Needs for community-based rehabilitation services and support 12 months after moderate and severe physical traumatic injuries: a brief report.

ABSTRACT: Patients with physical traumatic injuries frequently require long-term rehabilitation services. To strengthen rehabilitation services in the post-acute phase, we need to assess characteristics of this population and their healthcare and rehabilitation needs in the community. This brief report summarizes the frequency of unmet rehabilitation needs in community-based rehabilitation during the first year after moderate and severe trauma. Additionally, the associations between sociodemographic, injury severity factors and unmet needs were examined. Data from a prospective multicenter cohort study of patients with moderate and severe trauma (New Injury Severity Score > 9) of all ages discharged alive from two regional trauma centers in 2020 were used. Needs were estimated using the Needs and Provision Complexity Scale. Overall, 46% of patients had unmet needs at 12 months post-injury, particularly related to the provision of rehabilitation services, specialist follow-ups, and social and family support. The probability of unmet needs was associated with age, pre-injury comorbidities, and impaired functioning. Our findings support strategies targeting younger patients, those with pre-injury comorbidities, and those with higher levels of disability and provide a starting point for the development of standardized rehabilitation needs assessment and guidelines following injury.

An antioxidant and multivitamin supplement reduced improvements in VO2max.

The aim of this study was to investigate the effect of an antioxidant supplement on training induced changes in VO2max in well-trained subjects. In a double-blinded placebo controlled design, a total of 40 amateur soccer players and 14 multi sports athletes were block-randomised into a placebo group or an antioxidant supplemented group (SUP). The SUP group consumed two commercially available antioxidant/vitamin supplements for 6 weeks according to manufacturer instructions (LifePak® Essentials Super A) and the placebo group took a similar amount of placebo tablets. Before and after the supplementation period, the athletes were tested for skin carotenoid score and VO2max. During the supplementation period all subjects continued their normal training in the preparation phase of the season. Six week supplementation with the antioxidant vitamin/mineral supplement increased skin carotenoid score by 27 ± 6% while no change was observed in the placebo group. VO2max increased by 5.6 ± 2.0% in the placebo group while no change was observed in the SUP group. The relative increase in VO2max was significantly higher in the placebo group than in the SUP group. In conclusion, the antioxidant vitamin/mineral supplement used in this study seemed to reduce training efficiency indicated by the lack of increase in VO2max in the SUP group.

Pulp-dentin biology in restorative dentistry. Part 3: Pulpal inflammation and its sequelae.

Physiologic and histopathologic experimental studies over the last 30 to 40 years have demonstrated that the healing of the dental pulp is comparable to that of connective tissue elsewhere, despite its location in the low-compliance pulp chamber. The greatest difficulty from a clinical point of view is to assess cellular changes and vitality of the pulp. If it is vital, the potential for repair is present, especially in young individuals.

Pulp-dentin biology in restorative dentistry. Part 1: normal structure and physiology.

Considerable knowledge has accumulated over the years on the structure and function of the dental pulp and dentin. Some of this knowledge has important clinical implications. This review, which is the first of seven articles, will be limited to those parts of the normal structure and physiology of the pulp and dentin that have been shown to result in, or are likely lead to, tissue reactions associated with the clinical treatment of these tissues. Although certain normal structures will be highlighted in some detail, a basic knowledge of pulpal and dentinal development and structure is a prerequisite for an understanding of this text.

Dielectric properties of some keratinised tissues. Part 1: Stratum corneum and nail in situ.

Blister-skin and warts have been studied as possible sources of 'pure' stratum corneum without sweat ducts. The purpose of the study was to assess whether the DC electrical conductance measured on human skin is totally dominated by the sweat ducts, or is also significantly contributed to by the stratum corneum itself. By means of galvanic skin response (GSR) measurements, these tissues were found to be unrealiable as sources of 'pure' stratum corneum. This is because they displayed significant GSR waves, and hence should have some form of active pores. However, measurements on blister-skin and nail in situ revealed a substantial frequency independent electrical conductance at frequencies typically below 10 Hz.

Computer acquisition, analysis and presentation of results from a Cobas Bio analyser.

Two computer programs for Macintosh computers have been developed in the LabVIEW programming language to perform data acquisition, analyses and presentation of results originating from a Cobas Bio analysing machine. One program is very flexible in its human interface, and is intended for research use. The program allows the results to be combined in a variety of ways, and allows the user to generate graphs to highlight the results. The other program is intended for routinely follow-up of analyses of proteases. It only allows the user to follow strict instructions, and only limited flexibility is built-in.

Weekly rinsing with a fluoride mouthrinse in an unfluoridated community: results after seven years.

In the fall of 1975, 1,915 children in grades K through eight began a school-based program of supervised weekly rinsing with 0.2 percent aqueous solution of sodium fluoride in an unfluoridated community in the Finger Lakes area of upstate New York. At baseline and annually thereafter, a random sample of children in grades K through 11 received clinical dental caries examinations. The prevalence of dental caries by grade at each of the follow-up dental examinations was compared to the grade-specific prevalence of dental caries at baseline. Overall, there was a decline of 57.8 percent in prevalence of caries in permanent teeth after seven years of rinsing. Among children in grades K through five, there was a decline of 35.4 percent in the prevalence of caries in primary teeth during the same time period. Tenth and eleventh grade children, after not rinsing for one and two years, respectively, continued to show the same trend toward lower caries prevalence as active rinsers. Caries prevalence among seventh and eighth graders after seven years of rinsing was not significantly different from caries prevalence among seventh and eighth grade lifetime residents of a nearby fluoridated community. A decline in the prevalence of caries in primary teeth among kindergartners prior to rinsing suggests that factors in addition to the mouthrinse program may have contributed to the decline in caries prevalence.

Efficacy of using benzocaine for temporary relief of toothache.

The purpose of this investigation was to determine the efficacy of benzocaine for temporary relief of toothache. The agent used is available at drug counters; it contains 7.5 percent benzocaine in propylene glycol and has the form of a gel. The study was double blind. The agent and a placebo were provided by the manufacturer in an equal number of randomly numbered but otherwise unlabeled tubes. Forty-nine patients (twenty-five males and twenty-four females) with throbbing toothache pain resulting from dental caries were included in the study. The mean age was 25.6 years for patients receiving the drug and 26.7 years for patients receiving the placebo. Of the twenty-four patients who received the active agent, twenty (83 percent) were relieved of pain. The average time for onset of relief was 3.7 minutes. In the placebo group, only four patients (16 percent) were relieved of pain. When the chi-square test is used, the difference is statistically significant at the 0.01 level. No adverse reaction to the agents used was observed.

A comparison of distal and proximal dendritic synapses on CAi pyramids in guinea-pig hippocampal slices in vitro.

1. In vitro slices of guinea-pig hippocampus have been employed to compare excitatory synapses located distally and proximally on the dendritic tree of CA1 pyramidal cells.2. The main orientation of unmyelinated afferent fibres was found to be parallel to each other and perpendicular to the dendritic axis.3. The density of boutons ending on dendritic spines was roughly similar throughout the greater part of the dendritic tree with an average of 42 +/- 7.2 synapses per 100 mum(2). Their number did, however, decrease in the distal fifth of the apical and in the distal third of the basal dendritic region in parallel with an increase of boutons on the dendritic shafts.4. Negative synaptic field potentials (extracellular field e.p.s.p.s) had their maximum in the region where activated afferent fibres terminated and showed reversal when recorded from sufficiently displaced positions along the dendritic axis. The field e.p.s.p. was preceded by a diphasic presynaptic fibre volley. By cutting all but a narrow bundle of afferent fibres selective activation of a small group of dendritic synapses was possible. Stimulation of fibres crossing tissue bridges (35-100 mum wide) evoked field e.p.s.p.s comparable in amplitude to those seen in slices without lesions. The size of the field e.p.s.p.s evoked via distal and proximal bridges was remarkably similar and linearly related to the size of the appropriate stimulus current and presynaptic volley.5. Selective activation of a small group of afferent fibres gave rise to large amplitude population spikes. Proximal and distal bridges were largely equipotent when they were equally wide. Above the threshold amplitude, the evoked population spikes were linearly related to both the presynaptic volley and the stimulus current. Constant current stimulation of fibres at all apical dendritic levels was equally effective in evoking population spikes, with the exception of the outer fifth of the tree where stimulation was unsuccessful. Input across distal or proximal bridges (400 or 50 mum from the soma) also gave the same high probability of discharge of single units (1.0 for thirty-five of thirty-six cells).6. An input across a narrow and distal bridge (35 mum), representing less than 5% of the fibres synapsing on the apical dendrite, was sufficient to give a firing probability of 1.0 for all cells tested (fifteen).7. For seventeen cells pairs of equally wide distal and proximal apical dendritic bridges were compared. Both inputs gave a mean probability of firing above 0.95 with stimulation strengths less than 2.5 times the spike threshold.8. Intracellular e.p.s.p.s had similar shapes following activation across distal and proximal dendritic bridges. The amplitude of neither type was significantly affected by hyperpolarization of the soma up to 25 mV. The half-width was prolonged to the same moderate degree for both inputs.9. The firing level for the action potential was similar for proximal and distal dendritic inputs and for spikes excited by depolarizing current pulses across the soma membrane.10. The apparent equipotentiality of synchronously activated distal and proximal dendritic synapses is discussed in the light of the known histology of the CA1 pyramidal cells.

Effects of chronic nerve conduction block on formation of neuromuscular junctions and junctional AChE in the rat.

The development of ectopic n.m.j.s. between the transplanted superficial fibular nerve and the soleus muscle has been studied in adult rats. Impulse conduction in the sciatic nerve was blocked chronically and synapse formation between the blocked fibular nerve and the paralysed soleus was compared with synapse formation between non-blocked fibular nerves and denervated soleus muscles. Nerves with conduction block readily made new n.m.j.s. Thus 6 and 10--14 days after the onset of the block the number of newly innervated muscle fibres, the percentage of innervated fibres responding with action potentials and the frequency of m.e.p.p.s. at new junctions were comparable to that observed during innervation by non-blocked nerves. Muscle fibres innervated by both the original soleus nerve and the foreign fibular nerve were regularly encountered in the impulse blocked preparations. Junctions formed by impulse blocked fibular nerves had either no or very little AChE activity 10--15 days after the onset of the block. The evidence for this was 1) weak staining for CHE; 2) prolonged rise time and 1/2 decay time of m.e.p.p.s; 3) positive correlation between m.e.p.p. amplitude and 1/2 decay time and 4) insensitivity to anticholinesterases. In contrast, junctions formed by non-blocked fibular nerves had strong AChE activity by these criteria at corresponding times. AChE activity at the original soleus endplates was much reduced 10--15 days after the onset of conduction block.

Possible mechanisms for long-lasting potentiation of synaptic transmission in hippocampal slices from guinea-pigs.

1. Long-lasting potentiation of synaptic transmission was studied in the CA1 region of guinea-pig hippocampal slices maintained in vitro. 2. Stimulating pulses were delivered alternately to two independent afferent pathways, stratum radiatum and stratum oriens. The presynaptic volleys and field e.p.s.p.s. were recorded from the same two layers, while an electrode in the pyramidal cell body layer recorded the population spike or in other experiments the extra- or intracellular potentials from a single pyramidal cell. 3. A short tetanus to either of the two input pathways produced a long-lasting enhancement of the field e.p.s.p. as well as an increased size and a reduced latency of the population spike. This long-lasting potentiation was observed for up to 110 min after tetanization. Extracellular unit recordings showed that this potentiation is accompanied by an increased probability of firing and a reduced firing latency. Intracellular recordings showed an increased e.p.s.p., through the increase was smaller and less regular than for the extracellular field e.p.s.p. 4. No corresponding changes were seen in the field potential responses to stimulation of the untetanized input path, or in the intracellularly measured soma membrane potential, resistance, or excitability. The latter two properties were measured by intracellular injection of current pulses. It is concluded that long-lasting potentiation is specific to the pathway which has received the tetanization. 5. Following tetanization there was also a short-lasting (usually 2-4 min) depression, most often seen for the control pathway but sometimes visible on the tetanized side as well, superimposed on the potentiation. It is concluded that the short-lasting depression is not confined to any particular pathway but is a generalized (unspecific) phenomenon.

A further assessment of predictors of the child's behavior in dental treatment.

The child's disruptiveness during dental treatment was related modestly to his age as well as his state, trait, and dental anxiety. In three samples comprising 132 experienced and 49 inexperienced pedodontic patients, the child's behavior during treatment could not be predicted from any aspect of maternal anxiety -- trait, state, or dental. Previous conceptions of maternal influence on the child's dental anxiety should be re-evaluated.

Functional characteristics of unmyelinated fibres in the hippocampal cortex.

(1) In transverse hippocampal slices (350 micrometer thick), taken from guinea pigs initially anaesthetized with ether, intracortical afferent fibres were activated by small current pulses delivered through tungsten microelectrodes. Extracellular potentials were recorded from the zone of activated fibres in dendritic layers while intracellular recordings were made from the soma of CA1 pyramidal cells. (2) When recording was made from the same level as the stimulating cathode, the extracellular potential consisted of a diphasic deflection followed by a larger negative wave with a superimposed population spike. The negative wave corresponded to an intracellularly recorded EPSP, and is called an extracellular EPSP, whereas the initial diphasic deflection had no intracellular counterpart. (3) The initial diphasic deflection was linearly related to the size of both the intracellular and extracellular EPSP. It was not changed by removal of calcium ions from the bathing fluid, whereas all postsynaptic activity disappeared. The diphasic deflection was propagated along fibres lying parallel to the pyramidal layer with a velocity of 0.3 m/sec. It could follow short bursts of stimulation at 300 Hz. The absolute refractory period was 2.0 msec. (4) The initial diphasic deflection is interpreted as the compound action potential of the largely unmyelinated afferent fibres to the CA1 neurones.