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Identifying cognitive deficits associated with pediatric brain tumors and their treatment is important in delineating the mechanisms of intellectual decline often associated with these diseases. The authors evaluated sustained attention, information processing speed, working memory, and IQ in 64 patients with posterior fossa tumors, including those treated with either: (a) surgery and cranial radiation (n = 32), and (b) surgery without radiation (n = 32). Ten patients treated for non-CNS solid tumors were included as a comparison group. The authors also examined the impact of relevant demographic and medical variables on neurocognitive outcome. The authors found that neither age at, nor time since, diagnosis predicted cognitive outcome in this sample. Further, sustained attention and working memory were largely intact and there were no differences between groups. Patients treated with cranial radiation demonstrated lowered short-form IQ and slow information processing speed: Patients treated with cranial radiation and who experienced postsurgical complications demonstrated the poorest performance. The authors consider information processing speed to be an excellent candidate mechanism in understanding the impact of cranial radiation on intellectual outcome.

The present investigation assessed 38 family members' perceptions of unmet, partly met and met needs following the brain injury of a relative. Follow-up data was collected at two time intervals averaging 6 and 24 months post-injury. There was no significant difference between the proportion of needs rated as important or very important at time I or II. Highly ranked needs included requests for information, clear and honest explanations from professionals, reassurance, respite care, educational and social activities for the patient, emotional support, financial counseling, and advice about community resources. Relatives rated nearly half of the 40 needs as not met at either time. A significant difference was noted in the proportion of un met/partly met needs within each factor scale at time I and II. A larger number of Emotional Support and Involvement with Care needs were reported as not met at time II. Needs for Professional Support were more frequently reported as met at time II. For both time periods, Health information needs were generally perceived as met while needs relating to Instrumental Support were largely unmet. The findings are discussed in light of implications for treatment and long term adjustment to injury related changes.

Information regarding traumatic brain injury sequelae in a sample of 503 traumatic brain injury patients was obtained using the Neurobehavioral Functioning Inventory (NFI). Data revealed that motor dysfunction was more frequently reported than somatic difficulties. Analyses of variance indicated that unemployed patients experienced significantly more motor problems than patients working 40 or more hours per week. No differences in the incidence of somatic complaints, headaches, or muscular pain were found between employed and unemployed patients. Data suggests that long-term, interdisciplinary rehabilitation may be cost effective, especially when viewed in the context of successful employment.

The present investigation examined the empirical and theoretical validity of an instrument developed to assess family members' perceptions of needs following the brain injury of a relative. The Family Needs Questionnaire (FNQ) consists of 40 items reflecting commonly reported family needs. The development of the items was based on the literature describing family reactions to brain injury and other medical disabilities. A principal-components factor analysis was executed based on the FNQ responses of 178 family members. A six-factor solution was selection as the best fit for the data, yielding the following independent subscales: (1) Need for Health Information; (2) Need for Emotional Support; (3) Need for Instrumental Support; (4) Need for Professional Support; (5) Need for a Support Network; and (6) Need for Involvement with Care. Further analysis indicated at least adequate internal reliability for each scale. Overall, the measure appears to offer unique information relevant to family members' needs after brain injury.

The pre- and postinjury patterns of alcohol and illicit drug use of 87 persons with traumatic brain injury ages 16 to 20 were examined. Follow-up data were collected at two time intervals averaging 8 and 28 months postinjury. A comparison with large-sample studies revealed that patients had preinjury drinking patterns similar to those in the general population. A review of data provided evidence of a decline in alcohol use at initial follow-up; however, preinjury and second follow-up alcohol use patterns were similar. Analyses suggested that drinking quantity and frequency increased over time, perhaps eventually returning to postinjury levels. A review of the literature and the findings of the present investigation indicate that men and persons with a history of preinjury heavy drinking are at greatest risk for long-term alcohol abuse postinjury. Postinjury illicit drug use rates remained relatively low, falling below 10% at both follow-up intervals. Among persons taking prescribed medications, 17% reported moderate or heavy drinking at second follow-up.

Objective: To determine whether minority status affected short-term and 1-year functional outcome and community integration for patients with traumatic brain injury (TBI) in the TBI Model Systems National Data Base. Design: Prospective study, consecutive sample. Setting: Four tertiary care rehabilitation centers. Patients: Five hundred and eighty-six patients with TBI admitted to one of four TBI Model Systems programs from February 1989 through June 1995. Inclusion criteria for the study included evidence of a TBI, admission to the system hospital emergency department within 8 hours of injury, 19 years of age or older, and acute care and inpatlent rehabilitation within the system hospitals. Information was collected for demographics such as race, age, gender, education, employment status, marital status, and data related to the injury such as injury severity, etiology of injury, and payer source. Over half of the sample was white (53.4%) with the 46.6% of minorities composed of blacks (37.2%), Hispanics (7.3%), and Asians (2.0%). Main Outcome Measures: Functional outcome was measured with the Functional Independence Measure (FIM), Disability Rating Scale (DRS), and Community Integration Questionnaire (CIQ). The FIM and DRS were measured at inpatient rehabilitation admission, discharge, and 1 year post injury. The CIQ total score and subscale scores for Home Integration, Social Integration, and Productivity were obtained at 1-year post injury. It was hypothesized that minority status would not predict functional outcome after acute rehabilitation but would predict functional outcome and community integration at 1 year post injury. Results: There were no significant differences between whites and minorities for DRS and FIM scores at acute rehabilitation discharge. There were also no significant differences between whites and minorities on FIM scores 1 year post injury, but there were significant differences between whites and minorities on the Social Integration and Productivity subscales and total score of the CIQ. Multiple regression indicated that minority status predicted functional outcome for CIQ total score (r=-.28) and two subscales, Social Integration (=-.28) and Productivity ( r= -.23) even after controlling for etiology, severity of injury, age, gender, and functional status at rehabilitation discharge. Conclusions: Although minority status does not negatively impact recovery of basic mobility and daily living skills, it may impact long-term outcome related to community integration as measured by productivity and social integration. Greater outreach and access to postdischargc services and support may be needed to optimize community integration outcomes. Further studies are needed to determine how best to serve the needs of this segment of the population with TBI

INTRODUCTION: New immigrant families from continental Africa account for an increasing proportion of pediatric patients with Sickle Cell Disease (SCD) in Canada and North America. As families enter the western medical system they face a myriad of tests and medications as well they encounter language barriers, endless forms and large teams. Previous experiences with healthcare also influence families' expectations and adjustment.There is no published data exploring the experiences of these families to help guide practice. Resources such as the Canadian Pediatric Society guide on immigrant health are not specific to SCD. We set out to examine cultural sensitivity methodologically in order to improve delivery of care. Research Questions: What are newcomer families' experiences with SCD in Canada and their home country?What are the prevailing values and beliefs related to SCD that shape the attitude and behaviors of newcomer families?How do newcomer families perceivethe current delivery of medical care (the barriers and the facilitators)? METHODS: Focused ethnography was used to understand the socio-cultural context in which newcomer families from Africa experience their child's SCD; to explore their perspectives, beliefs, how they manage daily life and experience the western medical system. A sample size of12-15 participants was selected to reach saturation.Participants were selected using purposeful and convenience sampling and semi-structured interviews were held with the primary caregiver(s) with use of aninterpreter if needed. Research Ethics Board approved. RESULTS: Saturation was reached at 10 families and 12 were interviewed due to recruiting methods. Demographics:12 caregivers (N=8 females; N=4 males); most were in their forties and from Congo, Nigeria or Liberia. The majority had 3 or more children, were married and employed. The majority did not have extended family within the region. Languages spoken at home were English, French, Yoruba, Swahili orMoorie. They immigrated to Canada between 2002 and 2015 For themes see table 1. CONCLUSIONS: Participants' attitude, perception and knowledge about SCD were profoundly affected by their experiences in their countries of origin. These mostly negative experiences (seeing children suffering without appropriate medical care; observing social stigma, etc.) were deeply embedded and determined their response to SCD in their children. 1. Practice guideline: Allow for sufficient time and provision oftranslation services to explore the families' experience with stigma within country of residence and origin as well as embedded in the healthcare system and the community. Despite the prevalence of SCD in their home countries the diagnosis was a surprise. The path towards acceptance was slow, emotionally convoluted and not linear. Acceptance of the diagnosis is a process and devastating in the context of previous experiences. 2. Practice guideline: Review diagnostic information early and have easily accessible information about SCD available for parents/family network. This information will also need to be reviewed with the child at key developmental time periods. SCD has a dominant impact on life causing renegotiation of all relationships: spousal, family, community, co-workers and school staff. Managing SCD influenced daily routines imposing structure which was disrupted for hospitalizations. Families were reluctant to leave children unattended in the hospital and thus sacrificed personal and employment goals. Social support is limited and families cope alone.Families tend to seek practical support and deny the desire for emotional support. 3. Practice guideline: 3a)Screen for potential isolation and explore whether other caretakers are aware of diagnosis and disease specific care 3b) Given the tendency to deny emotional support needs, lack of nearby extended family and the stigma in the community setting up networks that provide both practical and instrumental support could be meaningful and more likely utilized resources. The life-long complexity of SCD creates anxiety for the child's life expectancy. Families trust in medical expertise, improvements in medical treatments and their faith/religious beliefs are foundations for hope. 4. Practice guideline: HCP working with families should ensure awareness of clinical advances and develop means to easily share knowledge as it will strengthen hope for the future. Table 1 Table 1. Disclosures Bruce: Novartis: Consultancy, Honoraria; Apopharma: Consultancy.

Outcome of 295 rehabilitation patients with mild, moderate, and severe brain injury was investigated prospectively at five regional medical centers using the Neurobehavioral Rating Scale. Mean factor scale scores were generally low. with the cognition mean highest and the excitement mean lowest. Regardless of scale, the most significant neurobehavioral difficulties were related to memory, insight, attention, alertness, fatigue, and blunted affect. Conversely, problems rated as least severe included hallucinations, guilt, excitement and lability of mood. Approxi­ mately 9% of the sample had at least a moderate problem with agitation, an item on the excitement scale. The general pattern of mean factor scale elevations was consistent with other studies. No relationship was found between injury severity and neurobehavioral characteristics. The relatively low incidence of neurobehavioral problems may reflect recovery and effective interdisciplinary management.

This study investigated the presence of neuropsychological deficits associated with hitting the ball with one's head (heading) during soccer play. A neuro-cognitive test battery was administered to 60 male soccer players, high school, amateur and professional level, and 12 nonplaying control participants. The effects of currently reported heading behavior as well as that of estimated lifetime heading experience on neuropsychological test performance were examined. Players with the highest lifetime estimates of heading had poorer scores on scales measuring attention, concentration, cognitive flexibility and general intellectual functioning. Players' current level of heading was less predictive of neuro-cognitive level. Comparison of individual scores to age-appropriate norms revealed higher probabilities of clinical levels of impairment in players who reported greater lifetime frequencies of heading. Because of the worldwide popularity of the game, continued research is needed to assess the interaction between heading and soccer experience in the development of neuropsychological deficits associated with soccer play.

Professionals have suggested that aggressiveness, substance abuse, and criminality contribute to poor outcomes after brain injury. There is considerable research regarding post-injury aggressive behaviour, but limited information concerning criminal behaviour and alcohol use patterns. With a sample of 327 patients varying in severity of traumatic brain injury, the present investigation examined alcohol use patterns, arrest histories, behavioural characteristics, and psychiatric treatment histories. Relative to the uninjured population, analysis revealed relatively high incidence of heavy drinking, both pre- and post-injury, among patients with a history of arrest. Increases in abstinence rates were found regardless of arrest history. In addition, a history of arrest was associated with a greater likelihood of psychiatric treatment. Findings also indicated relatively high levels of aggressive behaviours. Discussion focuses on implications for evaluation, rehabilitation, and future research.