Patients' experience of return to work rehabilitation following traumatic brain injury: a phenomenological study.

Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in paid employment. Psychosocial outcome after TBI, for many, remains poor. This includes low rates of return to pre-injury work or education, among others. This qualitative study explored the experience of return to work (RTW) rehabilitation with 10 individuals who sustained TBI. Data were collected from semi-structured interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA). Some of the main findings from this study included the following: Individuals find the RTW experience difficult and painful. They experience a distinct grief reaction in the process of exploring re-engagement in occupation following TBI. In view of these and other findings, changes to RTW rehabilitation should be considered to facilitate the optimal support for patients with TBI engaging in the RTW rehabilitation process.

Interventions to reduce consumption of sugar-sweetened beverages or increase water intake: evidence from a systematic review and meta-analysis.

A systematic review and meta-analyses were conducted to evaluate the effects of interventions to reduce sugar-sweetened beverages (SSB) or increase water intakes and to examine the impact of behaviour change techniques (BCTs) in consumption patterns. Randomized and nonrandomized controlled trials published after January 1990 and until December 2016 reporting daily changes in intakes of SSB or water in volumetric measurements (mL d-1 ) were included. References were retrieved through searches of electronic databases and quality appraisal followed Cochrane principles. We calculated mean differences (MD) and synthesized data with random-effects models. Forty studies with 16 505 participants were meta-analysed. Interventions significantly decreased consumption of SSB in children by 76 mL d-1 (95% confidence interval [CI] -105 to -46; 23 studies, P < 0.01), and in adolescents (-66 mL d-1 , 95% CI -130 to -2; 5 studies, P = 0.04) but not in adults (-13 mL d-1 , 95% CI -44 to 18; 12 studies, P = 0.16). Pooled estimates of water intakes were only possible for interventions in children, and results were indicative of increases in water intake (MD +67 mL d-1 , 95% CI 6 to 128; 7 studies, P = 0.04). For children, there was evidence to suggest that modelling/demonstrating the behaviour helped to reduce SSB intake and that interventions within the home environment had greater effects than school-based interventions. In conclusion, public health interventions - mainly via nutritional education/counselling - are moderately successful at reducing intakes of SSB and increasing water intakes in children. However, on average, only small reductions in SSBs have been achieved by interventions targeting adolescents and adults. Complementary measures may be needed to achieve greater improvements in both dietary behaviours across all age groups.

The effect of water-soluble chemicals on the growth and mitosis of primary newborn rat kidney cells in culture.

Mass cultures of primary rat kidney cells were exposed briefly to aqueous solutions of 20 chemicals and their subsequent growth rate and mitotic activity measured. Proximate carcinogens, and some chemicals with a defined inhibitory action biochemically, depressed the growth and division of the cultures. Non-carcinogenic compounds and precarcinogens did not interfere with the subsequent growth rate and mitotic activity of the cultures. It is suggested that the possession of growth inhibitory properties could give an indication of the carcinogenic activity of a chemical on a short-term basis.

Short-term toxicity study of Chocolate Brown HT in pigs.

Chocolate Brown HT was given in the diet to groups of 3 male and 3 female pigs at dose levels of 0 (control), 5, 20 or 100 mg/kg/day for 13 weeks. No adverse effects were seen on body weight gain, urine composition of the incidence of histopathological lesions. The haemoglobin levels in all 3 treatment groups of male pigs at week 13 were significantly below the control values, but this effect was not considered to be attributable to treatment with Chocolate Brown HT. The no-untoward-effect level in this study was at least 100 mg/kg/day.

Long-term toxicity study of amaranth in rats using animals exposed in utero.

Groups of 90 (control) and 54 (treated) rats of each sex were given amaranth in their diet to provide daily intakes of 0 (control), 50, 250 or 1250 mg/kg for 111 wk (male) and 112 wk (female) after weaning. The rats had also been exposed to the same dose levels in utero, and their parents were exposed for 60 days before mating. The colouring had no adverse effects on fertility, haematological parameters, serum chemistry or incidence of tumours. All treated animals showed contamination of the fur and red colouring of the faeces and at the high dose only the faecal pellets were poorly formed. Rats in the high-dose group produced more pups, and the average pup weight was lower than that of the controls. Rats of the F1 generation given the highest dose level were slightly lighter than the controls despite a small increase in food and water intake. Both sexes given the highest dose level and males given 250 mg/kg/day had increased caecal weight. High-dose females excreted more protein in the urine after 18 months and on histopathological examination females in all treated groups showed an increased incidence of renal calcification and pelvic epithelial hyperplasia with degenerative changes. It is concluded that amaranth fed to rats at dose levels of up to 1250 mg/kg/day in the diet did not have any carcinogenic effect. However, because of the effect on the kidneys of the females it was not possible to establish a no-untoward-effect level in this study.

Long-term toxicity study quillaia extract in rats.

Groups of 48 male and 48 female rats were fed quillaia extract in the diet at levels of 0 (controls), 0.3, 1.0 and 3.0% for 2 yr. The material had no adverse effects on death rate, water consumption, serum chemistry or haematological parameters or on the incidence of histopathological findings, including tumours. In the males given the 3% dietary level, the death rate, total leucocyte count at wk 108, incidence of kidney lesions and weights of the kidneys, heart and thyroid were all below the control values. These differences were explicable, however, in terms of a lowered body weight consequent on a decreased food intake. It is concluded that, in rats, quillaia extract fed at levels up to 3.0% in the diet did not have any carcinogenic effect. The no-untoward-effect level established in this was 3.0% in the diet, approximately equivalent to an intake of 1.5 g/kg/day.

Cytotoxic carcinogeneic response to monocrotaline pyrrole.

The cytotoxic and carcinogenic effects of MCP, the possible proximate metabolite of the alkaloid monocrotaline, were investigated in rats by the subcutaneous route. Sequential of MCP subcutaneously produced an acute inflammatory reaction with necrosis of the local tissue. A slight delay in connective-tissue repair occurred and markedly enlarged fibroblasts were a distinctive feature of the lesion. Four injection site sarcomas were produced after repeated injection of 60 mug MCP in tricaprylin. Injection of 30 mug MCP in tricaprylin twice weekly gave rise to three local tumours. Controls injected repeatedly with tricaprylin developed two sarcomas at the injection site. The significance of these findings is discussed and it is concluded that MCP is undoubtedly cytotoxic but that its carcinogenic potency is equivocal.

Early reactions of the subcutaneous tissue to repeated injections of carcinogens in aqueous solutions.

Four water-soluble carcinogens were injected at the same site subcutaneously into rats, mice or guinea-pigs, twice weekly for 5-8 weeks in order to study the evolution of the early tissue reaction. MNU was injected into rats as 0·1 ml. of 0·5% solution, and into mice as 0·1 ml. of 0·05% solution. NQO was administered to rats (0·1 or 0·2 ml. of 0·25 or 0·1%) mice (0·1 of 0·05%) and guinea-pigs (0·5 of 0·1%). Propane sultone and BEI were administered to rats only, the former as 0·1 ml. of 3% and the latter as 0·5 ml. of 2·0% solution.The principal features of the tissue reaction produced by each of the four compounds in rats were similar and consisted of destruction of subcutaneous tissue, deposition of fibrin and "fibrinoid", an abnormal pattern of fibroblastic proliferation with cytomegaly of some fibroblasts and deposition of mucopolysaccharide but little collagen formation. Moreover, the appearance of fibroblastic proliferation was delayed from the normal 2-5 days to 14-16 days.These features are consistent with the known early effects of carcinogens on proliferating target tissues, and differ considerably from those found in the early reactive lesions to repeated injection of solutions of substances possessing physical properties such as surface activity or hypertonicity, or which precipitate at the injection site.

Injection site tumours and preceding pathological changes in rats treated subcutaneously with surfactants and carcinogens.

The sequential histological changes and neoplastic response occurring in the subcutaneous tissue of rats after injection of surfactants or carcinogens were compared. Twice weekly subcutaneous injections of the surfactants Blue VRS and Light Green SF elicited a deranged connective tissue repair with continued proliferation of fibroblasts and extensive collagen desposition. In contrast, the carcinogens N-methyl-N-nitrosourea (MNU) and N-nitroquinoline-N-oxide (NQO) appeared to inhibit connective tissue repair and produce morphologically abnormal fibroblasts. The spectrum of neoplastic response was also found to differ. Surfactants gave rise to local sarcomata only after about 47 weeks, whereas carcinogens produced local sarcomata and adenocarcinomata after 20 and 12 weeks respectively.

Ortho-toluene sulphonamide and saccharin in the promotion of bladder cancer in the rat.

The importance of the contaminant OTS in the promoting activity of commercial saccharin on rat bladder neoplasia was investigated. OTS, OTS-free and OTS-contaminated saccharin were administered in the drinking water or diet for 2 years to groups of rats pretreated with an intravesical instillation of MNU; OTS alone and OTS-free saccharin were also given to groups of rats not pretreated with MNU. Administration of OTS was not associated with changes in urinary pH, crystalluria or calculus formation, had no effect on the histology of normal rat bladder, and did not increase the incidence of bladder hyperplasia or neoplasia elicited by pretreatment with MNU. No differences could be found between the effect of OTS-free or OTS-contaminated saccharin on bladders of rats pretreated with MNU. These results indicate that OTS contamination played no part in the reported promoting activity of saccharin on the rat bladder. Administration of saccharin did not increase urinary pH, crystalluria or calculus formation, and failed to promote bladder neoplasia after a carcinogenic dose of MNU, though the numbers of proliferative lesions in the bladder were increased.