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BMJ No 7108 Volume 315 Papers - Abstracts Saturday 6 September 1997
Duration of cognitive dysfunction after concussion, and cognitive
dysfunction as a risk factor: a population study of young men
Duration of cognitive dysfunction after concussion, and cognitive dysfunction as a risk factor: a population study of young menThomas W Teasdale, Aase Engberg
AbstractObjectives: To establish how long cognitive dysfunction lasts after concussion, and the extent to which it may be a predisposing risk factor for concussion, by examining the prevalence of cognitive dysfunction among young men who have sustained concussion.Design: Observational study. Setting: Denmark. Subjects: 1,220 young men who had been admitted to hospital for concussion between the ages of 16 and 24 (identified in a national register of admissions) and who had also been cognitively tested by the Danish conscription draft board. Main outcome measure: Score on the draft board's cognitive screening test, dichotomised as dysfunctional or non-dysfunctional (20.4% of the general population of Danish men appearing before the draft board had a dysfunctional score). Results: 700 of the 1,220 men had been tested after sustaining concussion; 520 had been tested before concussion. Four (50%) of the eight men who were tested less than seven days after the injury had a dysfunctional score. Among groups of the remaining 692 men who were tested at later time points after injury, the rates were only marginally raised (range 21.4% to 26.5%) above the population level. Among men tested before injury, the rate of dysfunctional scores was higher (30.4% (158/520)). Apart from suggesting cognitive dysfunction as a risk factor for concussion, this higher proportion seems to relate to the fact that they were typically injured as young adults, whereas those men who were tested after concussion had more often been injured as adolescents. The relative risk for concussion in the presence of cognitive dysfunction is estimated to be 1.57 (95% confidence interval 1.32 to 1.86). Conclusions: Cognitive dysfunction is not only a short term consequence of concussion but also a predisposing risk factor for concussion, more so for young adults than for adolescents. Psychological Laboratory, Department of
Neurology, Correspondence to: Dr Teasdale Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire surveyM P Lucock, S Morley, C White, M D Peake AbstractObjective: To study the time course and prediction of responses to reassurance after gastroscopy showing no serious illness.Design: Selection of consecutive patients were assessed before gastroscopy, immediately after reassurance, and at follow up at 24 hours, 1 week, 1 month, and 1 year. Responses of subgroups of patients identified as high, medium, and low health anxiety by the health anxiety questionnaire were analysed. Setting: Endoscopy clinic in a general hospital. Intervention: Oral reassurance that there was "nothing seriously wrong." Subjects: One consultant physician and 60 patients aged 18-74 referred for gastroscopy. Main outcome measures: Physician's and patients' ratings of the extent of the reassurance and patients' ratings of their anxiety about their health and of their illness belief. Results: There was good agreement between the patients and the physician about whether reassurance had been given. Health anxiety and illness belief decreased markedly after reassurance. Patients with high health anxiety showed a significant resurgence in their worry and illness belief at 24 hours and 1 week, and these levels were maintained at 1 month and 1 year later. Patients with medium levels of health anxiety showed a reduction in worry and illness belief after reassurance, and this was generally maintained during follow up. Patients with low health anxiety maintained low levels of health worry and illness belief throughout the study. Partial correlation analyses showed that the levels of worry and illness belief after reassurance were predicted by the health anxiety questionnaire. This measure also had predictive value beyond that of a measure of general anxiety. Conclusions: Medical reassurance results in a reduction of worry about health and of illness belief, but this may be very short term. Measurable individual differences in health anxiety can be used to predict the response to reassurance. Department of Clinical Psychology, Division of Psychiatry and Behavioural Sciences, Pontefract General Infirmary
Chest Unit, Correspondence to: Professor Morley A systematic review of compression treatment for venous leg ulcersAlison Fletcher, Nicky Cullum, Trevor A Sheldon AbstractObjective: To estimate the clinical and cost effectiveness of compression systems for treating venous leg ulcers.Methods: Systematic review of research. Search of 19 electronic databases including Medline, CINAHL, and Embase. Relevant journals and conference proceedings were hand searched and experts were consulted. Main outcome measures: Rate of healing and proportion of ulcers healed within a time period. Study selection: Randomised controlled trials, published or unpublished, with no restriction on date or language, that evaluated compression as a treatment for venous leg ulcers. Results: 24 randomised controlled trials were included in the review. The research evidence was quite weak: many trials had inadequate sample size and generally poor methodology. Compression seems to increase healing rates. Various high compression regimens are more effective than low compression. Few trials have compared the effectiveness of different high compression systems. Conclusions: Compression systems improve the healing of venous leg ulcers and should be used routinely in uncomplicated venous ulcers. Insufficient reliable evidence exists to indicate which system is the most effective. More good quality randomised controlled trials in association with economic evaluations are needed, to ascertain the most cost effective system for treating venous leg ulcers.
NHS Centre for Reviews and
Dissemination, Department of Health
Studies, Correspondence to: Dr Cullum
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