A model of personality change after traumatic brain injury and the development of the Brain Injury Personality Scales.

OBJECTIVE: The aims of this study were to develop models of personality change after traumatic brain injury (TBI) based on information provided by the TBI survivor and a significant other (SO), and to compare the models generated from the two different sources of information. METHODS: Individuals with and without TBI and an SO were interviewed separately about their current personality. The SOs were also interviewed about the personality of the TBI survivor before the injury. A subset of TBI survivors and their SOs were interviewed twice to assess test-retest reliability. Items which were not associated with personality change after TBI, which could not be measured reliably or which did not contribute to the model, were excluded. RESULTS: Of the 123 original items, 29 items from the interview with the survivor and 31 items from the interview with the SO were retained to form the Brain Injury Personality Scales. Separate factor analyses of ratings from each interview (survivor and SO) resulted in seven first order factors. The second order factor analyses for each interview resulted in four factors. Concordance between the information obtained from the two interviews was low. CONCLUSIONS: The information obtained from the interviews with the TBI survivors and the SOs produced two models with a similar structure: three superordinate factors of personality items (affective regulation, behavioural regulation and engagement) and one superordinate factor of items relevant to mental state (restlessness and range of thought). Despite the similarity in structure, the content of the information obtained from the two interviews was different.

Sustainable waste management in the UK: the public health role.

This paper discusses waste management in the UK and its relationship with health. It aims to outline the role of health professionals in the promotion of waste management, and argues for a change in their role in waste management regulation to help make the process more sustainable. The most common definition of sustainable development is that by the Brundtland commission, i.e. "development that meets the needs of the present without compromising the ability of future generations to meet their own needs". Managing waste sites in a manner that minimises toxic impacts on the current and future generations is obviously a crucial part of this. Although the management of waste facilities is extremely complex, the Integrated Pollution Prevention and Control regime, which requires the input of public health professionals on the regulation of such sites, means that all waste management installations should now be operating in a fashion that minimises any toxicological risks to human health. However, the impacts upon climate change, resource use and health inequalities, as well as the effects of waste transportation, are currently not considered to be part of public health professionals' responsibilities when dealing with these sites. There is also no requirement for public health professionals to become involved in waste management planning issues. The fact that public health professionals are not involved in any of these issues makes it unlikely that the potential impacts upon health are being considered fully, and even more unlikely that waste management will become more sustainable. This paper aims to show that by only considering direct toxicological impacts, public health professionals are not fully addressing all the health issues and are not contributing towards sustainability. There is a need for a change in the way that health professionals deal with waste management issues.

Effects of pre- and postnatal cysteamine exposure on renal function in the rat.

The safety of cysteamine after renal transplantation and during pregnancy is an important issue, since girls with cystinosis are in better health on cysteamine therapy and thus more likely to become pregnant. In the first study, cysteamine was given to pregnant rats on days 6.5-18.5 post conception in oral doses of 0, 37.5, 75, 100, and 150 mg/kg per day. The dams were sacrificed on day 20.5, the fetal kidneys removed and prepared for histological examination. In the second study, cysteamine was given to dams on days 6.5-19.5 post conception in oral doses of 0, 37.5, 50, and 75 mg/kg per day. Dams were allowed to give birth naturally and pups were given cysteamine on days 4-21 to yield the same oral doses of cysteamine given to the dam. Renal function was evaluated on day 35. Histological examination of fetal kidneys revealed no changes even in kidneys from fetuses with growth retardation and malformations. Furthermore, there were no alterations in renal function in offspring on day 35. These findings demonstrate that cysteamine therapy does not affect renal development in the rat. Further investigations will be required to prove whether cysteamine therapy has the potential to affect renal development in the human.

The development of the Maternal Breastfeeding Evaluation Scale.

A Maternal Breastfeeding Evaluation Scale was developed from categories identified in qualitative research. Content validity was tested according to procedures described by Imle and Atwood and Lynn. A sample of 442 women who had breastfed completed an instrument of 56 Likert-scale items. A retest questionnaire was completed by a subsample of 28 women. Exploratory factor analysis resulted in three factors, accounting for 38.5 percent of the variance: Maternal Enjoyment/Role Attainment (29 percent), Infant Satisfaction/Growth (5 percent), and Lifestyle/Maternal Body Image (4 percent). A revised 30-item MBFES was developed using items loading strongly on these three factors. Cronbach's alphas for the revised scale and subscales were .93, .93, .88, and .80, respectively. Test-retest correlations (n = 28) were .93, .93, .94, and .82, respectively (p < .001 for all).

Maternal perceptions of successful breastfeeding.

Twenty-six mothers were interviewed concerning successful and unsuccessful breastfeeding. Constant comparative analysis yielded five major categories of successful breastfeeding: infant health, infant satisfaction, maternal enjoyment, desired maternal role attainment, and lifestyle compatibility. A core concept, working in harmony, emerged as a unifying theme. Mothers described successful breastfeeding as a complex interactive process resulting in mutual satisfaction of maternal and infant needs. This concept broadens definitions of successful breastfeeding often used by health professionals, which emphasize breastfeeding duration and nutritional aspects.

The breast-feeding experience of women with type I diabetes.

The purpose of this exploratory study was to identify the factors influencing the initiation and maintenance of breast-feeding in women with insulin-dependent diabetes. The lack of research in this area and the need for in-depth data necessitated exploratory methodology. Twenty-two mothers who were insulin dependent before pregnancy and who had given birth in the past 2 years were interviewed. Diabetes was not a principal factor in the decision to breast-feed or bottle-feed for the majority of the women. When diabetes was a factor, women were seeking a "normal" childbearing experience, including breast-feeding. Although the women did not perceive diabetes as influencing their breast-feeding experiences, they did find that maintaining good diabetic control required greater effort and flexibility during breast-feeding.