Head and neck burns are associated with long-term patient-reported dissatisfaction with appearance: A Burn Model System National Database study.

INTRODUCTION: Burns affecting the head and neck (H&N) can lead to significant changes in appearance. It is postulated that such injuries have a negative impact on patients' social functioning, quality of life, physical health, and satisfaction with appearance, but there has been little investigation of these effects using patient reported outcome measures. This study evaluates the effect of H&N burns on long-term patient reported outcomes compared to patients who sustained burns to other areas. METHODS: Data from the National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System National Database collected between 1996 and 2015 were used to investigate differences in outcomes between those with and without H&N burns. Demographic and clinical characteristics for adult burn survivors with and without H&N burns were compared. The following patient-reported outcome measures, collected at 6, 12, and 24 months after injury, were examined: satisfaction with life (SWL), community integration questionnaire (CIQ), satisfaction with appearance (SWAP), short form-12 physical component score (SF-12 PCS), and short form-12 mental component score (SF-12 MCS). Mixed regression model analyses were used to examine the associations between H&N burns and each outcome measure, controlling for medical and demographic characteristics. RESULTS: A total of 697 adults (373 with H&N burns; 324 without H&N burns) were included in the analyses. Over 75% of H&N injuries resulted from a fire/flame burn and those with H&N burns had significantly larger burn size (p<0.001). In the mixed model regression analyses, SWAP and SF-12 MCS were significantly worse for adults with H&N burns compared to those with non-H&N burns (p<0.01). There were no significant differences between SWL, CIQ, and SF-12 PCS. CONCLUSIONS: Survivors with H&N burns demonstrated community integration, physical health, and satisfaction with life outcomes similar to those of survivors with non-H&N burns. Scores in these domains improved over time. However, survivors with H&N burns demonstrated worse satisfaction with their appearance. These results suggest that strategies to address satisfaction with appearance, such as reconstructive surgery, cognitive behavior therapy, and social skills training, are an area of need for survivors with H&N burns.

Sex differences in obesity prevalence and cardiometabolic factors among Western Alaska Native people.

BACKGROUND AND AIMS: Obesity is associated with increased risks of cardiovascular disease, type 2 diabetes, and other chronic diseases. Prevalence estimates for metabolic disorders are well documented in many populations, but Alaska Native groups are understudied. The Western Alaska Tribal Collaborative for Health Study combines data from three Alaska Native study cohorts to assess differences in obesity prevalence and associations with cardiometabolic risk factors by sex. METHODS AND RESULTS: Analyses were based upon a sample of 3985 adult Yup'ik and Inupiat participants with a mean age of 40 years. Prevalence of obesity and metabolic risk factors was assessed according to nationally recognized guidelines. Regression analysis was used to evaluate the association between obesity and cardiometabolic risk factors, including lipids, blood pressure and glucose. The prevalence of obesity (BMI ≥ 30) was significantly higher in women (40%) than men (20%). Only 18.6% of men had a waist circumference (WC) > 102 cm, while 58% of women had a WC > 88 cm (p < 0.001). Women had higher mean HDL-C and triglyceride levels compared to men, while systolic and diastolic blood pressure, LDL-C, and glucose means were higher in men than in women. In multivariate analyses, BMI and WC were significantly associated with all of the cardiometabolic risk factors, although these associations were more pronounced in men than women. CONCLUSION: The high prevalence of obesity and central adiposity among AN women is an important public health concern. Differences in associations between obesity and cardiometabolic risk factors by sex warrants further investigation to develop effective intervention programs.

Stress, social support, and schizophrenia. Discussion.

Three review articles (Dohrenwend and Egri 1981; Hammer 1981; Lin, Dean, and Ensel 1981) addressing various aspects of stress, social support, and schizophrenia are discussed. Phenomena so complex as these, involving simultaneously chemical, biological, physiological, social, and cultural systems, may require a different research paradigm than the simple unidirectional causal model used in most current studies. Perhaps a mutual causal paradigm will ultimately enhance our understanding by permitting more realistic assumptions about social processes. Three distinct network models are outlined: network as a set of links, network as generated structure, and flow network. Understanding of social support systems might be enhanced by the analysis of interpersonal resources in terms of categories discovered by Uriel and Edna Foa: love, status, information, services, goods, money. It is to be hoped that we will soon be able to work with methods and models that do not require oversimplifying assumptions.

The aortic sinus vortex.

This paper describes an analytic and a numerical method for the aortic sinus problem. Both methods are based on the dynamics of point vortices, and both exploit a particular conformal mapping from a model aortic sinus to the upper half plane. The analytic description is based on an isolated point vortex in equilibrium with a free stream. This inviscid model is used to study the stability of the aortic sinus vortex and to elucidate the mechanism of aortic valve closure, but it cannot be used to study the formation of the sinus vortex and it gives a somewhat incorrect picture of the flow pattern. These difficulties are overcome by the introduction of a numerical method for the aortic sinus problem with fluid viscosity. We use Chorin's vortex method combined with conformal mapping. The conformal mapping approach gives an explicit formula for the vortex velocities and it resolves the singularities associated with the corners of the domain. This method is then used to study the formation of the sinus vortex and to confirm the predictions of the point vortex model with respect to the role of the vortex in valve closure.