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Biomedical subjects

A Rothwell

Publications and source records attributed to A Rothwell.

11 recordsLinked to original sources
PubMed2002

Impact of early intervention on outcome following mild head injury in adults.

BACKGROUND: The impact of mild head injury is variable and determinants of outcome remain poorly understood. Results of previous intervention studies have been mixed. OBJECTIVES: To evaluate the impact on outcome of the provision of information, measured in terms of reported symptoms, cognitive performance, and psychological adjustment three months postinjury. METHODS: 202 adults with mild head injury were studied: 79 were assigned to an intervention group and were assessed one week and three months after injury; 123 were assigned to a non-intervention control group and were seen at three months only. Participants completed measures of preinjury psychological adjustment, concurrent life stresses, post-concussion symptoms, and tests of attention, speed of information processing, and memory. Subjects seen at one week were given an information booklet outlining the symptoms associated with mild head injury and suggested coping strategies. Those seen only at three months after injury did not receive this booklet. RESULTS: Patients in the intervention group who were seen at one week and given the information booklet reported fewer symptoms overall and were significantly less stressed at three months after the injury. CONCLUSIONS: The provision of an information booklet reduces anxiety and reporting of ongoing problems.

Adult↗
PubMed2001

Impact of early intervention on outcome after mild traumatic brain injury in children.

OBJECTIVE: The impact of mild head injury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psychological adjustment in children 3 months after injury. METHODS: A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 children with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N = 45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury behavior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested coping strategies. Those seen 3 months after injury only did not receive this booklet. RESULTS: Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behavioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury. CONCLUSIONS: Providing an information booklet reduces anxiety and thereby lowers the incidence of ongoing problems.

Adaptation, Psychological↗
PubMed2000

Prefrontal neuropsychological effects of sleep deprivation in young adults--a model for healthy aging?

Neuropsychological testing and brain imaging show that healthy aging leads to a preferential impairment of the prefrontal cortex (PFC). Interestingly, in young adults sleep deprivation (SD) has similar effects. Psychological tasks not so oriented to the PFC are less sensitive both to SD and aging. The PFC is a cortical region working particularly hard during wakefulness, which may make it more vulnerable to "deterioration," whether this is through aging or SD. In these respects SD in young adults may offer a model for aging. No study has directly compared aging with SD. We compared groups comprising (equal sexes): YOUNG (av. 23y), MIDDLE AGED (av. 60y) and OLD (av. 73y). Young were subdivided into SD and non-sleep deprived groups. All participants were carefully screened, were healthy, good sleepers and with a similar educational background. A battery of PFC-oriented, short and straightforward neuropsychological tests was used to compare the effects of 36h of SD in the young group, with findings from the healthy, alert, non-sleep deprived groups. Tests relied on accuracy rather than speed (which took into account the problem of "global slowing" in the older participants), and were administered once (i.e., were novel). Test outcomes were significantly affected by: (1) SD in the young groups, and (2) by age. A non-PFC component of one test was not affected by SD or by age. It was concluded that 36h SD in young adults produces effects on the PFC similar to those found in normal, alert people aged about 60 years. However, it can not be concluded that an aged brain is a sleep-deprived brain.

Adult↗
PubMed2000

Factors influencing outcome following mild traumatic brain injury in adults.

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS-R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI.

Adolescent↗
PubMed1999

Cognitive and behavioral outcome following mild traumatic head injury in children.

OBJECTIVES: To investigate outcome in children with mild traumatic head injury (THI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. DESIGN: Postconcussional symptomatology, behavior ratings, and neuropsychological test performance were examined at 1 week and 3 months postinjury. SETTING: Participants were recruited from successive presentations to emergency departments of two major hospitals. PARTICIPANTS: 130 Children with mild THI were compared with 96 children having other minor injuries as controls. RESULTS: Children with mild THI experienced headaches, dizziness, and fatigue but exhibited no cognitive impairments, relative to controls, at 1 week postinjury. By 3 months, symptoms had resolved. However, 17% of children showed significant ongoing problems. They were more likely to have a history of previous head injury, learning difficulties, neurological or psychiatric problems, or family stressors. CONCLUSIONS: Persisting problems following mild head injury in children are more common in those with previous head injury, preexisting learning difficulties, or neurological, psychiatric, or family problems. These "at-risk" children should be identified in the emergency department and monitored.

Adolescent↗
PubMed1996

The added effectiveness of early geriatrician involvement on acute orthopaedic wards to orthogeriatric rehabilitation.

AIMS: To evaluate the effect of regular input by a geriatrician to an orthopaedic ward. METHOD: A geriatrician saw all patients aged over 65 years admitted to an acute orthopaedic ward-this was compared to an adjacent orthopaedic ward which had consultation only service, and also to both wards in the preceding year. All subjects over the age of 65 years with fractured neck of femur admitted over a 4 month period were enroled. Main outcome measures were length of stay, cost, discharge destination. RESULTS: In the year prior to study, patients in both wards had a mean total stay of 28 days. On the intervention ward the mean stay was reduced to 20.7 days, and on the control ward to 27 days. The cost per case on the intervention ward was NZ$9400, and on the control ward was NZ$11 500. Eleven percent went to a higher care level on the intervention ward, compared with 23% on the control ward. CONCLUSION: Geriatrician input on a twice weekly basis to all patients over 65 years of age on an orthopaedic ward, saves bed days, reduces costs and produces an improved outcome.

Aged↗
PubMed1995

Monocyte-macrophage antigen expression on chondrocytes.

OBJECTIVE: To characterize chondrocytes in normal and arthritic joints and compare their phenotype to that of synovial macrophages present in rheumatoid joints. METHODS: Using an immunoperoxidase staining technique, we examined the presence and distribution of a number of leukocyte activation and differentiation antigens on samples of cartilage obtained from resected joints of normal controls and subjects with rheumatoid arthritis or osteoarthritis. RESULTS: Chondrocytes in each group were CD14+, CD68+, Thy-1+, CD11a+, CD18+, MAX.3-, and MAX.24-. Staining was variable for MAX.1 and CD45. HLA-DR and CD71 were expressed only on cells located in the superficial layer of rheumatoid cartilage. We found lower levels of expression of CD14 on chondrocytes in arthritic joints, whereas CD58 was expressed at higher levels. Surface expression of CD14 was confirmed on normal chondrocytes using flow cytometry and further supported by the detection of CD14 mRNA by polymerase chain reaction. CONCLUSION: Our findings demonstrate that chondrocytes express several antigens that are also found on monocytes and macrophages.

Arthritis, Rheumatoid↗
PubMed1992

Noradrenergic intervention in Alzheimer's disease.

We report results of a double-blind, 13-week trial of the alpha2 noradrenergic agonist guanfacine in 29 patients meeting clinical criteria for probable Alzheimer's disease (AD). Patients studied were relatively young (mean = 71 years), well educated (mean = 13.5 years), and in the early stages of cognitive deterioration (mean Mini-Mental State score = 22). We found no evidence of improvement with a single .5-mg daily dose of guanfacine and some evidence of a modest negative effect of the drug on neuropsychological tests. We concluded that noradrenergic intervention alone is unlikely to be effective in Alzheimer's disease.

Aged↗