Head injury is associated with increased vulnerability to death from a variety of causes for at least 13 years after hospital admission. There is a need to understand how head injury influences mortality, particularly in younger adults and after mild head injury.
The purpose of the study was to investigate if a questionnaire sent by mail can give a reliable assessment of outcome on the Glasgow Outcome Scale. A questionnaire was developed for the Glasgow Outcome Scale (GOS) and a second questionnaire for the Extended Glasgow Outcome Scale (GOSE). The questionnaires were self-contained and designed to be completed by either a head-injured person or a proxy. The questionnaires were studied in two ways: each questionnaire was administered twice (at an interval of approximately 2 weeks), and ratings from the postal questionnaires were compared to ratings from a structured interview conducted by telephone. The four studies were carried out in separate groups of head-injured participants consisting of 32-38 individuals. For the test-retest comparison, k(w) (quadratic weights) was 0.94 for the GOS questionnaire and 0.98 for the GOSE questionnaire. For the comparison with the telephone interview, k(w) was 0.67 for the GOS and 0.92 for the GOSE. The values of k(w) indicate good agreement for all comparisons. We conclude that it is possible to obtain reliable outcome data after head injury using postal questionnaires.
STUDY OBJECTIVES-Insomnia in cancer patients is prevalent, persistent and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence. METHODS-173 females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12-months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3-monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer-Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed. RESULTS-Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%-49%) or to persist with insomnia (23%-46%). 77% of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio=0•08, 95% ci 0•02-0•29, p<•001) and pre-diagnosis ISI scores (odds ratio=1•13/unit increase in pre-diagnosis sleep score, 95% ci 1•05-1•21, p=•001) were identified as the main risk factors for persistent insomnia. CONCLUSIONS-These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritised for insomnia management protocols.
Background There is a need to establish how long term outcome evolves after head injury (HI) and factors related to this, to inform opportunities for intervention. Objective To determine late outcome in adults 12e14 years after hospital admission for HI and to examine relationships between injury, early and late factors, and disability. Methods A prospective cohort with HI, whose outcome was reported previously at 1 and 5e7 years after injury, were followed up after 12e14 years. Participants were assessed using structured and validated measures of disability (Glasgow Outcome Scale-Extended), psychological well being, alcohol use and health status. Results Of 219 survivors followed-up at 5e7 years, 34 (15.5%) had died by 12e14 years. Disability remained common in survivors at 12e14 years (51%), as found at 1 and 5e7 years (53%). For those disabled at 1 year, outcome was poor, with 80% dead or disabled at 12e14 years. Older age at injury, a premorbid history of brain illness or physical disability and post-injury low self-esteem and stress were associated with disability at 12e14 years. Disability changed between 5e7 and 12e14 years in 55% of survivors, improving in 23%. Late changes in disability between 5e7 and 12e14 years were associated with self-perceptions of locus of control as being 'powerful others' at 5e7 years. Conclusions Disability is common 12e14 years after hospital admission with a HI. For some there is a dynamic process of change in disability over time that is associated with self-perceptions of control that could be a target for intervention based research.
There was underrepresentation of the epsilon4 allele in this group when compared with previously studied cases of subarachnoid hemorrhage with a fatal outcome and with the general population. This suggests that patients with the epsilon4 allele who have a subarachnoid hemorrhage are less likely to be admitted to a neurosurgical unit. This study does not support an association between possession of an epsilon4 allele and poor outcome in patients admitted to a neurosurgical unit with spontaneous subarachnoid hemorrhage, although the wide confidence interval does not preclude a clinically relevant association between APOE genotype and outcome. The findings indicate that an association between genotype and the development of delayed ischemic complications after subarachnoid hemorrhage may be possible.
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