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The article details a study which examined the determinants of four-year cardiovascular event rates in outpatients with or at risk of atherothrombosis. Patients considered for the study were those diagnosed with coronary artery disease, cerebrovascular disease or peripheral arterial disease and those with multiple risk factors for atherothrombosis. Of the total 45,227 study participants, 2,315 died of cardiovascular reasons, 1,228 developed myocardial infarction and 1,898 experienced stroke. Study authors concluded that clinical descriptors are relevant in identifying patients at high risk of cardiovascular events.

While there has been strong evidence for the ability of neuropsychological performance at resolution of posttraumatic amnesia to predict later productivity, there has been less conclusive evidence for the relationship of neuropsychological test scores to concurrent productivity status. The purpose of the current study was to evaluate the relationship of neuropsychological test performance at 1 year post-injury to productivity assessed at the same time point. Participants were 518 persons with medically documented TBI who were enrolled in the TBI Model Systems Research and Demonstration Project. Stepwise logistic regression was utilized to determine the contributions of neuropsychological test scores to productivity after accounting for demographic characteristics, injury severity, and pre-injury productivity. Missing neuropsychological test scores were accounted for in the model. Variables that remained in the model and accounted for a significant proportion of the variance included age, duration of impaired consciousness, pre-injury productivity, and scores on measures of GOAT, Logical Memory II, and Trail Making Test, part B. The results indicate that neuropsychological test performance provides important information regarding the ability of persons with injury to return to productive activities. The results also indicate that inability to complete neuropsychological tests at 1 year post-injury is associated with non-productive activity. [ABSTRACT FROM AUTHOR]

Background: It is controversial whether a low cerebral blood flow (CBF) simply reflects the severity of injury or whether ischemia contributes to the brain's injury. It is also not clear whether posttraumatic cerebral hypoperfusion results from intracranial hypertension or from pathologic changes of the cerebral vasculature. The answers to these questions have important implications for whether and how to treat a low CBF.Methods: We performed a retrospective analysis of 77 patients with severe traumatic brain injury who had measurement of CBF within 12 hours of injury. CBF was measured using xenon-enhanced computed tomography (XeCT). Global CBF, physiological parameters at the time of XeCT, and outcome measures were analyzed.Results: Average global CBF for the 77 patients was 36+/-16 mL/100 g/minutes. Nine patients had an average global CBF<18 (average 12+/-5). The remaining 68 patients had a global CBF of 39+/-15. The initial ICP was >20 mmHg in 90% and >30 mmHg in 80% of patients in the group with CBF<18, compared to 33% and 16%, respectively, in the patients with CBF>or=18. Mortality was 90% at 6 months postinjury in patients with CBF<18. Mortality in the patients with CBF>18 was 19% at 6 months after injury.Conclusion: In patients with CBF<18 mL/100 g/minutes, intracranial hypertension plays a major causative role in the reduction in CBF. Treatment would most likely be directed at controlling intracranial pressure, but the early, severe intracranial hypertension also probably indicates a severe brain injury. For levels of CBF between 18 and 40 mL/100 g/minutes, the presence of regional hypoperfusion was a more important factor in reducing the average CBF. [ABSTRACT FROM AUTHOR]

To investigate the frequency and risk factors of major depressive disorder(MDD) after mild to moderate traumatic brain injury (TBI), 69 TBI and 52 generaltrauma (GT) patients were prospectively recruited and studied at 3-monthspostinjury. There was a nonsignificant difference in the proportion of MDDpatients in the TBI and GT groups. Therefore, a composite MDD group (TBI andGT patients) was compared to patients who were nondepressed. Female genderwas related to MDD, but no other risk factors were identified. MDD was associatedwith disability (Glasgow Outcome Scale, Community Integration Questionnaire)and cognitive impairment. MDD was comorbid with posttraumatic stress disorder.Implications for postacute management of mild to moderate TBI are discussed. [ABSTRACT FROM AUTHOR]

Previous studies of postconcussional disorder (PCD) have utilized a dimensionalapproach (i.e., number and/or severity ratings of symptoms) to study postconcussionalsymptoms. This study used a syndromal approach (modified form of the DSM-IVcriteria) for investigating risk factors for developing PCD, 3-months postinjury.The head trauma requirement was waived in order to determine specificity ofsymptoms to traumatic brain injury. Preliminary results from this ongoingstudy indicated significant risk factors including female gender, poor socialsupport, and elevated self-reported depressive symptoms at 1-month postinjury.Comorbidities included concurrent diagnosis of major depressive disorder and/orposttraumatic stress disorder. Hispanics were significantly less likely todevelop PCD than other racial/ethnic groups. PCD resulted more frequentlyfrom motor vehicle accidents and assaults. Screening tests for PCD risk factors/comorbiditiesperformed shortly after injury (i.e., during routine follow-up clinic appointments)coupled with appropriate referrals for psychoeducational interventions andsupport groups may avoid prolonged loss of productivity and poor perceivedquality of life in these patients. [ABSTRACT FROM AUTHOR]

Examines the effectivity of mixed-format curriculum in supporting the learning behaviors to characterize skills of medical students. Effectivity of problem-based learning (PBL) and medical ethics in developing learning skills; Use of the Cognitive Behavior Survey; Comparison between mixed traditional and PBL curriculum.

Objective: To determine the effects of human immunodeficiency virus (HIV) infection on children's development by identifying neurological and environmental variables associated with neuropsychological measures of cognitive development in HIV-seronegative (HIV−) and HIV-seropositive (HIV+) children and adolescents with hemophilia.Methods: Participants (N = 298; 60% HIV+) were males ages 7—19 years enrolled in the Hemophilia Growth and Development Study (HGDS). Least squares modeling was used to determine whether there was a difference at baseline in mean neuropsychological test scores by HIV status, age, and neurological baseline findings, adjusting for selected environmental and medical history variables.Results: The participants were within age expectations for general intelligence. Variables associated with lowered neuropsychological performance included academic problems, coordination and/or gait abnormalities, parents' education, and previous head trauma.Conclusions: Hemophilia-related morbidity has a subtle adverse influence on cognitive performance. HIV infection was not associated with neuropsychological dysfunction in this group even when MRI abnormalities were present. [ABSTRACT FROM AUTHOR]