Body-Region-Specific Injuries as Predictors of Psychosocial Outcomes Among Those Injured in Combat: Results From the Wounded Warrior Recovery Project

Associations between body region injured and psychosocial outcomes may have implications for injury prevention and mitigation strategies. The present study investigated the association of body-region—specific injuries and their association with 3 psychosocial outcomes (i.e., quality of life, QOL; posttraumatic stress disorder, PTSD; and depression) among a large sample of U.S. military service members injured in combat. A total of 1,011 individuals wounded in combat enrolled in the Wounded Warrior Recovery Project and provided QOL, depression, and PTSD measures on a Web-based survey. These psychosocial variables were linked with the presence/absence of combat injuries in 9 different body regions (head, face, neck, thorax, spine, abdomen, upper extremity, lower extremity, and external skin/other), as well as overall injury severity and demographic factors. Two-step hierarchical linear regressions revealed that after adjusting for overall injury severity and time since injury, those with combat-related head and spine injuries were particularly at risk for relatively worse psychosocial outcomes. Head and spinal injuries were associated with lower QOL and higher PTSD and depression. Overall, even those with relatively minor injuries may be at risk of lower QOL and adverse psychosocial outcomes. These findings may highlight the need for early interventions to minimize the psychological effects of combat injuries to the head and spine.     

Neuropsychological profiles of six children with anoxic brain injury

Anoxic brain injury (ABI) often results in severe memory impairment and other cognitive and behavioral deficits, although limited information is available regarding pediatric cases. This study reported the neuropsychological outcomes in six children and adolescents who sustained ABI. Profiles were compared by mechanism of injury (ischemic vs. hypoxemic) and three cases were evaluated more than once. Severe intellectual, attention, memory, and behavioral impairments were observed in all six cases although academic achievement, internalizing behavioral problems, and visuospatial deficits were in general less severe than other cognitive and behavioral deficits. The longitudinal case studies varied but showed steady increases in memory and intellectual performance in the younger children with strongest improvement in nonverbal abilities and little change in parent-reported behavior. This study raises several possible hypotheses about specific cognitive and behavioral outcomes observed in pediatric ABI.     

Agreement between Parents and Children on Ratings of Post-Concussive Symptoms Following Mild Traumatic Brain Injury

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.     

Parenting and the dysregulation profile predict executive functioning in children with acquired brain injury

Background: Children with acquired brain injury (ABI) present with high rates of psychological disorders commonly accompanied by deficits in hot and cold executive functions (EFs). Impairments in EFs have been reported to precede mental health problems. Moreover, children who are vulnerable to developing mental health problems in adulthood frequently present with a dysregulation profile in childhood, characterized by impairments in cognitive, behavioral and emotional regulation. Objective: To identify profiles of behaviors associated with impairment in hot and cold EFs and compare injury factors, environmental stressors and dysregulation profile between them. Methods: A latent profile analysis was conducted with 77 children with ABI aged between 6 and 12. Injury factors, child IQ, environmental stressors and the dysregulation profile were compared between these behavioral profiles. Logistic regressions were conducted to predict profile membership. Results: Two profiles were identified: Profile M, with mild deficits (1–2 SD above the mean) in working memory and social skills, and profile C, presenting clinically significant deficits (2–3 SD above the mean) in shift, initiate, working memory, planning and social skills and mild deficits in inhibit, emotional control and task monitor. Proximal environmental stressors (dysfunctional parenting practices, parental stress, parent’s executive dysfunction, anxiety-trait, and depressive symptoms) and dysregulation symptoms predicted profile membership, whereas injury factors, child IQ and distal environmental stressors did not. Conclusion: Following ABI, children with profile C are at risk of mental health problems and present with more proximal stressors. The dysregulation profile may be useful as a proxy for risk for later mental health problems in children with ABI.     

Using Medical Family Therapy with Parents of an Adult Child with Traumatic Brain Injury

Abstract

Acquired traumatic brain injury (ATBI) is a public health concern causing approximately 2.5 million emergency room visits in the United States annually. Medical family therapy (MedFT) displays how biological issues impact each area of a client’s life. This paper highlights how MedFT can be utilized with parents of an adult child with ATBI; the case is presented as treatment occurred with benefits of the inclusion of MedFT. Researchers propose a call to the field of marriage and family therapy to increase access of MedFT to afford more opportunities to help families who experience medical conditions.     

胃部恶性肿瘤临床实践中的医疗艺术

医学是一门讲求艺术性的科学.随着社会的发展,医疗艺术在整个医学临床实践中的重要性越来越突出.医疗艺术体现了医生对生命的尊重和伦理的理解.讲求医疗艺术对于建立和谐的医患关系具有重要意义.因此,如何在过硬的现代医学技术基础上提高临床医疗的艺术性,是医学教育和临床实践领域都应该思考的问题.本文以胃部恶性肿瘤的临床实践为例,从态度、语言、表情以及医患互动等细节方面入手,探讨在初诊、术前、康复以及面对晚期临终患者的不同情况中应该如何提高医疗艺术.     

外伤性脑梗死的病因分析与防治策略

外伤性脑梗死是颅脑外伤患者比较常见且严重的一种并发症.其病因主要是脑血管壁损伤、血管受机械牵拉挤压、脑血管痉挛及低灌注、氧自由基及其他血管活性物质的改变.随着影像技术的发展进步,外伤性脑梗死的早期诊断已基本能做到,了解其主要发病机制以后,针对性地给予扩容,保证脑灌注压.通过提早预防、早期手术和内科药物、物理治疗方法,改善预后.     

Pediatric traumatic brain injury: Language outcomes and their relationship to the arcuate fasciculus

Pediatric traumatic brain injury (TBI) may result in long-lasting language impairments alongside dysarthria, a motor-speech disorder. Whether this co-morbidity is due to the functional links between speech and language networks, or to widespread damage affecting both motor and language tracts, remains unknown.     

Social Skills Training in Two Subtypes of Psychiatric Inpatients with Generalized Social Phobia

The aim of this study was to investigate the differential effectiveness of broad-spectrum group social skills training (SST) in two subtypes of psychiatric inpatients with a DSM-IV diagnosis of generalized social phobia (GSP). SST participants were assigned to two GSP subtypes on the basis of their level of performance in social situations, i.e., a “reticent” subtype ( n = 28) and a “non-reticent” subtype (n = 28). As hypothesized, it was revealed that the benefit of SST did not differ in the two subtypes. These findings support the effectiveness and feasibility of comprehensive SST for patients with two subtypes of generalized social phobia.