Trends in demographics and outcome of patients presenting with traumatic brain injury

OBJECTIVE: To analyze the trends in demographics and outcomes of patients presenting with traumatic brain injury by performing a retrospective database review of the Illinois Department of Public Health (IDPH) Trauma Registry.METHODS: We utilized the IDPH Trauma Registry to retrieve data on patients treated for traumatic brain injuries at our large, tertiary care hospital from 2004 to 2012, inclusive. From this data, logistic regression models were used to analyze and compare basic demographics such as age, sex, and clinical outcome.RESULTS: Three thousand and thirty-nine patients were analyzed with a mean age of 43 (standard deviation, 24) and a median age of 41 (interquartile range, 23 to 60). Over the study period, patients’ age increased steadily from 32 to 49 years. The percentage of female patients increased, from 16.4% to 27.5% over the last 4 years. Overall mortality was greater for males than females (22.1% vs. 17.3%; odds ratio [OR], 1.36; 95% confidence interval [CI], 1.10 to 1.68). Mortality decreased over the period (OR, 0.88; 95% CI, 0.85 to 0.91), with a greater decrease in females (OR, 0.84; 95% CI, 0.78 to 0.90) than in males (OR, 0.90; 95% CI, 0.86 to 0.94).CONCLUSION: Although the age of patients presenting with traumatic brain injury is increasing substantially, the data suggests that overall mortality appears to be decreasing, and this decrease appears to be greater in females than in males. These changes in trends found in the IDPH Trauma Registry supports the importance for further analysis of other reliable public datasets to identify areas of future study.

Current status of biosimilars in the treatment of inflammatory bowel diseases

Introduction of biological therapies have led to dramatic changes in the management of debilitating immune-mediated inflammatory bowel diseases (IBD) including ulcerative colitis and Crohn's disease. However, the long term use of these agents may be very expensive, placing a significant burden on National Healthcare Systems. The development of first biosimilar to infliximab, CT-P13 (Remsima; Celltrion Inc., Incheon, Korea and Inflextra; Hospiral, Lake Forest, Illinois, USA) has become another way to decrease the medical care cost and increase patient treatment option, but, actual equivalence of efficacy and safety of CT-P13 was investigated in rheumatic diseases only. The extrapolation of outcome from rheumatic trials to IBD and the interchangeability of CT-P13 with infliximab have come to be a matter of concern. Two recent retrospective studies reported the similarity of CT-P13 in terms of efficacy and safety. Infliximab biosimilars may be promising new treatment options for IBD patients, however, well-designed, prospective randomized non-inferiority trials should be needed to confidently integrate infliximab biosimilars into IBD treatment.

Women Infant and Children program participants' beliefs and consumption of soy milk : Application of the Theory of Planned Behavior

The purpose of this study was to determine if Theory of Planned Behavior (TPB) variables predict soy milk intake in a sample of WIC participants in 2 Illinois counties (n = 380). A cross-sectional survey was used, which examined soy foods intake, behavioral beliefs, subjective norms, motivation, and intention. Soy product intake was low at both sites, and many participants (40%) did not know that soy milk was WIC approved. Most (> 70%) wanted to comply with their health care providers, but didn't know their opinions about soy milk (50-66%). Intention was significantly correlated with intake (0.507, P < or = 0.01; 0.308, P < or = 0.05). Environmental beliefs (0.282 and 0.410, P < or = 0.01) and expectancy beliefs (0.490 and 0.636, P < or = 0.01) were correlated with intention. At site 1, 30% of the variance in intention to consume soy milk was explained by expectancy beliefs and subjective norm beliefs (P < 0.0001); at site 2, 40% of the variance in intention was explained by expectancy beliefs. The TPB variables of expectancy beliefs predicted intention to consume soy milk in WIC participants. Therefore, knowing more about the health benefits of soy and how to cook with soy milk would increase WIC participants' intention to consume soy milk. Positive messages about soy milk from health care providers could influence intake.

The Evaluation of Scattering Effects for Various Source Locations within a Phantom in Gamma Camera / 의학물리

(131)I is a radiological isotope being used widely for treatment of cancer as emitting gamma-ray and it is also applied to estimate the function of thyroid for its accumulation in thyroid. However, (131)I is more difficult to quantitate comapred to (99m)Tc, because (131)I has multiple energy gamma-ray emissions compared to (99m)Tc which is a mono energetic gamma-ray source. Especially, scattered ray and septal penetration resulted by high energy gamma ray have a bad influence upon nuclear medicine image. The purpose of this study was to estimate scatter components depending on the different source locations within a phantom using Monte Carlo simulation (GATE). The simulation results were validated by comparing with the results of real experiments. Dual-head gamma camera (ECAM, Chicago, Illinois Siemens) with high energy, general-purpose, and parallel hole collimators (hole radius: 0.17 cm, septal thickness: 0.2 cm, length: 5.08 cm) was used in this experiment. The NaI crystal is 44.5x59.1 cm in height and width and 0.95 cm in thickness. The diameter and height of PMMA phantom were 16 cm and 15 cm, respectively. The images were acquired at 5 different locations of (131)I point source within the phantom and the images of (99m)Tc were also acquired for comparison purpose with low energy source. The simulation results indicated that the scattering was influenced by the location of source within a phantom. The scattering effects showed the same tendency in both simulation and actual experiment, and the results showed that the simulation was very adequate for further studies. The results supported that the simulation techniques may be used to generalize the scattering effects as a function of a point source location within a phantom.

Application of BMS(TM) Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene

PURPOSE: Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.

Tuberculosis in the New World: a study of ribs from the Schild Mississippian population, West-Central Illinois

Vertebral lesions have been the main evidence for infection by the Mycobacterium tuberculosis complex (MTC) in paleopathology. Skeletal involvement is expected in a small percentage of infected individuals. Recently, several authors report a correlation between rib lesions and tuberculosis (TB) complex infection. This study tests the hypothesis that rib lesions can serve as a useful marker for MTC infection within the Mississippian Schild skeletal collection from West-Central Illinois. Ribs from 221 adults and juveniles were examined, and affected individuals were tested for TB complex infection. DNA from rib samples of affected individuals was amplified with primers targeting the IS6110 insertion element, which is common to all members of the TB complex. Although it cannot allow discrimination between different species of TB, IS6110 is present in many copies within their genomes, and its presence is thus an indication of MTC infection. The results support the use of rib lesions as a marker for TB infection. Additionally, we demonstrate that MTC DNA can be recovered from ribs that lack lesions in individuals who have lesions of other bones. We recommend that an examination of ribs be incorporated into investigations for TB.

Tensile bond strength between elastomeric impression materials and tray resins depending on the thickness of the tray adhesive / 대한치과보철학회지

STATEMENT OF PROBLEM: Elastomeric impression materials have been widely used to obtain an accurate impression. However there have not been enough studies on the influence of the thickness of the tray adhesives on the bonding strength between the trays and the elastomeric impression materials. PURPOSE: In order to understand the relationship between the thickness of the tray adhesive and the tensile bond strength and to suggest the thickness at which the bonding strength is strongest, tensile bond strength related to the thickness of adhesives of 3 different elastomeric impression materials were tested. MATERIALS AND METHODS: 3 impression materials, Permlastic(R) Regular Set(Kerr Corp., Romulus, Michigan, U.S.A.), Impregum(TM) Penta(TM)(3M ESPE, Seefeld, Germany), and Aquasil Ultra Monophase Regular Set Smart Wetting(R) (Dentsply Caulk, Milford, Delaware, U.S.A.), were used in this study, and tray adhesives from the same manufacturers of the impression materials were used, which were Rubber Base Adhesive, Polyether Adhesive, and Silfix, respectively. The tray specimens were prepared by autopolymerizing the tray material(Instant Tray Mix, Lang, Wheeling, Illinois, U.S.A.), and a PVC pipe was used to house the impression material. In group A, tray adhesives were applied in multiple thin layers of 1 to 5 and in group B, adhesives were applied only once, in the thickness equivalent to several applications. Lightness(L*) of the adhesion surface was measured with a spectrophotometer (CM-3500d, Konica Minolta, Sakai, Osaka, Japan). The tensile bond strength of the elastomeric impression material and the tray resin was measured with universal materials testing machines(Instron, Model 3366, Instron Corp, Nowood, Massachusetts, U.S.A.). A formula between the number of adhesive application layers and the lightness of the adhesion surface was deduced in group A, and the number of adhesive layers in group B was estimated by applying the lightness(L*) to the deduced formula. RESULTS: 1. In group A, a statistically significant increase in tensile bond strength appeared when the number of application layers increased from 1 to 2 and from 4 to 5, and no significant difference was present between 2, 3, and 4 layers in Permlastic. In Impregum, the tensile bond strength was significantly increased when the number of adhesive layers increased from 1 to 3, but no significant difference after 3 layers. In Aquasil, the tensile bond strength significantly increased as the number of application layers increased up to 4 but showed no significant difference between 4 and 5. 2. In group B, the tensile bond strength was decreased when the thickness of the adhesive increased in Permlastic. Impregum showed an increased tensile bond strength when the thickness of the adhesive was increased. In Aquasil, the tensile bond strength increased as the number of adhesive application layers increased up to approximately 2.5 layers but it sharply decreased after approximately 4.5. CONCLUSION: From the study, the common idea that it is better to apply a thin and single coat of tray adhesive needs correction in more detailed ways, and instructions on some of the tray adhesives should be reconsidered since there were several cases in which the tensile bond strength increased according to the increase in the thickness of the adhesives.

Estudo da função ventricular na técnica de plicatura da parede livre do ventrículo esquerdo em cães / Left ventricular function after plication of the left ventricular free wall in dogs

OBJETIVO: Avaliar os efeitos da técnica na função ventricular esquerda em cães hígidos e com cardiomiopatia dilatada induzida pela doxorrubicina. MÉTODO: De 13 cães, oito receberam doxorrubicina até que a fração de encurtamento (FE) fosse menor que 20 por cento. Destes, quatro animais e os cinco não induzidos foram submetidos à plicatura da parede livre do ventrículo esquerdo (PPLVE). Os demais cães não foram operados. Foram avaliados débito cardíaco (DC), pressão arterial, exame físico, eletrocardiografia, sistema "Holter" e ecocardiografia, por 180 dias. RESULTADOS: Houve redução do volume ventricular esquerdo. Os cães induzidos melhoraram após a operação e a fração de ejeção (FEj) retornou aos valores normais para a espécie. O DC e a FE aumentaram após a operação. Um cão foi a óbito. Nos cães não operados, a FE diminuiu e foram a óbito em torno de 40 dias após a indução; nos cães não induzidos, esta não se alterou. Houve extra-sístoles ventriculares, que se resolveram espontaneamente. CONCLUSÕES: A PPLVE sem circulação extracorpórea reduz o volume ventricular esquerdo e melhora a função cardíaca dos cães com cardiomiopatia dilatada induzida pela doxorrubicina, demonstrando baixa morbidade e mortalidade tardia.

A Comparative Study on Spiritual Well-being and Perceived Health Status between Korean and Korean-American / 성인간호학회지

PURPOSE: The purpose of this study is to compare spiritual well-being and perceived health status between Korean and Korean-American and to provide basic data that might develop comprehensive health care program including spiritual dimension. METHOD: The subject of the study were 411 adults chosen from religious organization located in Gyeongsang Province, Korea and Chicago, U.S.A.. The instruments used in the study were Spiritual Well-being Scale by Paloutizian and Ellison and Health Self Rating Scale by North Illinois University. Analysis of data was done by using descriptive statistics, Pearson correlation coefficient, ANCOVA, ANOVA and Duncan test with SPSS program. RESULT: 1) The mean score of spiritual well-being of Korean was 3.17 and Korean-American was 2.63, there was significant difference between two groups. 2) Perceived health status of Korean was 2.37 and perceived health status of Korean-American was 2.54, there was significant difference between two groups. CONCLUSION: According to this study, it is important to take into considerations spiritual aspects and cultural and environmental elements in developing the comprehensive health care program.

Determinants of Health-Promoting Behavior in the Elderly / 기본간호학회지

This study was undertaken to grasp health-promoting behavior of the elderly and to identify variables related to them in order to facilitate nursing intervention for health promotion of this population. The subjects for this study were 291 old persons obtained by cluster sampling from twenty general social welfare centers located in Tague. Data were collected by self-reported questionnaires from August 13 to September 13, 1996. Questionnaires were developed based on Sherer and others Self-Efficacy scale, Rosenberg's Multidimensional Health Locus of Control scale, Northern Illinois University's Health Self Rating Scale, Walker and others' Health Promotion Lifestyles Profile. Analysis of the data was done by use of descriptive statistics, stepwise multiple regression, Pearson Correlation Coefficient, MANOVA, t-test, and ANOVA. The results were summarized as follows : 1. For the practice of health-promoting behavior, the mean score was 2.89 and range was 3.59 to 2.09. The factor of the highest mean score was regular diet(M=3.42) and factor of the lowest mean score was stress management(M=2.27). 2. The combination of self-efficacy, internal health locus of control, family number, and average monthly pocket money explained 30.0% of the variance of health-promoting behavior. 3. With regard to the relationship between health-promoting behavior and cognitive perceptual factor, self-efficacy correlated positively with health-promoting behavior(r=.4951, P=.0001), self-esteem correlated positively(r=.3263, P=.0001), internal health locus of control correlated positively(r=.3244, P=.0001), perceived health status correlated positively(r=.1355, P=.0274). 4. According to age(F=2.50, P=.0431), sex(t=2.14, P=.0332), marital status(F=7.85, P=.0005), education(F=5.44, P=.0003), family number(F=11.18, P=.0001), people living together(F=7.21, P=.0009), previous occupation(F=5.83, P=.0001), average monthly pocket money(F=7.27, P=.0001), there were differences of health-promoting behavior. The above findings show that health-promoting behavior are related to demographic characteristics, four cognitive perceptual factors(self-efficacy, self-esteem, internal health locus of control, perceived health status). On the basis of the above findings the following recommendations are made; 1. Nursing interventions enhancing exercise or activity, accountability for health, stress management of the elderly must be provided. 2. Nursing strategies enhancing self-efficacy which is most significant effect on health-promoting behavior must be developed.

Analysis of Factors Affecting Problem Based Learning / 한국의학교육

The University of Yonsei College of Medicine is implementing a new undergraduate curriculum that emphasizes active, self-directed learning. The aims of this study were to investigate the factors affecting problem-based le arning(PBL). We surveyed 169 senior students of medical college in Yonsei University. Among them, 137(82.0%) students answered. We developed a question form on seven areas, centering the factors affecting problem-based learning: small-grouping learning, teachers, teaching-learning environments, learning methods, working problem, assessment, the awareness on the problem-based learning method. Those questions were developed as five point scale and were conducted on April 26, 1997. The results of this study are like this: First, the factors affecting problem-based learning appear as working problem, teaching-learning environments, teaching-learning materials. Second, no difference based on working problem form was found. However, the group which used Harvard Working Problem proved to be think more positively than the group which used Illinois Working Problem. As the most important factors affecting problem-based learning appeared as working problem, teaching-learning environments and learning materials, so we should develop the environments and materials promoting self-regulated learning. Finally, the continuous and systematic study on problem-based learning is needed.