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Objective: To prospectively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness (LOC) and posttraumatic amnesia (PTA) on the severity of neurocognitive impairment immediately after concussion., Methods: A sports-related concussion research model was used to allow prospective immediate evaluation of concussion. A total of 2385 high school and college football players were studied. Ninety-one players (3.8%) sustained concussions during the study. A brief neurocognitive and neurological screening measure, the Standardized Assessment of Concussion, was used to assess cognitive functioning before the football season, immediately after injury, and 15 minutes, 48 hours, and 90 days after injury., Results: Standardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean, even for injured subjects without LOC or PTA. Subjects with LOC were most severely impaired immediately after injury, whereas those without LOC or PTA were least impaired. Significant impairment was also detected 15 minutes after injury, but all three groups returned to baseline levels of cognitive functioning within 48 hours., Conclusion: These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC.

Aims: This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality., Design: Longitudinal study with pre- and post-treatment initiation., Measurements: The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment., Setting: Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI)., Participants: Two hundred and seventy-nine patients., Intervention: Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks., Findings: Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF., Conclusions: Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

This paper illustrates the application of a Public Health Model toward understanding the nature and extent of alcohol-related problems and, in turn, provides examples of strategies targeted at reducing or preventing alcohol-related illness, injury and death in Wisconsin and Milwaukee County. More specifically, data are provided detailing the widespread use and misuse of alcohol as well as the medical, behavioral and social problems associated with its use. Alcohol use and misuse is the third leading cause of preventable death behind only tobacco use and diet/activity patterns, and therefore, warrants the implementation of prevention strategies from a public health perspective. In sum, the public health model specifies three interrelated factors--the host, the agent or vehicle, and the environment--that focus strategies to reduce and/or prevent illness, injury and death. The paper concludes with specific examples of alcohol-related public health strategies targeting the host (e.g., youth and families, minority groups), the agent/vehicle (e.g., alcohol content, labeling of containers, large containers), and the environment (e.g., motor vehicle operation BAC limits, zero tolerance laws, alcohol advertising).

This article operationally describes and empirically validates a composite outcome measure developed for use in a multisite alcohol treatment matching study. Using empirically based clinical guidelines to establish alcohol consumption and alcohol-related problems criteria, 1,726 subjects were classified as abstinent, moderate drinking without problems, heavy drinking or problems, or heavy drinking and problems at intake and 3, 6, 9, 12, and 15 months postintake. Subjects with poorer composite outcome also had poorer outcomes related to quantity and frequency of alcohol consumption, alcohol-related problems, serum gamma-glutamyltranspeptidase and other nonalcohol-related measures assessing psychiatric dysfunction, psychosocial functioning, and purpose or meaning in life. Differences in the present composite measure relative to other categorical measures used in research to date and the potential for incorporating nonalcohol-specific variables into composite measures are discussed.

Alcoholism treatment researchers have increasingly incorporated multiple measures representing multiple dimensions in assessing treatment outcomes. However, no satisfactory model exists for examining the dynamic interrelationships of multiple measures in determining clinically meaningful and interpretable outcomes. One approach to analyzing multiple outcomes is to combine them into a composite measure. In their most elementary form, composite measures combine alcohol consumption and consumption-related problems dimensions into treatment outcome classifications. This paper discusses conceptual and methodological issues in studies reporting composite outcomes and provides a model and recommendations for using composite measures in alcohol treatment research.

Upon admission to an inpatient psychiatric facility, 20 adolescent serious suicide attempters and 20 nonattempters matched on depression scores were asked about their perceived hopelessness, social support, and loss preceding hospitalization. Attempters and nonattempters were similar in psychiatric status, gender, age, race, and socioeconomic status. Measures included Reynold's (1987) Suicidal Ideation Questionnaire (SIQ) and assessment for recent loss of a significant other. Also included were versions of the Beck Depression Inventory (Beck, 1967), Beck Hopelessness Scale (Beck, Schuyler, & Herman, 1974), Suicide Intent Scale (Beck et al., 1974), and Sarason's Social Support Questionnaire (Sarason, Levine, Basham, & Sarason, 1983) modified to retrospectively assess the period of time just prior to hospitalization. Classification of serious suicide attempt using both staff screening and the Suicide Intent Scale was validated by attempters' high scores on the SIQ. Data show that loss and low family support were the best predictors of an adolescent's suicide attempt. Also, suicide attempters reported more hopelessness than did nonattempters. The influence of recent loss on serious suicide attempts, especially when paired with a perceived lack of family support and hopelessness, provides evidence for a "stress-vulnerability" model of adolescent suicide behavior.