Targeting the Epidemic: Interventions and Follow-up Are Necessary in the Pediatric Traumatic Brain Injury Clinic.

Traumatic brain injury is a major public health problem in the pediatric population. Previously, management was acute emergency department/primary care evaluation with follow-up by primary care. However, persistent symptoms after traumatic brain injury are common, and many do not have access to a specialized traumatic brain injury clinic to manage chronic issues. The goal of this study was to determine the factors related to outcomes, and identify the interventions provided in this subspecialty clinic. Data were extracted from medical records of 151 retrospective and 403 prospective patients. Relationships between sequelae, injury characteristics, and clinical interventions were analyzed. Most patients returning to clinic were not fully recovered from their injury. Headaches were more common after milder injuries, and seizures were more common after severe. The majority of patients received clinical intervention. The presence of persistent sequelae for traumatic brain injury patients can be evaluated and managed by a specialty concussion/traumatic brain injury clinic ensuring that medical needs are met.

A strategy for reducing tuberculosis among Oglala Sioux Native Americans.

BACKGROUND: The Oglala Sioux people, who live on the second largest Native American reservation in the United States, the Pine Ridge Reservation in South Dakota, have a history of high rates of tuberculosis. METHODS: To determine a strategy for reducing tuberculosis in this population, Pine Ridge Reservation tuberculosis cases since 1968 were analyzed. Diabetic patients were identified through chart reviews and characterized for tuberculosis status. Age-specific tuberculosis rates and age-specific relative risks (RRs) were calculated and compared with those of South Dakota excluding Pine Ridge. RESULTS: Between 1968 and 1994, the RR for tuberculosis was 18.9 for a Pine Ridge Native American compared with rates for the rest of South Dakota. The age-specific RR was 65.7 for the Pine Ridge population 65 and older from 1985-1994. Tuberculin tests were positive in 70% of diabetic patients on the reservation. Diabetic patients comprise 23% of the population 45 and older at Pine Ridge. Fifty-five percent of all the tuberculosis disease in the 45 and older age group can be prevented by eliminating it in the diabetic population. CONCLUSIONS: A major stride toward reducing tuberculosis can be made by targeting high-risk groups such as diabetic patients, especially in a time of dwindling resources and personnel for tuberculosis control.