Disengagement of visual attention in infancy is associated with emerging autism in toddlerhood.

BACKGROUND: Early emerging characteristics of visual orienting have been associated with a wide range of typical and atypical developmental outcomes. In the current study, we examined the development of visual disengagement in infants at risk for autism. METHODS: We measured the efficiency of disengaging from a central visual stimulus to orient to a peripheral one in a cohort of 104 infants with and without familial risk for autism by virtue of having an older sibling with autism. RESULTS: At 7 months of age, disengagement was not robustly associated with later diagnostic outcomes. However, by 14 months, longer latencies to disengage in the subset of the risk group later diagnosed with autism was observed relative to other infants at risk and the low-risk control group. Moreover, between 7 months and 14 months, infants who were later diagnosed with autism at 36 months showed no consistent increases in the speed and flexibility of visual orienting. However, the latter developmental effect also characterized those infants who exhibited some form of developmental concerns (but not meeting criteria for autism) at 36 months. CONCLUSIONS: Infants who develop autism or other developmental concerns show atypicality in the development of visual attention skills from the first year of life.

Patient outcome after traumatic brain injury in high-, middle- and low-income countries: analysis of data on 8927 patients in 46 countries.

BACKGROUND: Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. The burden of TBI is greatest in low- and middle-income countries (LAMIC), yet little is known about patient outcomes in these settings. METHODS: Complete data on 8927 patients from 46 countries from the corticosteroid randomization after significant head injury (CRASH) trial were analysed to explore whether outcomes 6 months after TBI differed between high-income countries and LAMIC. RESULTS: Just under half of patients experienced a good recovery, one-third moderate or severe disability and one-quarter died within 6 months of their injury. Univariate analyses showed that patients in LAMIC were more likely to die following severe TBI, but were less likely to be disabled following mild and moderate TBI. These results were confirmed in multivariate analyses. Compared to patients in high-income countries, patients in LAMIC have over twice the odds of dying following severe TBI (OR 2.23, 95% CI 1.51-3.30) but half the odds of disability following mild (OR 0.41, 95% CI 0.23-0.72) and moderate TBI (OR 0.53, 95% CI 0.35-0.81). There were no differences between settings in the odds of death following either mild or moderate TBI. CONCLUSIONS: Reduced death rates following severe TBI in patients from high-income countries may be due to differences in medical care which may result in a higher proportion of patients surviving with a disability. Socio-cultural factors may explain the lower levels of disability after mild and moderate TBI in LAMIC.

Young men were at risk of becoming lost to follow-up in a cohort of head-injured adults.

OBJECTIVE: This study is to identify predictors of loss to follow-up among adults with head injury. STUDY DESIGN AND SETTING: A prospective cohort of 1,857 adults enrolled in the Medical Research Council (MRC) CRASH trial known to be alive 2 weeks after head injury. Six-month follow-up was defined as "overdue" if over 6 months late. Patient information collected at enrollment and after 14 days was used to predict overdue follow-up. A random two-thirds of the cohort was analyzed using logistic regression and binary recursive partitioning. The regression model and decision rule derived by recursive partitioning were evaluated using the remaining third. RESULTS: Overdue follow-up was more likely in patients aged 25-34 years (odds ratio, 1.76; 95% confidence interval [CI]=1.18-2.62), victims of assault (1.63; 1.09-2.45), patients independent after 2 weeks (1.79; 1.18-2.72) and patients for whom postcodes (2.36; 1.65-3.39), telephone numbers (1.82; 1.19-2.79) or general practitioners (1.67; 1.16-2.39) were unknown. Binary recursive partitioning specifically identified males aged younger than 43 years to be at risk. CONCLUSION: Successful follow-up in head-injury studies requires patients' postcodes and telephone numbers to be available. Young men remain at risk of becoming lost to follow-up, presenting a challenge for researchers aiming for complete data.

Subjetividade e solidariedade: a diversidade das formas de implicação dos jovens na economia solidária / Subjectivity and solidarity: the diverse ways young workers commit themselves in social economy projects

O estudo enfoca a forma de inserção profissional e implicação no trabalho dos jovens no campo da economia solidária e do associativismo. O objetivo principal é discutir as relações entre os processos de subjetivação e a construção do ideal profissional de trabalhadores de até 30 anos. A análise das entrevistas, metodologicamente baseada na abordagem biográfica, aponta para uma diversidade das formas de compreender a relação com o trabalho e com os colegas no que se refere aos princípios da economia solidária e do associativismo. A ausência de suportes sociais (o apoio do Estado ou da sociedade civil) e a sustentabilidade financeira dos projetos influenciam nas formas dos trabalhadores aderirem (ou não) ao modelo de gestão solidário. A análise das entrevistas e o acompanhamento dos projetos indicam que os princípios da autogestão são parcialmente efetivados, existindo uma tendência a reproduzir relações hierárquicas e paternalistas(AU)

Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India.

BACKGROUND: Gender disadvantage and reproductive health are major determinants of women's health in developing countries. OBJECTIVE: To determine the association of factors indicative of gender disadvantage and reproductive health with the risk of common mental disorders (CMDs) in women. DESIGN: Cross-sectional survey from November 1, 2001, to June 15, 2003. PARTICIPANTS: A total of 3000 women randomly selected from a sampling frame of women aged 18 to 45 years in Goa; 2494 women participated. MAIN OUTCOME MEASURES: The primary outcome was the presence of a CMD, as defined by the Revised Clinical Interview Schedule. An interview and blood and vaginal/urine specimens were collected to ascertain risk factors. RESULTS: The prevalence of CMD was 6.6% (95% confidence interval [CI], 5.7%-7.6%). Mixed anxiety-depressive disorder was the most common diagnosis (64.8%). Factors independently associated with the risk for CMD were factors indicative of gender disadvantage, particularly sexual violence by the husband (odds ratio [OR], 2.3; 95% CI, 1.1-4.6), being widowed or separated (OR, 5.4; 95% CI, 1.0-30.0), having low autonomy in decision making (OR, 1.98; 95% CI, 1.2-3.2), and having low levels of support from one's family (OR, 2.2; 95% CI, 1.4-3.3); reproductive health factors, particularly gynecological complaints such as vaginal discharge (OR, 3.2; 95% CI, 2.2-4.8) and dyspareunia (OR, 2.5; 95% CI, 1.4-4.6); and factors indicative of severe economic difficulties, such as hunger (OR, 2.7; 95% CI, 1.6-4.6). There was no association between biological indicators (anemia and reproductive tract infections) and CMD. CONCLUSIONS: The clinical assessment of CMD in women must include exploration of violence and gender disadvantage. Gynecological symptoms may be somatic equivalents of CMD in women in Asian cultures.

Subjetividade e solidariedade: a diversidade das formas de implicação dos jovens na economia solidária / Subjectivity and solidarity: the diverse ways young workers commit themselves in social economy projects

O estudo enfoca a forma de inserção profissional e implicação no trabalho dos jovens no campo da economia solidária e do associativismo. O objetivo principal é discutir as relações entre os processos de subjetivação e a construção do ideal profissional de trabalhadores de até 30 anos. A análise das entrevistas, metodologicamente baseada na abordagem biográfica, aponta para uma diversidade das formas de compreender a relação com o trabalho e com os colegas no que se refere aos princípios da economia solidária e do associativismo. A ausência de suportes sociais (o apoio do Estado ou da sociedade civil) e a sustentabilidade financeira dos projetos influenciam nas formas dos trabalhadores aderirem (ou não) ao modelo de gestão solidário. A análise das entrevistas e o acompanhamento dos projetos indicam que os princípios da autogestão são parcialmente efetivados, existindo uma tendência a reproduzir relações hierárquicas e paternalistas.

This article discusses the way young professionals enter and commit themselves in the social economy and associative work field. The main objective is to understand the relationships between the process of subjectification and the construction of the professional ideal among workers up to 30 years old. The analysis of the interviews, methodologically based on the biographical approach, indicates a great diversity of ways of comprehending work relationships, concerning the principles of social economy and associativism. Lack of social support (from government or civil society) and financial sustainability of projects influence in the way young workers cohere to the model of social economy management. The analysis of the interviews and the long-term observation of the projects indicate that self-management principles are only partially accomplished, existing a tendency to reproduce paternalist and hierarchical relationships.

Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months.

MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96.7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25.7%] vs 1075 [22.3%] deaths; relative risk 1.15, 95% CI 1.07-1.24; p=0.0001), as was the risk of death or severe disability (1828 [38.1%] vs 1728 [36.3%] dead or severely disabled; 1.05, 0.99-1.10; p=0.079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.

Chronic fatigue in developing countries: population based survey of women in India.

OBJECTIVES: To describe the prevalence of and risk factors for chronic fatigue in a developing country; in particular, to determine the association of anaemia, mental health, and gender disadvantage factors with chronic fatigue. DESIGN: Community survey. SETTING: Primary health centre catchment area in Goa, India. PARTICIPANTS: 3000 randomly sampled women aged 18 to 50 years. MAIN OUTCOME MEASURES: Data on the primary outcome (reporting of fatigue for at least six months) and psychosocial exposures elicited by structured interview; presence of anaemia determined from a blood sample. RESULTS: 2494 (83%) women consented to participate; 12.1% (95% confidence interval 10.8 to 13.4%) complained of chronic fatigue. In multivariate analyses, older women (P = 0.03) and those experiencing socioeconomic deprivation-less education (P < 0.001), families in debt (P = 0.09), or hunger in the past three months (P = 0.03)-were more likely to report chronic fatigue. After adjustment for these factors, factors indicating gender disadvantage (notably sexual violence by the husband; P < 0.001) and poor mental health (P < 0.001) were strongly associated with chronic fatigue. Although women with a high body mass index had a reduced risk, suggesting an influence of poor nutrition, no association was found between chronic fatigue and haemoglobin concentrations. CONCLUSIONS: Chronic fatigue was commonly reported by women in this community study from India. The strongest associations with chronic fatigue were for psychosocial factors indicative of poor mental health and gender disadvantage.