The contribution of social cognition in predicting social participation following moderate and severe TBI in youth.

Youth with moderate or severe traumatic brain injury (TBI) are at risk for reduced social participation after the injury, and the contribution of social cognition to these changes in functioning has been little studied. This study aimed to examine social participation and to measure the contribution of social and non-social cognitive functions to social participation impairment in youth (ages 12-21) who sustained moderate or severe TBI. Youth with TBI (n = 23) were compared to typically developing (TD) controls on self- and parent-rated social participation questionnaires. Direct testing of social cognition (mentalising, social knowledge, emotion recognition) and higher order cognitive abilities (intellectual abilities, attention and executive functions) was also conducted. Significant differences were found between the TBI participants and TD controls on social participation measures. Mentalising and problem-solving abilities revealed to be significant correlates of social participation as reported by youth with brain-injury and their parents. Overall, these results corroborate previous findings by showing that social participation is significantly reduced after TBI, and further shows that mentalising, which is not always considered during rehabilitation, is an important contributing factor. In addition to executive function measures, social cognition should therefore be systematically included in assessment following youth TBI for intervention and prevention purposes.

Interrupting the social processes linked with initiation of injection drug use: results from a pilot study.

BACKGROUND: Injection drug use is a skill learned in social settings. Change the Cycle (CTC), a peer-delivered, one-session intervention, is designed to reduce among people who inject drugs (PIDs) injection initiation-related behaviours (i.e., speaking positively about injecting to non-injectors, injecting in front of non-injectors, explaining or showing a non-injector how to inject) and initiation of non-injectors. We hypothesized that participation in CTC would lead to reductions in initiation-related behaviours six months later. METHODS: Using respondent driven sampling (RDS), 98 PIDs were recruited in Toronto, Canada to participate in pilot testing of CTC. The baseline session consisted of a structured interview, the peer-delivered CTC intervention, instructions regarding RDS coupon distribution, and an invitation to return in six months for a follow-up interview. For the 84 PIDs completing the six-month interview, we compared initiation-related behaviours at baseline with six-month follow-up. RESULTS: The proportion of PIDs offering to initiate a non-injector was reduced from 8.4% (95% CI: 2.5, 15.9) at baseline to 1.59% (95% CI: 0.4, 3.7) at 6-month follow-up. The prevalence of speaking positively about injection to non-injectors also decreased significantly. The proportion of PIDs who helped a non-injector with a first injection at baseline was 6.2% (95% CI: 2.1, 11.3) and at follow-up was 3.5% (95% CI: 0.8, 7.1). Paired analyses of initiator baseline versus follow-up data showed a 72.7% reduction in initiation (95%CI: 47.7, 83.1). CONCLUSIONS: While further refinements remain to be tested, pilot study results suggest that CTC holds promise as a prevention intervention.

Gross abnormalities of the umbilical cord: related placental histology and clinical significance.

OBJECTIVE: To evaluate umbilical cord abnormalities predisposing to mechanical cord compression and determine their relationship to adverse clinical outcomes and stasis-associated histologic changes in the placenta. METHODS: Placental slides of 224 singleton pregnancies with gross cord abnormality (true knots, long cords, nuchal/body cords, abnormal cord insertion, hypercoiled cords, narrow cords with diminished Wharton's jelly), delivered on or after 28 weeks gestational age, and 317 gestational age-matched controls, were reviewed and specifically evaluated for the following histologic changes: (1) fetal vascular ectasia, (2) fetal vascular thrombosis, (3) and fetal thrombotic vasculopathy/avascular villi. These changes were analyzed in relation to both clinical information and findings at gross pathologic examination. RESULTS: Gross cord abnormalities were associated with stillbirth, intrauterine growth restriction, non-reassuring fetal tracing, meconium-stained amniotic fluid, and increased rate of emergency Cesarean section. At microscopic evaluation, cases with gross cord abnormalities showed a statistically significant association with both ectasia and thrombosis in the fetal vasculature, as well as changes of fetal thrombotic vasculopathy in the terminal villi. When considering individual gross cord abnormalities, long cord and nuchal cord had the highest rates of thrombosis-related histopathology. Finally, cases with both abnormal cords and histologic thrombosis had significantly higher rates of adverse outcomes, including IUGR and stillbirth. CONCLUSION: Gross cord abnormalities predispose the fetus to stasis-induced vascular ectasia and thrombosis, thus leading to vascular obstruction and adverse neonatal outcome, including IUGR and stillbirth. We recommend a thorough histopathologic evaluation of all placentas with gross cord abnormalities predisposing to cord compression.