Characterizing the profiles of patients with acute concussion versus prolonged post-concussion symptoms in Ontario

Identifying vulnerability factors for developing persisting concussion symptoms is imperative for determining which patients may require specialized treatment. Using cross-sectional questionnaire data from an Ontario-wide observational concussion study, we compared patients with acute concussion (≤ 14 days) and prolonged post-concussion symptoms (PPCS) (≥ 90 days) on four factors of interest: sex, history of mental health disorders, history of headaches/migraines, and past concussions. Differences in profile between the two groups were also explored. 110 patients with acute concussion and 96 patients with PPCS were included in our study. The groups did not differ on the four factors of interest. Interestingly, both groups had greater proportions of females (acute concussion: 61.1% F; PPCS: 66.3% F). Patient profiles, however, differed wherein patients with PPCS were significantly older, more symptomatic, more likely to have been injured in a transportation-related incident, and more likely to live outside a Metropolitan city. These novel risk factors for persisting concussion symptoms require replication and highlight the need to re-evaluate previously identified risk factors as more and more concussions occur in non-athletes and different risk factors may be at play.

Inheritance and molecular mapping of new green bug resistance genes in wheat germ plasms derived from Aegilops tauschii

Molecular mapping of genes for crop resistance to the green bug, Schizaphis graminum Rondani, will facilitate selection of green bug resistance in breeding through marker-assisted selection and provide information for map-based gene cloning. In the present study, microsatellite marker and deletion line analyses were used to map green bug resistance genes in five newly identified wheat germ plasms derived from Aegilops tauschii. Our results indicate that the Gb genes in these germ plasms are inherited as single dominant traits. Microsatellite markers X wmc 157 and X gdm 150 flank G bx 1 at 2.7 and 3.3 cM, respectively. Xwmc 671 is proximately linked to G ba, G bb, G bc and G bd at 34.3, 5.4, 13.7, 7.9 cM, respectively. X barc 53 is linked distally to G ba and G bb at 20.7 and 20.2 cM, respectively. X gdm 150 is distal to G bc at 17.9 cM, and X wmc 157 is distal to G bd at 1.9 cM. G bx 1, G ba, G bb, G bc, G bd and the previously characterized G bz are located in the distal 18% region of wheat chromosome 7 DL. G bd appears to be a new green bug resistance gene different from G bx 1 or G bz. G bx 1, G bz G ba, G bb, G bc and G bd are either allelic or linked to Gb 3.

Molecular genetic mapping of Gby, a new greenbug resistance gene in bread wheat

The greenbug, Schizaphis graminum (Rhodani),is one of the major insect pests of wheat worldwide and it is important to develop a basic understanding of the chromosomal locations of known and new greenbug resistance genes. Gby is a new greenbug resistance gene in the wheat line 'Sando's selection 4040'. A mapping population used in this study was derived from a cross of Sando's 4040 and PI220127, a greenbug susceptible wheat land race from Afghanistan. A progeny test indicated that Gby is inherited as a single semi-dominant gene. A genetic linkage map consisting of Gby, Xgwm322 (a wheat microsatellite marker), XksuD2 (an STS marker) and 18 restriction fragment length polymorphism (RFLP) loci was constructed. We used DNA from Chinese Spring 7A deletion lines to show that the gwm332 and ksuD2 amplified fragments mapped in this study are located on along arm of chromosome 7A. This suggests that Gby is located on wheat chromosome 7A. Gby was mapped to the area in the middle of the 'island' of putative defense response genes that are represented by RFLP markers(Xpsr l9, XZnfp, Xbcd98 and Prl b) previously mapped to the distal part of the short arm of wheat chromosome group 7. This region of chromosome 7A is characterized by a high recombination rate and a high physical density of markers which makes Gby a very good candidate for map-based cloning. The selection accuracy when theRFLP markers Xbcd98, Xpsrll9 or XZnfp and Prlb flanking Gby are used together to tag Gby is 99.78%,suggesting that they can be successfully used in marker assisted selection.

Hypertension and diabetes among Siberian Yupik Eskimos of St. Lawrence Island, Alaska

CHANGING DIETS AND LIFESTYLES contribute to an increase in the prevalence of cardiovascular disease and diabetes in Alaska Natives. To examine the problem in detail, we have begun a systematic screening of various ethnic groups by carrying out a pilot study of Siberian Yupik Eskimos ages 39 and over. Mean LDL and HDL levels were 157 mg/dl and 63 mg/dl. Mean fasting insulin was 7.0 microunits/ml; and mean BMI, 27.1. Fasting insulin level was significantly related to both diastolic blood pressure and fasting triglyceride levels, but not to systolic blood pressure, total cholesterol, LDL cholesterol, or HDL cholesterol levels. Of the 66 people screened, 27% had evidence of hypertension.

Binding the elderly: a prospective study of the use of mechanical restraints in an acute care hospital

Little information exists on the use of mechanical restraints among nonpsychiatric inpatients. This prospective study evaluates their use among consecutive medical and surgical admissions to an acute care hospital. Daily direct observation of patients and hospital record review provided data on potential predictors of restraint, reasons for their application, complications, and outcome. Cox regression analysis was used to calculate relative risk of restraint while adjusting for duration of hospitalization as well as other variables. Restraints were applied to 37 (17%) of the 222 study patients. Restrained patients were eight times more likely to die during hospitalization (24% v 3%; P less than 0.01). Abnormal mental status exam, diagnosis of dementia, surgery, and presence of monitoring and support devices (eg, intravenous lines) were statistically significant independent predictors of restraint. Mechanical restraint is a common occurrence among nonpsychiatric inpatients particularly those with impaired mentation, requirement for surgery, or intensive medical intervention. Identification of medical and surgical patients at risk for restraint may reduce the use of these devices by concentrating surveillance and prevention on this group.

Health beliefs as predictors of success of alternate modalities of smoking cessation: results of a controlled trial

The primary objective of this study was to determine whether health beliefs influenced the outcome of the three alternate modalities of reducing cigarette consumption. The study randomized volunteers either to a control group or to one of three cessation programs, using behavior modification, health education, or hypnosis. A questionnaire was used to document health beliefs, demographic characteristics, and smoking history. Blood samples were taken before and after the completion of intervention programs to measure changes in serum thiocyanate. A follow-up questionnaire was used to assess smoking behavior after 6 months. Statistically significant decreases in serum thiocyanate levels followed participation in each of the three programs. Factor analysis and reliability tests were used to identify four scales reflecting major variable dimensions in the health belief model. Significant correlations between change in serum thiocyanate and two of the scales (general health concern and perceived vulnerability) were found only for the group randomly assigned to the health education intervention program.

A randomized trial comparing smoking cessation programs utilizing behaviour modification, health education or hypnosis

The purpose of this study was to determine the efficacy of hypnosis, health education, and behaviour modification programs for cigarette smoking cessation. A randomized clinical trial comparing these three programs and a control group was conducted in 168 volunteers. Follow-up data three weeks after completion was available in 140 subjects. Each program showed significant reductions in reported cigarette consumption and serum thiocyanate levels, an indicator of long-term cigarette consumption, compared to entry and to the control group. However, there were no significant differences between the hypnosis, health education, or behaviour modification groups with respect to the proportion who reported quitting smoking, the number cigarettes smoked or change in serum thiocyanate levels. Reported cigarette consumption ascertained six months later again showed no significant differences between these three approaches. Factors such as subject age, age at starting cigarette smoking, educational level, marital status, spouse or partners smoking did not identify subgroups with differences between treatment responses. Thus, hypnosis, health education, and behaviour modification are each effective programs for changing cigarette smoking and each is equally effective in this regard.

Changes in high density lipoprotein cholesterol after initiation of insulin therapy in non-insulin dependent diabetes mellitus: relationship to changes in body weight

To determine the interrelationships of serum lipoproteins and body weight changes with insulin therapy, 55 diabetics (mean age 52.0 +/- 2.2 years), had measurements of body weight, sum of skinfold thickness, fasting serum glucose, serum high density (HDL-C) and low density (LDL-C) lipoprotein cholesterol and serum triglycerides before and 6 weeks after beginning insulin. At entry HDL-C had a significant (p less than 0.05) negative correlation with indices of body weight-body mass index, relative weight and a significant positive correlation with serum triglycerides but no significant association with sum of skinfold thickness, fasting serum glucose or LDL-C. The relationships were seen mainly in patients who previously had not been receiving oral hypoglycemic medications. Insulin significantly increased HDL-C and body weight, and decreased glucose, triglycerides and LDL-C. Changes in HDL-C showed a significant inverse association with changes in triglycerides and direct correlation with changes in body weight, but no significant association with changes in fasting serum glucose or LDL-C. Thus, insulin therapy of diabetes mellitus favorably affects HDL-C concentration perhaps by altering triglyceride metabolism and represents a unique situation where increases in body weight are associated with increases in serum HDL-C concentration.

A randomized clinical trial comparing behavior modification and individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus: comparison of the effect on blood sugar, body weight, and serum lipids

To determine whether a group behavior modification approach might be preferable to individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus, 40 adults younger than 65 yr of age with diabetes mellitus who were not receiving insulin were randomized to either a program of individualized dietary review and recommendations or a program of group meetings aimed at controlling the signals leading to overeating and noncompliance with a diabetic dietary regimen. Statistically significant (P less than 0.05) decreases in body weight, sum skin-fold thickness, fasting serum glucose, and serum triglycerides but not LDL-C or HDL-C were observed. The individual counseling group had a greater amount of weight loss than the behavior modification group. There were no significant (P greater than 0.05) differences between the two groups with respect to the biochemical outcome variables. Patient characteristics assessed at entry--namely anxiety, internal versus external locus of control and perceived disease severity, and compliance with advice--were significantly associated with weight loss in the behavior modification group while only the latter index was of value in the individual counseling group. Thus, our use of these programs does not identify a clear advantage of either approach in the nutritional therapy of non-insulin-dependent diabetic patients.

Relationship of weight loss and cigarette smoking to changes in high-density lipoprotein cholesterol

To determine the effect of weight loss on serum high-density lipoprotein cholesterol (HDL-C), we measured serum HDL-C as well as total cholesterol and triglycerides in 65 subjects 56 women and 9 men, mean age 41.1 +/- 1.5 (+/- SEM yr) before and after a weight reduction program. At entry into the program there was a significant correlation between HDL-C and several indices of overweight--relative weight, body mass index and sum of skinfold thickness. For all subjects, despite a significant weight loss of 4.5 kg or 5.8% of initial body weight and significant decrease in sum of skinfold thickness, there was no significant increase in HDL-C or correlation between changes in HDL-C and change in body weight or skinfold thickness. For women, but not men, a weak negative correlation between change in HDL-C and change in weight or percentage change in weight was observed. However, in the subset of women who were current cigarette smokers a significant (p less than 0.01) correlation was observed between change in HDL-C and change in weight (r = -0.876) and percentage change in weight (r = -0.881). Thus a modest weight loss is not usually associated with a significant increase in serum HDL-C concentration except in cigarette smoking women.

Nutrition therapy in non-insulin-dependent diabetes mellitus

The purpose of this study was to evaluate nutritional therapy for non-insulin-dependent diabetic subjects by examining the changes in, and interrelationship of, the outcome criteria of efficacy, namely, blood glucose, body weight and serum lipids, total cholesterol, and triglycerides. Eight-two patients, who represented all those seen by one nutritionist at a diabetic education center, were contacted for long-term follow-up data, which was obtained on 80.5% of the patients. They had short-term follow-up 66.0 +/- 4.5 days after the initial visit and long-term follow-up 31.0 +/- 1.1 mo later. Four treatment groups were defined: group 1, diet only at entry and follow-up; group 2, oral hypoglycemic agents at entry and follow-up; group 3, intensified treatment (diet or oral agents at entry and oral agents or insulin at follow-up; and group 4, decrease in intensity of treatment (oral agents at entry but not at long-term follow-up). Serum glucose fell significantly (P less than 0.05) at short- and long-term follow-up in groups 1, 2, and 3. Body weight reductions were significant at short-term follow-up in all groups and were significant at long-term follow-up only in group 1. Serum cholesterol was significantly reduced at short-term follow-up in group 2. Serum triglyceride changes were significantly reduced at short-term follow-up in groups 1 and 2 and at long-term follow-up in group 1. Serum glucose changes correlated with changes in serum cholesterol and triglycerides but did not correlate with body weight changes. These findings demonstrate the effectiveness of nutritional counseling, show that lowering serum glucose did not correlate with weight reduction, and suggest that more attention should be given to factors reducing serum glucose and less attention to weight loss in the treatment of non-insulin-dependent diabetes.

Changes in plasma high-density lipoprotein cholesterol concentration after weight reduction in grossly obese subjects

Changes in serum lipoproteins associated with weight loss were assessed in 13 grossly obese (relative weight 183%) patients who had participated in an outpatient semi-starvation diet consisting of liquid protein and carbohydrate. At the follow-up examination an average of six and a half months after the start of refeeding the mean weight loss was 16.1 +/- 4.5 kg or 15% of initial body weight. Significant increases in high-density lipoprotein (HDL) cholesterol of 0.16 +/- 0.05 mmol/l (6 +/- 2 mg/100 ml) and decreases in triglycerides (0.8 +/- 0.23 mmol/l; 73 +/- 20 mg/100 ml) and fasting blood sugar (0.6 +/- 0.22 mmol/l; 11 +/- 4 mg/100 ml) were observed. Changes in HDL cholesterol correlated significantly with changes in weight (r = 0.667) and percentage change in weight. The intercept of the regression equation relating HDL cholesterol to percentage change in weight was -7.3, indicating that a change in HDL cholesterol greater than zero required a weight loss of at least 7.3% of body weight. Thus, weight loss can significantly increase HDL cholesterol concentrations but a considerable amount of weight must be lost to produce a significant increase in HDL cholesterol concentration.