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Biomedical subjects

B Willer

Publications and source records attributed to B Willer.

At least 19 recordsLinked to original sources
PubMed2004

A population based investigation of head injuries and symptoms of concussion of children and adolescents in schools.

OBJECTIVE: To examine the incidence of head injury and symptoms of concussion among children at school and to determine the relationship of age, gender, and cause to incidence rates. DESIGN: Incident reports involving head injury for schools in the Province of Ontario, Canada during the year 2000 were evaluated. PARTICIPANTS: The population base for the schools represented was 1 372 979 children aged 6 to 16. SETTING: 95% of schools in the province of Ontario, Canada participated in the injury reporting system. MAIN OUTCOME MEASURES: A head injury was defined as any injury to the head that came to the attention of a school official. Head injuries accompanied by symptoms of concussion became a secondary outcome measure. RESULTS: There were 11 068 unduplicated head injury reports for the year 2000 of which 1861 qualified as producing signs or symptoms of concussion. Young children were more likely to have a head injury than older children, but slightly less likely to experience concussive symptoms. The primary cause of injury to young children was falls. Older children were more likely to receive head injuries and symptoms of concussion from sports activities. CONCLUSIONS: Overall rate of injury (3.98 per 100 children) was consistent with previous studies using prospective injury reporting systems. Probability of a head injury with symptoms of concussion among schoolchildren was only 1.9% for boys and <1% for girls during the course of their school years. There is ample justification for prevention efforts in schools.

Accidental Falls↗
PubMed2000

Effects of creatine supplementation on muscle weakness in patients with rheumatoid arthritis.

BACKGROUND AND OBJECTIVES: Patients with rheumatoid arthritis (RA) frequently suffer from muscle weakness. Oral administration of creatine has been shown to improve muscle strength in healthy subjects. The objective of this study was to examine the effect of oral creatine supplementation on muscle weakness, disease activity and activities of daily living in patients with RA. METHODS: During a period of 3 weeks, 12 patients with RA were treated with creatine monohydrate (20 g/day for 5 days followed by 2 g/day for 16 days). They were examined on entry and at the end of the study. The patients were investigated clinically, blood and urine samples were obtained, muscle biopsies were performed before and after treatment, muscle strength was determined, and self-administered patient questionnaires were completed. RESULTS: From all patients we were able to obtain full clinical and questionnaire data, while biopsies were taken from 12 patients at the start and from nine patients at the end of the study. Muscle strength, as determined by the muscle strength index, increased in eight of 12 patients. In contrast, physical functional ability and disease activity did not change significantly. The creatine concentration in serum and skeletal muscle increased significantly, while creatine phosphate and total creatine did not increase in skeletal muscle. The skeletal muscle creatine content was associated with muscle strength at baseline but not after administration of creatine. The changes in muscle strength were not associated with the changes in skeletal muscle creatine or creatine phosphate. CONCLUSION: Although the skeletal muscle creatine content and muscle strength increased with creatine administration in some patients with RA, a clear clinical benefit could not be demonstrated for this treatment when the patients were considered as one group.

Adult↗
PubMed1999

Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: a case control study.

OBJECTIVES: To compare the outcomes of severely brain-injured individuals treated in a postacute residential rehabilitation program with a matched sample of individuals receiving limited services in their homes or on an outpatient basis. DESIGN: Controlled study using a matched design in a before-and-after trial and a 1-year follow-up trial. SETTING: A postacute community-based residential rehabilitation program or in the homes of patients. PATIENTS AND OTHER PARTICIPANTS: The treatment group included all persons admitted consecutively for rehabilitation to the postacute residential program over a 3-year period (n = 23). All subjects had severe traumatic brain injury. The comparison group was selected from the roster of a support group on the basis of a systematic matching procedure. Matching variables included gender, age, length of coma, time since injury, and level of disability. Subjects of the two groups were matched on an individual basis. MAIN OUTCOME MEASURES: A functional assessment instrument (modified Health andActivity Limitations Survey [HALS]) and the Community Integration Questionnaire (CIQ). RESULTS: Individuals with traumatic brain injury who received residential-based postacute rehabilitation displayed a statistically significant increase in functional abilities when compared with a traditional (home-based) service group. More specifically, treatment subjects showed significantly greater improvement in motor skills and cognitive abilities. Treatment subjects also showed greater improvement in community integration, although this may have been accounted for by initial group differences. CONCLUSIONS: Postacute rehabilitation appears to be effective in improving function for individuals with severe brain injury. Residential-based services appear to produce greater functional improvement, whereas home-based services are more effective at maintaining community integration.

Adult↗
PubMed1999

Carnitine homeostasis in patients with rheumatoid arthritis.

Myopathy is a frequent finding in patients with rheumatoid arthritis (RA). Since carnitine is important for skeletal muscle energy metabolism, carnitine metabolism was investigated in patients with RA and myopathy. Muscle strength was estimated by determination of a muscle strength index (MSI) which is derived from isometric measurements of muscle strength at knees and elbows. Carnitine was determined by a radioenzymatic method and 3-methylhistidine by high-performance liquid chromatography. In comparison to control subjects, patients had a reduced MSI. Both the 24-h creatinine and 3-methylhistidine excretions were reduced in patients. The plasma carnitine pool was not different between patients and control subjects, except for a higher long-chain acylcarnitine concentration in patients. Urinary excretion of carnitine was decreased in patients, also after normalization for body weight. Accordingly, renal carnitine clearance and excretion fraction were both decreased in patients. Skeletal muscle free- and total carnitine levels were increased in patients, whereas the long-chain acylcarnitine content was markedly decreased. The total skeletal muscle carnitine content showed a negative correlation with the MSI and no association with disease activity. Carnitine deficiency does not explain reduced skeletal muscle strength in patients with RA. Decreased renal carnitine excretion in patients is most likely due to reduced carnitine biosynthesis, leading to more efficient tubular carnitine reabsorption for maintaining the carnitine body stores.

Adult↗
PubMed1998

Performance of administrators, professionals, and paraprofessionals during community-based brain injury rehabilitation training.

OBJECTIVE: Two related studies that evaluated the impact of a continuing education program about community-based rehabilitation on the performance of administrators, professionals, and paraprofessionals are presented. One study contained a second part that examined whether differences between pre-course test performance and post-course test performance might be accounted for by practice effects. DESIGN: Factorial mixed model designs. SETTING: University classroom. PARTICIPANTS: Three hundred and eight professionals, administrators, and paraprofessionals from a variety of community-based rehabilitation programs. INTERVENTION: The 4-day graduate-level course focused on three content areas: brain and behavior relationships, behavioral and cognitive intervention strategies, and a rehabilitation philosophy that emphasizes individual client rights. MAIN OUTCOME MEASURE: An examination completed before and immediately after taking the course. RESULTS: Professionals and administrators perform better than paraprofessionals when tested at the beginning and end of the training. However, the absolute differences among these groups were not substantial. In addition, the rate of learning course content was the same for administrators, paraprofessionals, and professionals. CONCLUSIONS: The results support the usefulness of training for all levels of staff and suggest that all levels of staff benefit in an equal fashion.

Administrative Personnel↗
PubMed1996

Low serum creatine kinase activity is associated with muscle weakness in patients with rheumatoid arthritis.

OBJECTIVE: In rheumatoid arthritis (RA) serum creatine kinase (CK) is reduced in association with inflammatory response variables. Our objective was to examine whether low CK is associated with muscle weakness and to what extent the hypothesized relationship between CK and muscle weakness can be explained by anthropometric and sociodemographic variables and/or disease variables. METHODS: Cross sectional and longitudinal retrospective analyses of clinical, radiological, and biochemical data of a prospective cohort of consecutive patients with RA. Isometric muscle strength was measured with a validated muscle strength index (MSI); CK was measured with an enzymatic assay (N-acetyl-cysteine, 37 degrees C). RESULTS: 65 patients were enrolled in the study and we obtained complete one year followup data from 47. In cross sectional analysis, CK was a significant, moderate correlate of the MSI (r = 0.43, p < 0.01). CK remained a significant explanatory variable of the MSI in multivariate models that controlled for demographic variables and lean body mass, corticosteroid use, and biochemical, clinical, and radiological disease variables. In longitudinal dichotomous analyses, worsening in CK was weakly but significantly associated with decreased muscle strength, whereas in linear analyses the association did not reach significance. CONCLUSION: In patients with RA, low CK activity is associated with muscle weakness. Demographic, anthropometric, and disease variables related to muscle mass or muscle atrophy explain only part of this association. Our findings support the hypothesis that muscle weakness may be partly caused by a disease related reduction of CK activity independent of muscle atrophy.

Adrenal Cortex Hormones↗
PubMed1994

The community integration questionnaire. A comparative examination.

The community integration questionnaire (CIQ) was designed to assess home integration, social integration and productive activity in persons with acquired brain injury. The instrument consists of 15 items and can be completed by self report or with the assistance of a family member or caregiver familiar with the person's health status and social activities. Previous research has demonstrated adequate test-retest reliability and internal consistency. This study was designed to examine further, the psychometric characteristics of the CIQ and begin the process of establishing the instrument's validity. The CIQ was administered to 341 persons with traumatic brain injury (TBI) and 210 persons without TBI or any other apparent disabilities. The results indicate that the total scores are normally distributed for both persons with and without TBI. A statistically significant difference (P < 0.01) was found between subjects with TBI and those without TBI for all three subscales of the CIQ and for total scores. Data analysis also revealed that the total CIQ scores statistically differentiated among subjects with TBI living in three different settings: (1) living independently; (2) living in a supported community situation and (3) living in an institution. Intercorrelations among the three subscales (home, social and productivity) demonstrated that the CIQ provides unique information in the assessment of community integration for persons with TBI. Areas of future research necessary to expand the research and program evaluation usefulness of the CIQ are identified.

Activities of Daily Living↗
PubMed1994

Whatever it takes: a model for community-based services.

The Whatever It Takes model is presented as an extension of the medical/rehabilitation model. It is not presented as an alternative to the rehabilitation model, although it does represent an opposition to the manner in which the model is typically implemented in community-based programmes for individuals with acquired brain injury. After brain injury, medical complications persist and a strictly anti-medical model in a community-based programme is unwise. On the other hand, community-based programmes that attempt to treat the individual, or provide rehabilitation services, in the absence of careful consideration of environmental barriers or the need for natural supports, are not likely to meet the long-term community reintegration needs of the individual, and may be unjustly using up finite resources. There are numerous complications associated with living with the effects of acquired brain injury. There also is considerable complexity associated with a health-care system and reimbursement system that emphasize acute care. Given these complexities, and the strong probability that a cure for brain injury is not likely to be found within the next decade, even the most learned professionals in brain injury are likely to say that practical solutions are needed for the present. Most notable is the late Dr Sheldon Berroll, who provided so much leadership to the field, but when asked about solving the day-to-day problems for an individual, would often respond: 'Do whatever it takes'. This advice was not presented in desperation, but rather as practical guidance. We have attempted to describe the whatever it takes approach, and to provide some guidelines for its implementation in community integration programmes.

Activities of Daily Living↗
PubMed1993

A note concerning misconceptions of the general public about brain injury.

A survey performed in South Louisiana disclosed that the general population held a number of misconceptions about the sequelae of brain injury. The authors cautioned that the respondents represented a convenient sample and were representative of only a small geographic region, and challenged others to conduct similar surveys in other regions of the country. The present study represents a replication of the Gouvier et al. survey in samples of individuals residing in Western New York State and Southern Ontario, Canada. The results of the current study are consistent with those reported by Gouvier et al., namely that misconceptions about brain injury are common. The impact of these misconceptions for individuals with brain injury are discussed.

Journal Article↗
PubMed1992

[Drug prescription in Dakar and outskirts].

Drugs are very important to human life due to their human mission and to the essential role they play in modern society through their real social function. When used in certain conditions, drugs are expensive, ineffective and can even become dangerous and the source of poisoning with serious consequences. In order to minimize risks and accidents, special attention is paid to drugs from their conception to their elimination by the body, resulting inter alia in a severe control of their prescription. In Dakar, where are can find the greatest number of prescribers in Senegal, this control is rarely respected. This situation can be fraught with serious consequences for the health of populations.

Drug Prescriptions↗
PubMed1992

[Surveillance of heavy metal pollution of mangrove oysters in Senegal].

Joal-Fadiouth, located in department of Mbour (region of Thies), 118 kilometers from Dakar, the capital of Senegal, is an area where one can find a large swamp with mangroves whose self-propagating roots serve as growth support for young oysters. The importance of those oysters, both on the domestic and foreign markets and the ever greater threat of pollution of our coasts led us to search for and measure out heavy metals. In fact, it is well know that the accumulation of those elements in the food chain can be at the origin of severe poisoning. It appears, in the light of the results obtained that the level of pollution by heavy metals in this part of the senegalese coast has not yet reached alarming limits.

Animals↗
PubMed1990

Traumatic brain injury and marital relationships: a literature review.

This is a review of the research regarding the effects of traumatic brain injury (TBI) on the marital relationship. Individuals who have withstood a severe traumatic brain injury usually exhibit a range of cognitive and behavioural disabilities. Typical problems outlined in the research include: attention and concentration deficits, memory and information-processing deficits, judgement and perception difficulties. While these impediments pose problems for community re-integration, they may become sources of difficulty for the spouse. The following report critically examines the literature on the effects of head injury on marital relationships. This research has demonstrated that spouses' reactions to TBI include feelings of anxiety, isolation, and loss. In addition, this literature review shows that there is a dearth of research that has regarded the individual with TBI to be a valid source of information, or has considered women with TBI in a marital situation.

Brain Damage, Chronic↗
PubMed1986

Role of the family in case management of the mentally ill.

This article provides a systematic discussion and assessment of the actual and potential contributions that families of the chronic mentally ill can make to the case management of their patient-relatives. It examines family members' involvement with six major case management functions including assessment, linkage, monitoring, assistance with daily problems, crisis intervention, and advocacy. For each function, the authors consider the potential of family members to make a contribution, specific activities that are more appropriately assumed by professional staff, and any limitations or caveats about family members' involvement with the given case management activity. The article points out that family members are clearly quite capable of making significant contributions in almost all aspects of managing their patient-relatives and that their potential contributions are too frequently ignored or underused by professionals. The authors recommend that professionals give greater acknowledgment to the case management efforts of family members, work to integrate the contributions of these natural helpers with formal case management systems, and provide family members with the encouragement and support they need to enhance their caring contributions.

Activities of Daily Living↗
PubMed1984

Survey of U.S. and Canadian medical schools on admissions and psychiatrically at-risk students.

A survey of directors of admissions and chairmen of departments of psychiatry in U.S. and Canadian medical schools was undertaken concerning problems of the identification of students with emotional problems prior to admission and the role of psychiatry faculty members on the admissions committee. In general, the respondents felt that the preadmission interview was the best opportunity to identify the at-risk student but that current interview procedures would have to be improved. The respondents also indicated that U.S. law, which prohibits asking questions about psychiatric problems or treatment, is restrictive and greatly reduces the potential effectiveness of the interview. The survey results are compared with the results of earlier surveys.

Canada↗
PubMed1982

Primary care and medical education.

There is considerable argument for the value of educating medical students in the basics of primary care, comprehensive care and concern for psychological needs of patients. However, medical schools do not place much emphasis on primary care. Most clinical experiences take place in tertiary care centers, and most teaching is provided by specialists. Relatively little attention is paid to psychological issues of care and development of interpersonal skills among would-be physicians. The impact of the tertiary care orientation is widespread. Medical students are expected to adopt the role of the physician-specialist or technologist. Those who want to be primary care physicians have to face value conflicts with the establishment, and some develop emotional problems. The effects carry over into practice. Physicians who do not develop adequate personal skills are less likely to be viewed as competent by their patients. They are also more likely to develop mental health problems themselves. This article argues for a modification of the medical school curriculum to reflect the orientation of the primary care model.

Clinical Competence↗
PubMed1982

Comparison of family-care and group homes as alternatives to institutions.

Two residential alternatives, family-care and group homes, for deinstitutionalized mentally retarded adults were compared. Residents in both settings displayed essentially no improvement in self-care skills. Individuals placed in family-care homes were significantly more likely to improve their maladaptive behavior. Individuals in group homes were more likely to improve in community living skills. Residents of both settings were equally likely to have friends, maintain ongoing contact with family, and make use of community resources. A differential use of family-care and group homes was suggested.

Activities of Daily Living↗