Association of depressive symptoms with functional outcome after traumatic brain injury.

OBJECTIVE: To test whether improved functional status correlates with more depressive symptoms after traumatic brain injury (TBI). This is based on the concept that increasing awareness of deficits may exacerbate depression, even while survivors are making functional improvements. PARTICIPANTS: A total of 471 individuals with TBI (72% white; 71% men; median Glasgow Coma Scale (GCS) score = 11) enrolled during acute care or inpatient rehabilitation and followed up at a median of 6 months. MAIN MEASURE: Beck Depression Inventory-II (BDI-II), Glasgow Outcome Scale-Extended, and Functional Status Examination (FSE). RESULTS: We found significant Spearman rank order correlations between BDI-II scores and the total FSE as well as all domains of the FSE. Lower functional levels correlated with more depressive symptoms. Modeling of predictive factors, including subject characteristics, injury-related characteristics, and outcome measures, resulted in 2 models, both containing age and GCS along with other factors. CONCLUSION: The relation between depressive symptoms and functional outcomes is complex and a fertile area for further research. The authors would encourage clinicians to monitor patients for depressive symptoms to help to prevent the detrimental impact on recovery.

The fats of life: the role of omega-3 fatty acids in the prevention of coronary heart disease.

Epidemiological and clinical trial evidence suggests that omega-3 polyunsaturated fatty acids (PUFAs) might have a significant role in the prevention of coronary heart disease. Dietary sources of omega-3 PUFA include fish oils rich in eicosapentaenoic acid and docosahexaenoic acid along with plants rich in alpha-linolenic acid. Randomized clinical trials with fish oils (eicosapentaenoic acid and docosahexaenoic acid) and alpha-linolenic acid have demonstrated reductions in risk that compare favorably with those seen in landmark secondary prevention trials with lipid-lowering drugs. Several mechanisms explaining the cardioprotective effect of omega-3 PUFAs have been suggested, including antiarrhythmic, hypolipidemic, and antithrombotic roles. Although official US guidelines for the dietary intake of omega-3 PUFAs are not available, several international guidelines have been published. Fish is an important source of omega-3 PUFAs in the US diet; however, vegetable sources, including grains and oils, offer an alternative source for those who are unable to regularly consume fish.

Affective illness in children and adolescents: patterns of presentation in relation to pubertal maturation and family history.

Affective illness is now recognized as a common problem in all age groups, and the various patterns have been well documented in adults. The objective of this study was to evaluate the patterns of affective illness in children and determine changes with increasing age and family history. One hundred children/adolescents with affective illness (72 boys and 28 girls; age range 2-20 years; mean age 10 years), who were consecutively referred to the Pediatric Behavioral Neurology Program, Children's Medical Center at Dallas, were evaluated for the pattern and course of affective illness symptoms, family history, and pubertal stage. Seven patterns of affective illness were identified. In the 65 prepubertal children (Tanner stage 1), disorders with hypomanic/manic symptomatology were most common (47/65, 72%): mania (2/65, 3%), hypomania (8/65, 12%), cyclothymia (11/65, 17%), juvenile rapid-cycling bipolar disorder/ultradian cycling bipolar disorder (8/65, 12%), and dysthymia with bipolar features (18/65, 28%). In contrast, the 26 fully pubertal adolescents (Tanner stages 3-5) had a predominance of patterns with only depressive symptomatology (16/26, 61%): dysthymia (4/26, 15%) and depression (12/26, 46%), along with juvenile rapid-cycling bipolar disorder/ultradian cycling bipolar disorder (6/26, 23%). Affective illness, alcoholism, and drug abuse were prominent in the family histories, regardless of the child's pattern of symptoms. Family histories of character disorder and Briquet's syndrome were also common, but thought disorder, suicide, and homicide were infrequent. This study supports the clinical observation that the presentation of affective illness changes with age: manic features predominate in younger children, whereas depressive symptomatology is more evident with pubertal maturation.

New perspectives on the management of low levels of high-density lipoprotein cholesterol.

A low serum high-density lipoprotein cholesterol (HDL-C) level is a potent predictor of coronary heart disease (CHD). It has been estimated that 11% of US men have isolated low HDL-C levels, and there is uncertainty regarding the management of these patients. A cause-and-effect relationship between low HDL-C levels and CHD is supported by epidemiological, animal, and human clinical studies. We reviewed the structure and function of HDL-C and its role in preventing atherosclerosis. We then suggested an approach to the patient with isolated low HDL-C that may be useful to the primary care physician. An algorithm was proposed for use in patients with existing CHD, while the decision to treat patients without CHD was based on their score on the Framingham Heart Study risk prediction chart.

Properties of crimpable archwire hooks: a laboratory investigation.

The aim of the present study was to utilize a strain gauge, which enabled the force applied to produce firmly attached crimpable hooks to rectangular stainless steel arch wires, to be measured. In vitro testing of two hooks, American Orthodontic (AO) and TP Orthodontic (TP), and two dimensions of stainless steel archwire, 0.019 x 0.025 and 0.018 x 0.025-inch, was carried out using an Instron Universal Testing machine. The results demonstrate that there was a significant difference in the behaviour of the two types of crimpable hooks, with almost twice the force needed to dislodge the TP hooks compared with the AO hooks (11.7 and 6.22 N, respectively). When using TP hooks attached to either 0.019 x 0.025 or 0.018 x 0.025-inch stainless steel wires, the archwire size makes little difference to the force required to produce movement. The clinical significance of these findings is discussed.

Use of the Symbol Language and Communication Battery in the physician's office for assessment of higher brain functions.

Higher brain functions are readily observable within the office setting. The Symbol Language and Communication Battery offers a systematic approach to evaluation, with resultant reproducible findings. It should be part of the neurologic evaluation for children who are having difficulty in their environments, with the differences in communication skills categorized into specific syndromes.

Vigilance and its disorders.

Vigilance has been defined as steady-state alertness-wakefulness. The right cerebral hemisphere, predominantly the right inferior parietal lobule and posterior parietal cortices, seems specialized for vigilance. Studies of the primary disorder of vigilance, a genetically determined condition, should provide a better understanding of the neurobiology of vigilance. Common causes of secondary hypovigilance (depression, learning disability, narcolepsy, and acquired focal right cerebral hemisphere brain lesions) explain the symptom complex of ADHD. If these specific entities producing hypovigilance are correctly identified, treatment is successful and with favorable outcome. The neuroanatomic substrate of lowered vigilance seems to be loss of modulating influence of the right cerebral hemisphere on the diencephalon and select brain stem nuclei. We propose that the right (more than the left) cerebral hemisphere is responsible for alertness and wakefulness (vigilance) with the reticular formation being accountable for sleep.

A practical approach to children failing in school.

The most likely causes of failure in school in otherwise capable children who come from homes in which they are loved and cared for are learning disabilities, affective illness, primary disorder of vigilance and, on occasion, narcolepsy. The various learning disabilities are often accompanied by problems of attention, concentration, organization, mood and feelings, and social interaction. These latter problems are reflections of biochemical disorders that respond effectively to judicious pharmacologic intervention. When this type of medical management is combined with constructive counseling and suitable curriculum adjustments, the child can attain his or her maximum education potential and become a productive and contributing adult member of society.

Airline pilot alcoholism: one airline's experience.

The rehabilitation program at United Airlines strives for early identification of alcoholics, with constant monitoring by an educated team consisting of the flight surgeon, flight manager, and union representative. Confidentiality is essential and great caution and planning are required before confronting a suspected alcoholic pilot. UAL now has over 120 recovering pilots with an average rehabilitation time of 4 months and remission time of 3 years, by which time the probability of relapse has returned to baseline.