James L. Gale

Psychosocial functioning at 1 month after head injury.

The authors examined the psychosocial sequelae of head trauma at 1 month after injury in a group of 102 adult head-injured patients representing a broad range of severity of trauma. One hundred two control subjects selected from friends of the head-injured patients were used for comparison purposes. Outcome was determined with a battery of psychosocial measures assessing a number of different areas of daily functioning. The results support the following conclusions: (a) at 1 month after injury, head-injured patients experience difficulties in a number of areas of psychosocial functioning, especially the resumption of major role activities (i.e., work, school, and home management) and leisure/recreational activities; (b) the relationship between head injury severity level and the adequacy of psychosocial functional differs for the various measures; and (c) in determining the psychosocial consequences of head trauma, the use of an appropriate control group is essential.

Development and evaluation of modifications to the sickness impact profile for head injury

Three modifications were made to the Sickness Impact Profile, a behavior-based measure of health status, to improve its sensitivity to the effects of head injury. (1) Additional items were included to capture head injury sequelae and behaviors typical of young adults, the age group to which head injury most frequently occurs. (2) Subjects individually excluded behaviors irrelevant to them, thus allowing the score to better reflect injury-related changes. (3) The different areas of functioning on the Sickness Impact Profile were reweighted to reflect global judgments of the constructs contribution to overall functioning rather than the sum of the item contributions. Only the first modification is head-injury specific. The others, are relevant to any disease or injury. The performance of the modifications was evaluated in a longitudinal study of 102 head injured and 102 comparison subjects tested at 1 and 12 months after injury. The evaluation of the modifications was based on their ability to distinguish head injury from comparison subjects and on the strength of their relationship with measures of brain dysfunction. Despite a few statistically significant improvements in discrimination, differences of a practical degree were not obtained. The standard Sickness Impact Profile performed well and is recommended for evaluation of day-to-day functioning in head injury studies.

Head Injury in the Pacific Northwest

This report describes 451 consecutive patients admitted to a regional trauma center with head injury over 1 years time. Our results replicate findings from other hospital- and population-based studies of head trauma. Males exceeded females by 3 to 1; the most frequent age of patients was between 15 and 24 years; and motor vehicles were the most common cause of injuries. Mortality was related inversely to Glasgow coma scale (GCS) scores and directly to age. This study also points out two current problems in head trauma research. One is the difficulty in using the GCS in a community with highly sophisticated emergency medical services. In 38% of the patients, one or more GCS components could not be assessed directly. In 17% of cases, GCS scores could not be confidently assigned. This was principally because endotracheal tubes were in place before arrival at the hospital, precluding determination of the verbal response. A second problem is the influence of chronic pre-existing central nervous system conditions on head outcome. Twenty-nine per cent of our patients had one or more such conditions at the time of their injury. Minimal estimates of prevalence ranged from 1% (mental retardation) to 18% (alcoholism).

Patients treated by physicians and folk healers: A comparative outcome study in Taiwan

Outcome of 118 patients treated by shamans in Taipei, Taiwan, is compared with that of 112 roughly matched patients treated by physicians. Impressive among the chief findings at time of follow-up evaluation, more than three-fourths of patients in both groups across five distinctive sickness types perceived their health problems as improved and were so evaluated by the research staff. Patient attributions of source of threapeutic efficacy were more complex and ambivalent. Counter to our hypothesis a higher proportion of patients were dissatisfied with shamanistic treatment than with biomedical care, and this held true even for somatization patients with psychiatric problems. The findings are interpreted with respect to serious limitations on research design and methods that pertain to this and, we believe, any other study of indigenous healing. These limitations call into question certain of the findings in particular, and illustrate why assessments of therapeutic outcome, besides reflecting biological constraints, should be recognized as differential cultural construals of socially constructed reality.

Cerebrospinal fluid analysis in children with seizures.

Cerebrospinal fluid (CSF) examinations of 212 children aged two to 24 months with idiopathic nonfebrile seizures, complex febrile seizures, or status epilepticus, who had a lumbar puncture within 24 hours of the convulsion, were reviewed to determine whether an idiopathic convulsion can result in CSF abnormalities. Children with complex febrile seizures had a median CSF white blood cell count of 1 cell/mm3 (range 0–19 cells/mm3) and a median CSF polymorphonuclear (PMN) cell count of 0 cells/mm3 (range 0–8 cells/mm3). The CSF white blood cell (WBC) count was elevated above the upper limit of normal of 5 cells/mm3 in 9.8% and the absolute number of polymorphonuclear cells was more than 0 cells/mm3 in 26.2% of the complex febrile seizure subjects. Values at the 95th percentile were calculated; a total of 8 WBC/mm3, 4 PMN/mm3, protein of 73 mg/dl and glucose of 119 mg/dl determined the 95th percentile CSF values for the patients with complex febrile seizures. Patients with nonfebrile seizures or with status epilepticus had similar findings. We conclude that complex febrile, idiopathic nonfebrile convulsions or status epilepticus may affect CSF findings in children: CSF with >20 WBC/mm3 or >10 PMN/mm3 should not be attributed to seizures.

From competencies to capacity: Assessing the national epidemiology workforce

Objectives. We determined the competency of the public health epidemiology workforce within state health agencies based on the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs). Methods. The competence level of current state health agency staff and the need for additional training was assessed against 30 mid-level AECs. Respondents used a five-point Likert scale—ranging from “strongly agree” to “strongly disagree”—to designate whether staff was competent in certain areas or whether additional training was needed for each of the competencies. Results. Most states indicated their epidemiology workforce was competent in most of the AECs subject areas. Subject areas with the greatest number of states reporting competency (82%) are creating and managing databases and applying privacy laws. However, at least one-third of the states reported a need for additional training in all competencies assessed. The greatest reported needs were for additional training in surveillance system evaluation and use of knowledge of environmental and behavioral science in epidemiology practice. Conclusions. The results indicate that most epidemiologists mastered the traditional discipline-specific competencies. However, it is unclear how this level of competency was achieved and what strategies are in place to sustain and strengthen it. The results indicate that epidemiologists have lower levels of competence in the nontraditional epidemiologic fields of knowledge. Future steps to ensure a well-qualified epidemiology workforce include assessing the full AECs in a subgroup of Tier 2 epidemiologists and implementing competencies in academic curricula to sustain reported competency achievements.

Epidemiology Competency Development and Application to Training for Local and Regional Public Health Practitioners

In 2002, the Northwest Center for Public Health Practice (NWCPHP) at the University of Washington initiated the Epidemiology Competencies Project, with the goal of developing competency-based epidemiology training for non-epidemiologist public health practitioners in the northwestern United States. An advisory committee consisting of epidemiology faculty and experienced public health practitioners developed the epidemiology competencies. NWCPHP used the competencies to guide the development of in-person trainings, a series of online epidemiology modules, and a Web-based repository of epidemiology teaching materials. The epidemiology competencies provided a framework for collaborative work between NWCPHP and local and regional public health partners to develop trainings that best met the needs of a particular public health organization. Evaluation surveys indicated a high level of satisfaction with the online epidemiology modules developed from the epidemiology competencies. However, measuring the effectiveness of competency-based epidemiology training for expanding epidemiology knowledge and skills of the public health workforce remains a challenge.

RESPONSE BIAS ASSOCIATED WITH ASKING FORMER STUDY PARTICIPANTS TO ASSIST IN NEW RESEARCH

To limit research costs, former parent-participants from a completed pediatric neurology study were asked to assist with new research on behavioral contributors to childhood injury. An evaluation of the response bias associated with this recontact effort showed that 224 parents who completed the survey did not differ from the 51 who failed to complete it in race, age, education, or income. Nonresponders were significantly less likely to be married than responders.