad de Alzheimer , Encéfalo , Imagenología Tridimensional , Aprendizaje Automático , Humanos , Imagenología Tridimensional/métodos , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/patología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Fotograbar/métodos , Disección , Imagen por Resonancia Magnética/métodos , Neuropatología/métodos , Neuroimagen/métodos
6.
Trauma Surg Acute Care Open ; 9(1): e001501, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39081460

RESUMEN

Objectives: An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort. Methods: Data from hospitalized subjects with Glasgow Coma Scale score of 3-12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014-2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-3 (vs. 4-8)) at 3, 6, and 12 months after injury. Results: Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01-4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months. Conclusions: After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed. Level of evidence: IV. Trial registration number: NCT02119182.

7.
BMJ Open Qual ; 12(4)2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37931984

RESUMEN

A common practice exists in hospitals where extra tubes of blood are collected for possible add-on testing, this practice contributes to wastage of consumables. Baseline estimates from a 5-month local lab information system audit revealed that ~65 extra tubes per day were being collected, with an additional 2-week manual audit of all extra tubes received in the laboratory confirming the practice. The audits showed that the majority of the tubes (~99%) were being drawn from the adult emergency department (ED). Furthermore, only 5% of the extra tubes were being used for add-on testing, whereas the remaining tubes had no testing performed on them and were discarded at the end of the day. This translates to over 23 000 extra tubes being wasted annually.After initial discussion with ED leadership, the practice was identified as primarily nurse driven. An educational intervention was created and entitled 'Every Tube Counts', with the aim to reduce extra tube collections in the adult ED by 50% within the first month of intervention. First, a memo with initial findings and a request to stop the practice of extra tube collection was sent out to all ED staff. After 2 weeks of additional data collection, it was noticed that extra tubes were still being collected. A second intervention, which consisted of another communication and utilisation of nurse educators to disseminate the information to nursing staff, saw a remarkable ~80% reduction in collection of extra tubes in the following few months after the second intervention. The practice was followed for an additional 15 months, which saw a slight increase of extra tube collections over time with a levelling off towards the latter period of the study. However, the target goal was maintained over the entire study period.


Asunto(s)
Servicio de Urgencia en Hospital , Hospitales , Adulto , Humanos , Comunicación , Recolección de Datos
8.
Nurse Educ Today ; 110: 105263, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35114439

RESUMEN

BACKGROUND: Incivility within nursing is professionally unacceptable. Little research exists regarding student nurses' experiences with incivility from healthcare professionals and others within the clinical environment and particularly within a Canadian context. AIM: To describe the incidence and perceptions of incivility experienced by undergraduate nursing students from healthcare professionals and others within clinical practice. METHOD: This descriptive study used an electronic survey and was conducted at an eastern Canadian university. Descriptive statistics were applied. RESULTS: Of 650 nursing students invited to participate in the study, 260 surveys were fully completed. Of these, 70% of respondents indicated experiencing incivility, mostly in acute care settings. Registered nurses and licensed practical nurses were the major offenders. Discourteous gestures and condescending remarks were the most frequently experienced uncivil acts, resulting in feelings of high anxiety and inadequacy. Participants coped by avoiding communication with the perpetrator. Incivility was rarely reported because of a belief it would be fruitless to do so, lack of awareness of policies and fear of retaliation. CONCLUSIONS: Nursing students experience incivility frequently in clinical practice with serious consequences. Recommendations arising from this study encourage educators and healthcare leaders to collaborate to review, implement and evaluate curricula, policies and processes to address incivility.


Asunto(s)
Bachillerato en Enfermería , Incivilidad , Estudiantes de Enfermería , Canadá , Docentes de Enfermería , Humanos , Incidencia
10.
Front Pediatr ; 9: 711083, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34805032

RESUMEN

Introduction: Patients in the pediatric intensive care unit (PICU) are at risk of developing long-term morbidities following recovery from their critical illness. One such health outcome is called post-intensive care syndrome (PICS). PICS in pediatrics may be mitigated by interventions that facilitate adjustment to the PICU setting. Methods: The PICU implemented a two-pronged Peer and Volunteer (P/V) Program to help: (a) families adjust to the PICU experience with the support of a peer mentor (PM); and (b) patients receive non-medical interaction from trained volunteers (V). We designed a mixed-methods program evaluation targeting perspectives and feedback from PICU families and healthcare professionals (HCPs). Results: All stakeholder groups agreed that the PICU P/V Program was a valuable resource for PICU patients and their families. HCPs reported that they lack both time and training to provide regular developmental care to patients. However, the P/V Program may influence both families' and HCP's confidence in their ability to offer non-medical interaction to children in the PICU. Discussion: Important initial and on-going strengths and barriers to successful implementation were identified, including the need to clarify roles and intervention scope. The program evaluation served as a change management strategy and also helped to identify both areas for improvement and strategies for on-going sustainability. HCP's exposure to the program and modeling by PMs may have helped HCPs to feel that it is within their job description and capacity to provide emotional support and guidance to families.

11.
Nurse Educ Today ; 91: 104456, 2020 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-32450382

RESUMEN

BACKGROUND: Qatar aspires to provide world-class healthcare comparable with Western countries. Compelling evidence demonstrating the positive effects of bachelor of nursing (BN) educated nurses on patient outcomes is creating a global demand for these graduates, particularly in contexts such as Qatar where historically RN-to-BN programs were unavailable. OBJECTIVE: The aim of this study was to examine the return to education experiences of diploma educated registered nurses (RNs) undertaking a bachelor program. METHODS: This descriptive qualitative study included 19 diploma educated registered nurses enrolled in a BN program in a Qatar campus of a Canadian university. Focus groups and thematic analysis were used. RESULTS: Three major themes described RNs' experiences of returning to education: the right time, balancing act and rewards. The convergence of timing, BN program availability and employer sponsorship were significant levers. Returning to education was challenging and required balancing competing demands of work, home, and study. The exposure to enquiry-based learning required rapid development of study skills to enable learning. Previous education was often seen as incongruent with requirements for academic success. A notable omission from accounts was reference to professional identity. Undertaking the program brought returns such as increased self-esteem, enhanced knowledge and potential for career progression. Organizational culture and commitment appeared to impact on students' experience. CONCLUSIONS: Completing a BN program was reward for the challenges engendered by returning to education. Effective partnerships and structural support between academic and service providers are required to ensure the benefits of BN attainment become embedded and impact on professional identity.

12.
Aust Health Rev ; 32(4): 786-91, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18980575

RESUMEN

The establishment of the Grampians After-Hours Service has led to the development of a quality framework for nurse telephone triage. The service providers believe this framework is the basis for the service's success. While quality frameworks including critical evaluation and peer review are not new to the health industry, the development of organisational systems to improve quality in after-hours services is innovative. The framework developed is comprehensive, evidenced-based and emphasises training, protocols and documentation. It also involves a continuous and non-punitive quality review process that operates at the individual, small group, organisation and whole-system level. The framework will continue to improve and at this time provides a foundation for discussion and further application in the pursuit of quality improvement in rural after-hours health services.


Asunto(s)
Garantía de la Calidad de Atención de Salud , Telecomunicaciones , Triaje/normas , Atención Posterior/normas , Medicina Familiar y Comunitaria , Humanos , Rol de la Enfermera , Victoria
13.
J Genet Psychol ; 168(1): 43-61, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17879511

RESUMEN

Children aged 5-8 years (N = 64) were given 3 first- and 3 second-order tasks testing their ability to represent false beliefs about physical facts, positive emotions, and negative emotions. The children were also asked to justify their responses to the test questions. Older children were more successful than younger children at both answering the test questions correctly and justifying their responses. On the first-order problems, performance was better on the physical fact task than on the emotions tasks; the reverse was true for the second-order problems. Children primarily used situational explanations to explain correct judgments on the physical problems, whereas mentalistic explanations were more common than situational explanations on 3 of the 4 emotions tasks. The results extend knowledge of false belief beyond the simple forms studied at the preschool level.


Asunto(s)
Afecto , Cognición , Formación de Concepto , Cultura , Actividad Motora , Percepción Social , Niño , Preescolar , Femenino , Humanos , Masculino
14.
J Neurotrauma ; 32(16): 1254-71, 2015 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-25758167

RESUMEN

Concussion, or mild traumatic brain injury (mTBI), can cause persistent behavioral symptoms and cognitive impairment, but it is unclear if this condition is associated with detectable structural or functional brain changes. At two sites, chronic mTBI human subjects with persistent post-concussive symptoms (three months to five years after injury) and age- and education-matched healthy human control subjects underwent extensive neuropsychological and visual tracking eye movement tests. At one site, patients and controls also performed the visual tracking tasks while blood-oxygen-level-dependent (BOLD) signals were measured with functional magnetic resonance imaging. Although neither neuropsychological nor visual tracking measures distinguished patients from controls at the level of individual subjects, abnormal BOLD signals were reliably detected in patients. The most consistent changes were localized in white matter regions: anterior internal capsule and superior longitudinal fasciculus. In contrast, BOLD signals were normal in cortical regions, such as the frontal eye field and intraparietal sulcus, that mediate oculomotor and attention functions necessary for visual tracking. The abnormal BOLD signals accurately differentiated chronic mTBI patients from healthy controls at the single-subject level, although they did not correlate with symptoms or neuropsychological performance. We conclude that subjects with persistent post-concussive symptoms can be identified years after their TBI using fMRI and an eye movement task despite showing normal structural MRI and DTI.


Asunto(s)
Lesión Encefálica Crónica , Imagen por Resonancia Magnética/métodos , Síndrome Posconmocional , Sustancia Blanca , Adulto , Lesión Encefálica Crónica/patología , Lesión Encefálica Crónica/fisiopatología , Medidas del Movimiento Ocular , Femenino , Neuroimagen Funcional , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Síndrome Posconmocional/patología , Síndrome Posconmocional/fisiopatología , Sustancia Blanca/patología , Sustancia Blanca/fisiopatología
15.
J Neurotrauma ; 31(10): 889-98, 2014 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-24367929

RESUMEN

Fundamental questions remain unanswered about the longitudinal impact of blast-plus-impact complex traumatic brain injuries (TBI) from wars in Iraq and Afghanistan. This prospective, observational study investigated measures of clinical outcome in US military personnel evacuated to Landstuhl Regional Medical Center (LRMC) in Germany after such "blast-plus" concussive TBIs. Glasgow Outcome Scale-Extended assessments completed 6-12 months after injury indicated a moderate overall disability in 41/47 (87%) blast-plus TBI subjects and a substantial but smaller number (11/18, 61%, p=0.018) of demographically similar US military controls without TBI evacuated for other medical reasons. Cognitive function assessed with a neuropsychological test battery was not different between blast-plus TBI subjects and controls; performance of both groups was generally in the normal range. No subject was found to have focal neurological deficits. However, 29/47 (57%) of blast-plus subjects with TBI met all criteria for post-traumatic stress disorder (PTSD) versus 5/18 (28%) of controls (p=0.014). PTSD was highly associated with overall disability; 31/34 patients with PTSD versus 19/31 patients who did not meet full PTSD criteria had moderate to severe disability (p=0.0003). Symptoms of depression were also more severe in the TBI group (p=0.05), and highly correlated with PTSD severity (r=0.86, p<0.0001). Thus, in summary, high rates of PTSD and depression but not cognitive impairment or focal neurological deficits were observed 6-12 months after concussive blast-plus-impact complex TBI. Overall disability was substantially greater than typically reported in civilian non-blast concussive ("mild") patients with TBI, even with polytrauma. The relationship between these clinical outcomes and specific blast-related aspects of brain injuries versus other combat-related factors remains unknown.


Asunto(s)
Traumatismos por Explosión/psicología , Lesiones Encefálicas/psicología , Depresión/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Campaña Afgana 2001- , Traumatismos por Explosión/complicaciones , Lesiones Encefálicas/complicaciones , Depresión/etiología , Evaluación de la Discapacidad , Escala de Coma de Glasgow , Humanos , Guerra de Irak 2003-2011 , Masculino , Persona de Mediana Edad , Personal Militar/psicología , Pruebas Neuropsicológicas , Estudios Prospectivos , Trastornos por Estrés Postraumático/etiología , Estados Unidos , Adulto Joven
17.
J Obstet Gynaecol ; 22(6): 586-9, 2002 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-12554241

RESUMEN

We have been reminded many times in the medical and lay press about the views of London female obstetricians choosing elective caesarean section for non-medical reasons. This paper asked Scottish female obstetricians for their personal choice regarding delivery and showed that only 15.5% would choose elective caesarean section compared with 31% and 21% in two surveys of London female obstetricians. None of the women in this group who had had a vaginal delivery would choose elective section.


Asunto(s)
Actitud del Personal de Salud , Cesárea/psicología , Obstetricia , Médicos Mujeres/psicología , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Escocia
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