Search

ObjectiveTo summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).MethodsA prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults 6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.ResultsOf 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6–5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction6 ml, adjusted OR 0.75, 95%CI 0.60 to 0.92; p=0.0077) and relative (≥33%, adjusted OR 0.82, 95%CI 0.68 to 0.99; p=0.034) haematoma growth.InterpretationOverall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.PROSPERO registration numberCRD42019141136.

Attention deficit hyperactivity disorder (ADHD) is an inheritable neurodevelopmental condition, often coexisting with other psychiatric conditions and learning difficulties. This exploratory qualitative investigation sought to explore and advance knowledge on mental health recovery–oriented principles and practices for young people and their families. We examined factors identified by parents as promoting and enabling young people living with ADHD to lead an engaged and meaningful life despite experiencing the challenges of their condition. The study was guided by grounded theory with purposeful sampling deployed to recruit 11 parents (8 mothers and 3 fathers) of children with ADHD. Two focus groups adopting a semi-structured interview format were convened to collect data. The interviews were audio recorded and transcribed verbatim. Thematic analysis was employed and focused on the identification and organization of common themes and patterns observed across the dataset. Nine primary themes were identified as captured by the acronym THRIVESSS (Time, Having a plan, Routine and structure, Identity, Valued social supports, Educating and collaborating, Self-awareness, Self-acceptance, and Symptom control) and explicated by 22 subthemes. Results showed that personal recovery for young people with ADHD is a specific and definable construct which offers a conceptual and applied alternative to the deficit-focused view of ADHD. Our findings provide support for the pressing need to develop a novel lexicon to represent a mental health personal recovery pathway specific for young people and their families predicated upon a strength-based foundation.

Objective: In this paper we describe the origins of suicide prevention contracting, identify the historical factors that led to the adoption of the intervention, and describe legal tensions that have emerged during its use. Conclusions: It would appear that one of the most frequently used clinical interventions for responding to suicidality has established a place in clinical practice without evidence attesting to its efficacy. We develop some propositions about how and why this clinical technique has been able to consolidate its place in mental health practice and, in so doing, suggest that the original technique was able to secure a clinical place without much apparent resistance because of the confluence of a number of emerging theories and community trends.

Primary objective: To investigate body image concerns and psycho-emotional health in females with acquired brain injury (ABI). Research design: Between subjects design. Methods and procedures: Thirteen females with ABI and thirteen matched controls were assessed on a number of variables relating to body image, self-esteem and affect. Main outcomes and results: Indicated that women with ABI had a different profile of body image dissatisfaction than controls and that in some areas it was significantly worse. The women with ABI had significantly lower self-esteem and higher levels of depression than controls and this related to body image. Conclusion: Significant changes in body image and self-concept are potentially damaging to quality of life post-injury and suggest a role for targeted therapeutic work with women with ABI.

Acquired traumatic brain injury (TBI) can leave the survivor with a complex range of psychological sequalae. This study aims to investigate the experience from the perspective of women with acquired TBI. Using a qualitative research method, six women with a TBI were interviewed about their experience, and the interviews were transcribed verbatim and analysed according to Interpretative Phenomenological Analysis (IPA). The major themes that emerged were: awareness of change; the emotional reaction; struggling to make sense; adaptation and acceptance. This article describes the process of adaptation, and the implications for rehabilitation are discussed. It is suggested that an intervention based on these themes might be an effective tool in rehabilitation.

Penile cancer, although statistically rare in Western countries (1:100 000 per year), results in considerable physical and psychological morbidity. The treatment of choice for penile cancer is either partial or total amputation of the penis. Metastatic spread into the surrounding lymphatic system may require additional surgery. To date, little is known of the lived experiences of men with penile cancer regarding the impact of the disease and its treatment on dimensions of masculinity.A small-scale qualitative study using Interpretative Phenomenological Analysis (IPA). IPA aims at exploring the experience of life events and the meaning and implications for the person living through them. A purposive sample of men with penile cancer who were within a minimum of 18 months post-surgery were recruited via a specialist urology clinic (n = 9). Participants were interviewed by a male researcher using a pre-agreed semi-structured interview schedule; interviews were audio recorded for transcription with detailed analyses of main and sub-themes conducted independently by three researchers. To maintain analytical rigour, constant comparisons of main and sub-themes were made between the individual transcripts and across the emergent themes within the research group.Central themes were (1) grappling with reality; (2) learning to cope and (3) changes to self.That men should have an altered sense of masculine identity following penile cancer surgery is not unexpected. However, the ways in which altered masculinity manifested itself were both subtle and insidious. The results have implications for clinical practice and demonstrated the need for further research.

The mean numbers of interphase fibrillar centers have been determined in triplicate experiments, using the argyrophil (AgNOR) method. Promonocytic U937 cells were incubated with each of three inducing agents, namely, interleukin-6, granulocyte-macrophage colony-stimulating factor, and the phorbol ester 12-O-tetradecanoylphorbol-13-acetate. The cells were examined at 24, 48, and 72 h during the induction periods and their doubling time and mean AgNOR score were calculated. After 72 h, the cells were maintained in culture for a further 24 h in the absence of an inducing agent and these parameters were determined again. It was found that whereas the unstimulated U937 cells had a mean value in the region of 50 AgNORs per nucleus, this diminished to about 20 after a 72 h incubation, but rose to 30 or more when the inducing agents had been withdrawn for 24 h. These observation confirm the results of previous studies using melanoma and HL60 cell lines: however, it has now been demonstrated that a variety of agents can modulate the numbers of fibrillar centers in a very similar way in a single cell line. Furthermore, we have shown that the “undifferentiated” U937 cell AgNOR score recovers when the agents no longer act upon the cells; this implies that fibrillar center numbers are intimately related to differentiation state in cell lines, as in the case in, for example, tumor specimens.

A paper delivered to a Medicolegal Seminar conducted by the Medical Record Association of Australia — WA Branch entitled “Medicolegal Countdown — Do Your Health Records Meet Ethical and Legal Requirements?” in Perth on 25 August 1989.

For decades, emergency planning for natural disasters, public health emergencies, workplace accidents, and other calamities has been the responsibility of government agencies on all levels and certain nongovernment organizations such as the American Red Cross. In the case of terrorism, however, entirely new approaches to emergency planning are under development for a variety of reasons. Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if they are not monitored carefully.This article is designed to provide an overview of key issues for the pediatrician with respect to disaster, terrorism, and public health emergency preparedness. It is not intended to be a complete compendium of didactic content but rather offers an approach to what pediatricians need to know and how pediatricians must lend their expertise to enhance preparedness in every community. To become fully and optimally prepared, pediatricians need to become familiar with these key areas of emergency preparedness: unique aspects of children related to terrorism and other disasters; terrorism preparedness; mental health vulnerabilities and development of resiliency; managing family concerns about terrorism and disaster preparedness; office-based preparedness; hospital preparedness; community, government, and public health preparedness; and advocating for children and families in preparedness planning.

Psychiatric manifestations ofoitamin B-12 deficiency are reuieuiedfrom 1986 to thepresent. Specific clinical entities reviewed include depression, organic psychosis , obsessive-compulsive disorder, childhood manifestations and dementia. We recommend that consideration be given to B-12 deficiency as an etiological fa ctor in some cases qf depression, organic psychosis, certain childhood disorders and dementia. Routinescreening ofpeople overage65 is addressed. Vita min B-12 (Co ba la m in) deficien cy may be as high as 5% in populat ions over age 50 a nd up to 10% in patients over age 65 ( I). The deficiency can result from inad equate intak e (e .g., chro nic unbalan ced diet , breast -fed ba bies of vegan mothers), impaired abso rpt ion (e.g., gas t r ic lesions, pernicious anemia, gast rectomy, small bowel disease), vit amin B-12 degr ad at ion (e .g., nit ro us oxide anesthesia) , increased re quire me nt (e .g., pan cr eatic insu fficien cy, hype rthyroidism), or can be multifactoria l (e .g., chro nic a lcoho lism) ( 1-3) . Since the firs t rep ort of psychiatric sequelae by Addison in 1868 (4), a number of th e manifesta tion s of this deficiency hav e been recorded. H ect or a nd Burton reviewed th e lit erature up to 1986 (5) and cited the following diagn oses, or sympto ms, with a n et iology of B-12 deficiency: 20 pat ient s presen ted with delirium; 24 with depression ; 14 with psych osis; 65 with slow cerebration, confus ion, or mem ory loss; 4 with irritability or person ality cha nge; 15 with hallucinations or delusions; 4 with schizophre nia or paraphreni a ; 3 with mania; a nd 3 wit h dem entia. Recently, Lindenbaum e t al (6) found a number of psychi atric man ifestations of cobala min deficiency in th e 40 pati ents whom th ey stud ied. They found 15 patients who exhibite d combinations of th e followin g sympto ms : 13 wit h memory loss; 3 with disorientation; I with obtundation; 2 with depression ; I with irrit ability; 2 with hallucinations; I with agitation; 2 with marked personality cha nge ; and I with

The data in this paper show that when the inhibition of growth is measured, xeroderma pigmentosum (XP) complementation groups A, G and D are very sensitive to 4-nitroquinoline-1-oxide (4NQO), whereas only XP groups G and D are very sensitive to 3-methyl-4NQO (3me4NQO). Cells belonging to XP-C group are not particularly sensitive to either agent. Thus there are different epistasis groups for the excision repair of DNA adducts induced by these agents as opposed to the repair of u.v. damage. DNA polymerase alpha is involved in the repair of 4NQO-induced lesions because aphidicolin blocks their repair. XP cells from all the above groups are defective to some extent in this repair. The degree of repair defectiveness follows that seen after u.v., with even the XP-C cell line used having reduced repair (despite the fact that the inhibition of growth by 4NQO in this cell line was not markedly different from normal). Aphidicolin did not induce breaks in the normal or XP cell lines exposed to 3me4NQO, thus the repair of lesions induced by 3me4NQO does not involve DNA polymerase alpha in any of the cell lines. Finally, catalase reduces the alkaline labile lesions induced by 4NQO, but not 3me4NQO, suggesting the latter agent does not induce substantial amounts of DNA damage by the generation of radicals.

4-Nitroquinoline-1-oxide (4NQO) reacts with DNA primarily at the N2 and C8 of guanosine, with a small percent of reaction at the N6 of adenosine. In human cells it has been unclear whether or not all 4NQO-induced adducts are removed by a nucleotide excision repair mechanism. In this paper we demonstrate that the inhibitor of DNA polymerases alpha and delta, aphidicolin, blocks the repair of all 4NQO adducts. Hence excision repair must operate on all of these lesions. After 4NQO the residual excision repair seen in a xeroderma pigmentosum group A cell line virtually totally defective in UV repair was 40-60% of that in normal cells. Therefore there must be some differences between the excision repair operating on UV as opposed to 4NQO-induced DNA damage.

Auto racing is a diverse sport in terms of car design and sophistication, topography of race courses, speeds achieved, and driver experience. These factors relate directly to potential hazards of auto races and the approaches to safety utilized by the groups conducting these events. The evolution in recent years of technologically advanced racing machines capable of speeds exceeding 200 mph has mandated commensurate sophistication in acute medical care programs serving professional racing teams. A comprehensive team approach to the on-track evaluation and treatment of speed-sport-related trauma is described.