Postconcussive Symptoms Following Mild TBI and Extracranial Injury: What Are the Contributing Factors?

OBJECTIVES: Whether mild traumatic brain injury (mTBI) sustained by children results in persistent or recurrent symptoms, over and above those experienced by children who solely sustain mild extracranial injuries, remains debated. The current prospective longitudinal case-controlled study aimed to examine the relative influence of injury and noninjury factors on symptoms in preschool and primary school-aged children who sustained an mTBI or mild extracranial injury at least 8 month earlier. METHODS: Participants were 64 parents of children (31 mTBI, 33 trauma controls) who sustained injury between ages 2 and 12, whose postconcussive symptoms across the first 3-month postinjury have been previously described. The current study assessed postconcussive symptoms at 8 or more months postinjury (M = 24.3, SD = 8.4) and examined a range of injury and noninjury predictive factors. RESULTS: At or beyond 8-month postinjury, symptom numbers in the mTBI group were comparable with those of the group who sustained mild extracranial injury. Educational attainment of parents (below or above high-school attainment level) was the only predictor of symptoms at follow-up, with preexisting learning difficulties approaching significance as a predictor. CONCLUSIONS: While our earlier study found that mTBI was associated with symptoms at 3-month postinjury, follow-up at more than 8 months showed mTBI no longer predicted symptom reporting. While mTBI contributes significantly to the presence of symptoms in the first few months postinjury, researchers and healthcare practitioners in this field need to consider the potential impact of noninjury factors on persistent or recurrent symptoms after mTBI.

Do Concussive Symptoms Really Resolve in Young Children?

OBJECTIVES: To examine the frequency and nature of postconcussive symptoms (PCSs) and behavioral outcomes in young children following mild traumatic brain injury (mTBI) or concussion. SETTING: Emergency department. PARTICIPANTS: Children aged 2 to 12 years presenting with either a concussion or minor bodily injury (control). OUTCOME MEASUREMENT: Parent ratings of PCS were obtained within 72 hours of injury, at 1 week, and 1, 2, and 3 months postinjury using a comprehensive PCS checklist. Preinjury behavior was examined at baseline using the Clinical Assessment of Behavior, which was readministered 1 and 3 months postinjury. RESULTS: PCS burden following mTBI peaked in the acute phase postinjury but reduced significantly from 1 week to 1 month postinjury. Parents of children with mTBI reported more persistent PCSs up to 3 months postinjury than trauma controls, characterized mostly by behavioral and sleep-related symptoms. Subtle increases in problematic behaviors were observed from baseline (preinjury) to 1 month postinjury and persisted at 3 months postinjury; however, scores were not classified as clinically "at risk." CONCLUSIONS: A significant minority of young children experienced persistent PCS and problematic behavior following mTBI. Care must be taken when assessing PCS in younger children as method of PCS assessment may influence parental reporting.

Predictors of Post-concussive Symptoms in Young Children: Injury versus Non-injury Related Factors.

OBJECTIVES: A notable minority of children will experience persistent post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI), likely maintained by a combination of injury and non-injury related factors. Adopting a prospective longitudinal design, this study aimed to investigate the relative influence of child, family, and injury factors on both acute and persistent PCS in young children. METHODS: Participants were 101 children aged 2-12 who presented to an Emergency Department, with either mTBI or minor bodily trauma (control). PCS were assessed at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors included injury and demographic variables, premorbid child behavior, sleep hygiene, and parental stress. Random effects ordinal logistic regression models were used to analyze the relative influence of these predictors on PCS at early (acute - 1 week) and late (1-3 month) post-injury phases. RESULTS: Presence of mTBI was a stronger predictor of PCS in the early [odds ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at injury and pre-existing learning difficulties were significant predictors of PCS beyond 1 month post-injury. Family factors, including higher levels of parental stress, higher socio-economic status, and being of Anglo-Saxon descent, consistently predicted greater PCS. CONCLUSIONS: Injury characteristics were significantly associated with PCS for 3 months following mTBI but the association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Follow-up for these "at-risk" children which also addresses family stress may minimize longer-term complications. (JINS, 2016, 22, 793-803).

[Eleven years of experience with permanently implanted port-systems in 329 cancer patients]. / Elf Jahre Erfahrung mit permanenten Port-Systemen bei 329 Tumor-Patienten.

Intravenous port-systems are predominantly used for long-term chemotherapy in oncology. 164 of our patients were implanted with a Port-a-Cath and 165 patients with a Chemosite system. Indications, the duration of implantation, the duration of use, the access and complications were analysed. This retrospective study analyses 329 tumor patients, who have been treated at the Cancer Center Klinik im Park from September 1987 until February 1998. The preferred access of implantation were: v. subclavia (47%) and v. cephalica (35%). The average duration of implantation was 279 days for the Port-a-Cath system and 443 days for the Chemosite system. The most frequent complication immediately following surgery was a pneumothorax in 4% of the patients. The frequency of late complications was: thromboses 2%, infections 4%. This study analyses our experiences with fully implantable permanent intravenous catheter-systems in 329 tumor patients. These catheters can be used for very long periods with a low rate of complications.

[Effect of socioeconomic transformations on the nutritional status of children of the Cashibo tribe (Peruvian Amazonia)]. / Influence des transformations socio-économiques sur l'état nutritionnel des enfants de la tribu Cashibo (Amazonie Péruvienne).

Investigation for malnutrition, carried out in Peruvian Amazonia, showed 16.4% of malnutrition among 98 children of the Indian Cashibo tribe. This rate is 4 times higher the rate recorded in an indian Brazilian tribe, which is protected and living aside the americano-latin civilization. Some aspects of the acculturation are discussed to explain such a difference.

[Epidemiologic survey of intestinal parasitoses in Peruvian Amazonia]. / Enquête épidémiologique sur les parasitoses intestinales en Amazonie péruvienne.

An epidemiological survey was carried out in 4 native villages from tribe Cashibo, in Amazonia (Peru). Among 165 stools examination, 92% were positives for helminthic (hookworms: 72%, roundworms and whipworms: 55% each, strongyloides: 5%) and protozoan infections (Entamoeba coli and Endolimax nana: 50% each, Entamoeba histolytica 24%, Giardia intestinalis 17%). Balantidium coli is not seldom (6%). Polyparasitism, very frequent, is reported with a maximum of 10 species. The most important villages are the most infested. Several factors can explain these results: lack of hygien and treatment, and no sanitary education. These rates are among the highest recorded for the South-American Indian people.