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Slipped capital femoral epiphysis is an important hip condition that is steadily increasing in incidence. Clinicians and health-care workers who regularly work with children or adolescents need to be fully aware of its presenting features and diagnostic pathways to prevent a delay in diagnosis. [ABSTRACT FROM AUTHOR]

As part of a prospective study of closed head injury, 54 relatives were interviewed within a month of the patient's accident and again six and twelve months later. The degree of stress on the relatives was measured by means of the Wakefield Depression Scale and by interview questions. The worst period of stress for the majority of relatives appeared to be during the first month after the accident. However, the degree of stress appeared to level off by the sixth month and no further diminution was found at twelve months. Stress was apparently mediated by the relatives' perception of personality changes and subjective defects. It was not affected by the severity of the head injury or associated disabilities, nor by whether the patient had resumed work and leisure activities. The nature of the stress is analysed and methods of alleviating it discussed. [ABSTRACT FROM AUTHOR]

A group of severely head injured patients were reassessed 7 years after injury. This group was the same as that previously reported 2 years after injury. There was no change in their physical or cognitive status; personality problems were still commonly reported but the less disabled had made further progress in returning to their former level of vocational and social activity. [ABSTRACT FROM AUTHOR]

A group of 54 patients who had suffered severe closed head injury (PTA >24 hours) were followed from the time of their injury for a period of two years. Relatives were interviewed within the first four weeks to assess the patient's previous personality and social adjustment. Patients and relatives were then assessed personally six and 12 months later and by postal questionnaires after two years. Only six patients were still not back at work after two years but more had not resumed all their leisure activities. Family relationships appeared to have settled down again by this stage but social contacts were still less frequent. Personality changes were associated with prior family relationships, cognitive changes with diminished social contacts whilst premorbid personality and physical deficits were associated with time taken to return to work. [ABSTRACT FROM AUTHOR]

The level of social recovery achieved by a representative series of 50 young adults was assessed six months after a severe closed head injury (post-traumatic amnesia greater than 24 hours). Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process. Many patients were still suffering from subjective symptoms, but these appeared to have relatively minor effects on ability to resume normal activities. Physical disability was a much more important factor at this stage. A control group of patients with limb injuries suffered similar disruption of their lives, but reported few subjective complaints. [ABSTRACT FROM AUTHOR]

The article presents a case study of 22-year old woman with a history of a slow growing mass at her right lateral foot for three years. Magnetic Resonance Imaging (MRI) was taken and surgical biopsy was performed for diagnostic purposes. The biopsy showed granulomatous infiltration of fungal hyphae and was diagnosed with Madurella mycetomatis. Surgical excision was performed for curative purposes together with the intake of antifungal drugs.

Objective : To investigate the characteristics of head injury (HI) and its association with offending behaviour, psychological and neurobehavioral functioning, and cognitive performance in female prisoners. Methods : Using a cross-sectional design, female prisoners in the UK reporting a HI with a loss of consciousness (LOC) over ten minutes (n = 10) were compared with a group without a HI with LOC over ten minutes (n = 41) across a range of measures; including scores on standardized clinical questionnaires and performance-based cognitive assessments. Semi-structured clinical interviews assessed HI and forensic history, with forensic history triangulated against the prison database. Results : Domestic abuse was the most frequently reported cause of HI. The HI with LOC group had been to prison a greater number of times and had committed a greater number violent offences. No significant difference was found on self-reported psychological and neurobehavioral measures, or between the groups' cognitive functioning on neuropsychological tests. Conclusions : Psychosocial factors such as trauma may contribute to higher rates of violent offending and imprisonment in those with a HI with LOC. Domestic abuse is an important factor in HI amongst female prisoners. Forensic screening and interventions need to be designed, adapted and evaluated with consideration of trauma and HI.

To evaluate the efficacy of neurobehavioural rehabilitation (NbR) programmes, services should employ valid, reliable assessment tools; the ability to detect change on repeated assessment is a particular requirement. The United Kingdom Rehabilitation Outcomes Collaborative (UKROC) requires neurorehabilitation services to collect data using a standardized basket of measures, but the responsiveness and usefulness of using these in the context of NbR remains unknown. Anonymous data collected at two assessments for 123 people were examined using multiple methods to determine responsiveness of four outcome measures routinely used in NbR (HoNOS-ABI, FIM + FAM UK, MPAI-4, SASNOS). Predictive validity of two measures of rehabilitation complexity (RCS-E, SRS) regarding the extent of difference scores on these outcome measures at reassessment was also determined. All four outcome measures demonstrated responsiveness, with higher levels for SASNOS and MPAI-4 when only participants categorized as "most likely to change" at first assessment were analyzed. Predictive validity of the RCS-E and SRS in estimating the extent of change was variable. SRS was only predictive of improvement on the MPAI-4 whilst RCS-E was not predictive at all. Recommendations are made regarding ideal characteristics of NbR outcome measures, along with the need to develop measures of rehabilitation complexity specifically conceptualized for these programmes.

The aim of this study was to investigate the psychometric properties and screening accuracy of the Brain Injury Screening Index (BISI), a self-report questionnaire designed to identify a history of acquired brain injury. The study was conducted in a closed male prison in the UK. The purposive sample comprised 55 male prisoners who arrived at the establishment during the study. A repeated measures design was used, where the Brain Injury Screening Index (BISI) was administered on three occasions. Inter-rater reliability was poor to moderate, but test retest reliability was moderate to good. Medical records were not available for all participants, but the limited number obtained resulted in a sensitivity of .38 to .71 and specificity of .47 to .70 across the three screening administrations of the BISI. The limitations of the present findings are discussed in the context of the use of the tool in custodial environments. It is argued that these results suggest that, when used as recommended, the BISI has acceptable reliability and validity as an initial screen for identifying individuals who should receive support and a comprehensive neuropsychological assessment, and it merits further investigation and development.

There is a high prevalence of traumatic brain injury (TBI) in prisoners, but screening tools for identifying TBI in female prisoners are not readily available. Using a cross-sectional design, the psychometric properties of the Brain Injury Screening Index (BISI) were investigated in a closed United Kingdom female prison. Purposive sampling comprised 56 females. Assessment included clinical interview, the BISI, self-report measures of mood, and a battery of measures of cognitive functioning. Seven of the 10 clinical indicators on the BISI met test-retest reliability criteria. Two of the three BISI summary variables demonstrated correlations with questionnaires in the hypothesized directions; however, only two BISI variables were associated with cognitive functioning. Findings support further investigation into the validity and reliability of the BISI with a larger sample.

Purpose: Neurorehabilitation aims to increase independence and participation in ordinary life. It is argued that the fundamental indices of this are independent living and engagement in occupational or productive activity. The Brain Injury Rehabilitation Trust Independent Living Scale was designed to capture change in levels of participation and independence following neurorehabilitation. With greater use of outcome measures in health care, it becomes necessary to develop tools which are simple to use and that capture the holistic impact of rehabilitation. This study examines the inter-rater reliability and validity of the Brain Injury Rehabilitation Trust Independent Living Scale, which comprises two single item, multiple-choice sub-scales., Method: Inter-rater reliability was assessed by comparing the ratings on the Brain Injury Rehabilitation Trust Independent Living Scale, by five pairs of graduate psychologists, of 37 individuals who had undergone neurorehabilitation. Retrospective data collected by other members of the clinical team for the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and Care And Needs Scale were correlated with the Brain Injury Rehabilitation Trust Independent Living Scale to establish concurrent validity., Results: Weighted kappa coefficients revealed moderate (occupation) to strong (accommodation) inter-rater reliability for the two sub-scales. All correlations between the Brain Injury Rehabilitation Trust Independent Living Scale and the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and the Care And Needs Scale were high, demonstrating good concurrent validity., Conclusions: This study highlights some of the psychometric properties of the Brain Injury Rehabilitation Trust Independent Living Scale and demonstrates its utility in assessing independent living ability and level of social participation after neurorehabilitation. Implications for rehabilitation The BIRT Independent Living Scale is a validated method for ranking accommodation and occupation status as an indicator of independent living ability and occupational activity. The two freely available single-item scales emerging from this study provide a brief method for measuring independent living ability and participation following rehabilitation in research and clinical practice. The BIRT Independent Living Scale's simplicity means it does not require specific training to administer, facilitating its use by a wide range of multidisciplinary staff members and researchers.

X-linked hypophosphatemia (XLH) is the most common monogenic disorder causing hypophosphatemia. This case-note review documents the clinical features and the complications of treatment in 59 adults (19 male, 40 female) with XLH. XLH is associated with a large number of private mutations; 37 different mutations in the PHEX gene were identified in this cohort, 14 of which have not been previously reported. Orthopaedic involvement requiring surgical intervention (osteotomy) was frequent. Joint replacement and decompressive laminectomy were observed in those older than 40 years. Dental disease (63%), nephrocalcinosis (42%), and hearing impairment (14%) were also common. The rarity of the disease and the large number of variants make it difficult to discern specific genotype-phenotype relationships. A new treatment, an anti-FGF23 antibody, that may affect the natural history of the disease is currently being investigated in clinical trials.

Deficits in social cognition following acquired brain injury (ABI) have been found to be both prevalent and disabling. Despite this, relatively little attention has been given to identifying the characteristics of such deficits in a systematic way. We describe the development of self and informant versions of a new questionnaire designed to measure the changes in social cognition that may occur following ABI, the Brain Injury Rehabilitation Trust (BIRT) Social Cognition Questionnaire (BSCQ). Seventy-two participants (Mean age  = 36 years, SD = 12), with different forms of ABI (76% traumatic brain injury, 8% cerebrovascular accident, 15% other) and who were on average 20 months post-injury (SD = 16), took part in the study. The measure demonstrates excellent psychometric properties, including high test-retest (.94) and split-half (.92) reliability, high internal consistency (Cronbach's alpha = .92), and good concurrent validity. The questionnaire measures characteristics that are distinguishable from measures of cognitive ability. There was moderate overlap between self-report and informant versions of the questionnaire (r = .50), but the informant version had the strongest predictive value of outcome, measured with the Mayo-Portland Adaptability Inventory III, one year later. The potential uses of the measure in relation to theory and practice are discussed. The results suggest that the BSCQ is a useful screening tool for those with ABI.

Evidence suggests that traumatic brain injury (TBI) is more prevalent amongst offender populations than in the general population, and that it can lead to aggressive behaviour while in custody and impair engagement with offender rehabilitation programmes. The aim of this study was to develop, implement, and evaluate a brain injury Linkworker approach designed to support prisoners who report a significant TBI or multiple mild TBIs. Three clinical case examples are reported to illustrate the conceptual foundations of the approach and to demonstrate the feasibility of the service. Early results showed that engagement with a Linkworker led to effective identification of key areas of intervention and resulted in better integration for prisoners while in custody and in enhancement of the outcomes of offender rehabilitation. These initial findings provide justification for wider implementation and systematic evaluation of the efficacy of this model of service.

The aim of this study was to describe the translation and adaptation of the BIRT personality questionnaires for the Italian population. This included the replication of validity testing and the collection of normative data. Following translation and adaptation according to cross-cultural guidelines, the questionnaires were administered as a pre-test to a sample of 20 healthy subjects and then to 10 patients. The questionnaires were then administered to 120 healthy subjects equally distributed by sex, education, and age, to collect normative data from an Italian population. The questionnaires were easily administered to both healthy subjects and patients. Statistical analysis on normative data was conducted to find the mean value for each questionnaire. This study lays the foundations for using a new instrument to assess behavioral changes after acquired brain injury on the Italian population.

Risk factors for head injury are also risk factors for becoming homeless but there is little research on this vulnerable group, who can be neglected by health services that specialize in acquired brain injury. This study investigates the prevalence of admissions to hospital with a head injury in the homeless and associations with later mortality. It compares homeless people with and without a record of hospitalized head injury (HHI) and the Glasgow population. Data were obtained from a U.K. National Health Service strategy to enhance care of the homeless. This included development and production of local registers of homeless people. In Glasgow, the initiative took place over a seven-year period (2004-2010) and comprised 40 general practitioner (family practice) services in the locality of 55 homeless hostels. The register was linked to hospital admissions with head injury recorded in Scottish Medical Records and to the General Register of Scotland, which records deaths. A total of 1590 homeless people was registered in general practitioner (family doctor) returns. The prevalence of admission to hospital with head injury in the homeless over a 30-year period (13.5%) was 5.4 times higher than in the Glasgow population. In the homeless with HHI, 33.6% died in the seven-year census period, compared with 13.9% in the homeless with no hospitalized HI (NHHI). The standardized mortality ratio for HHI (4.51) was more than twice that for NHHI (2.08). The standardized mortality ratio for HHI aged 15-34 (17.54) was particularly high. These findings suggest that HHI is common in the homeless relative to the general population and is a risk factor for late mortality in the homeless population.

This study employed a correlational and group comparison design to investigate whether self-report of traumatic brain injury (TBI) in a sample of male prisoners screened using the Brain Injury Screening Index (BISI) was associated with impaired cognitive performance on standardised questionnaires and neuropsychological tests. A total of 139 male prisoners who reported having suffered a TBI in the BISI were interviewed, and completed further questionnaires and neuropsychological assessments. Their results were compared to 50 prisoners who had no reported history of TBI. The results of the screening questionnaire correlated with responses in a follow-up interview, with self-report questionnaires of neurobehavioural disorder (.31 to .50) and neuropsychological measures (-.24 to -.45). The "TBI Index", an indicator summarising the number and severity of self-reported injuries in a single score, also correlated well with scores on formal neuropsychological tests (-.20 to -.42). Self-report of traumatic brain injury among prisoners is consistently associated with measurable neuropsychological and neurobehavioural disability. The implications of these findings for current practice in identifying and referring individuals to specialist services are considered.