Thomas W. Teasdale

An adoption study of human obesity.

We examined the contributions of genetic factors and the family environment to human fatness in a sample of 540 adult Danish adoptees who were selected from a population of 3580 and divided into four weight classes: thin, median weight, overweight, and obese. There was a strong relation between the weight class of the adoptees and the body-mass index of their biologic parents - for the mothers, P less than 0.0001; for the fathers, P less than 0.02. There was no relation between the weight class of the adoptees and the body-mass index of their adoptive parents. Cumulative distributions of the body-mass index of parents showed similar results; there was a strong relation between the body-mass index of biologic parents and adoptee weight class and no relation between the index of adoptive parents and adoptee weight class. Furthermore, the relation between biologic parents and adoptees was not confined to the obesity weight class, but was present across the whole range of body fatness - from very thin to very fat. We conclude that genetic influences have an important role in determining human fatness in adults, whereas the family environment alone has no apparent effect.

Subjective experience in brain injured patients and their close relatives: A European Brain Injury Questionnaire study

Results are reported from an international project the aim of which has been to develop and validate a wide-ranging questionnaire suitable for administration to brain-injured patients and their relatives. A self-report questionnaire concerning subjective experience of cognitive, emotional and social difficulties (The European Brain Injury Questionnaire, EBIQ) was administered to a group of 905 brain-injured patients, and close relatives to these competed a parallel version of the questionnaire concerning the brain-injured person. The sample was drawn from seven European countries together with Brazil. The same questionnaire was also administered to a group of 203-non-brain-injured controls, similarly in self-report and relative-report versions. Scales relating to eight specific areas of functioning, together with a global scale, are derived from the questionnaire and their internal reliability was estimated in the present data. Analyses of the 63 items of the questionnaire showed consistently greater levels of problems for the brain-injured group, especially as indicated by relatives. This pattern was substantially replicated among the nine scales. The scales discriminated well between stroke patients and those who had suffered a traumatic brain injury. There was also a tendency for reported problems to be greater for patients who were surveyed later post-injury (> or = 19 months) rather than earlier. Comparison of sets of controls derived from two countries (France and Brazil) showed small but important differences. It is concluded that the questionnaire has an acceptable reliability and validity, but that it will be necessary to obtain culturally relevant non-brain-injured control data when employing it in different countries.

Psychosocial outcome following traumatic brain injury in adults: a long-term population-based follow-up.

Primary objective: On a national basis to conduct a 5, 10 and 15 year follow-up study of representative samples of survivors after traumatic brain injury (TBI) and to identify factors of importance for long-term survival and life satisfaction after TBI occurring in 1982, 1987 or 1992. Research design: Epidemiological, register-based questionnaire survey. Main outcomes, result and conclusions: Out of 389 survivors randomly chosen from a national complete hospital register, 173 had suffered a cranial fracture, 186 a cerebral lesion (brain contusion or traumatic haemorrhage) and 30 patients a chronic subdural haematoma. Out of 337 survivors found eligible for a questionnaire, 76% responded. Among the data registered according to the above mentioned areas, the main findings were that 23–31% of the cerebral lesion responders were unable to maintain earlier work/education at pre-injury level, against up to 14% of cranial fracture patients. Significantly more cerebral lesion patients than cranial fracture patients found emotional control more difficult, as well as increased difficulties with memory and concentration, maintenance of leisure time interests and general life satisfaction. In the long run, an important factor influencing survival among cerebral lesion patients seemed to be whether relations with family and friends could be maintained at the pre-injury level.

Continuing secular increases in intellgence and a stable prevalence of high intelligence levels

Abstract Appreciable secular increases in mean intelligence test scores have recently been demonstrated for numerous economically advanced nations. Data from large and representative samples of Danish draftees indicate that the test score gains may be continuing to the present day. The gains appear to be concentrated among lower intelligence levels, and we find no evidence of gains at the higher levels. Monte Carlo simulations suggest that this distributional change is not a result of a ceiling effect in the intelligence test itself. These findings are compatible with the view that changes in the educational system have played an important role in elevating intelligence test scores.

Forty-Year Secular Trends in Cognitive Abilties

Changes are shown in the distribution of scores on a set of tests used by the Danish draft board since the late 1950s until the present day. Whereas there were marked gains in earlier decades, especially in the lower end of the distribution, the last 10 years have only seen very modest gains. Such gains as have occurred appear primarily to manifest themselves in a test of visuo-spatial abilities.

Social class correlations among adoptees and their biological and adoptive parents.

Positive correlations for SES ratings are reported for a large sample of adoptees and their biological and adoptive parents. The possible effects of selective placement and late placement are examined, and the validity of the SES scale is discussed.

Suicide after a stroke: a population study

STUDY OBJECTIVE To establish whether there are increased rates of suicide after a stroke and the degree to which any increase is related to gender, age at stroke, diagnosis, duration of hospitalisation, and time since stroke. DESIGN Cross linkage of national registers for hospitalisations and causes of death. SETTING The population of Denmark, 1979–1993. PATIENTS A study cohort was defined comprising all 114 098 stroke patients discharged alive from hospital during the period 1979–1993. These patients were then screened in a register of causes of death over the same time period, and 359 cases of suicide were identified. MAIN RESULTS Annual incidence rates, both observed and expected, together with standardised mortality ratios (SMR) were computed based on annual population and suicide statistics, stratified by age and gender. The overall annual incidence rate of suicide in the cohort was 83 per 100 000 per year compared with an expected figure of 45 (difference = 38, 95% CI = 27, 49). Correspondingly, SMR were increased for stroke patients. Across all age bands the SMR for mens was 1.88 (95%CI 1.66, 2.13) and for women 1.78 (1.48, 2.14). SMR were greatest (2.85; 2.17, 3.76) for patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of hospitalisation, being lowest for those hospitalised for more than three months (0.88; 0.65, 1.19) and highest for those hospitalised for less than two weeks (2.32; 1.92, 2.80). Survival analysis suggested that the risk for suicide is greatest up to about five years after a stroke. CONCLUSIONS Stroke patients are at an approximately doubled risk for suicide. This risk is greater among younger patients and among patients hospitalised for a relatively shorter time. The risk appears to decline with time after a stroke, being greatest within the first five years.

Psychosocial outcome following individualized neuropsychological rehabilitation of brain damage.

At the center for Rehabilitation of Brain Damage, University of Copenhagen, 46 consecutively admitted brain‐damaged patients with varying pathologies and who were on average 2.9 years post‐injury were treated in a daily four‐month rehabilitation program in groups of about 10, followed by a six‐month period of contact varying according to individual needs. An evaluation of psychosocial outcome is presented. The results, based on comparisons between pre‐, post‐treatment and follow‐up questionnaire data, show continuing functional improvements in the areas of family life and living conditions. Dependence on health services declined. Over 70% of the patients returned to either work, further education or voluntary work activities. For the whole group, leisure activities returned to the pre‐injury level. Follow‐up at about two years revealed continuing improvements in all areas, suggesting social readaptation to a degree above expectations as judged from the existing literature

Traumatic brain injury in Denmark 1979-1996. A national study of incidence and mortality

In order to describe and analyse the development of the incidence of traumatic brain injury (TBI) in Denmark for different age groups of the two genders from 1979 through 1993 (for fatal injuries through 1996), a computerised search corresponding to diagnoses ICD 8th ed., 800, 801, 803, 850–854 from 1979 through 1993 was carried through in the national hospital register. Each person was counted only once, according to the most serious injury during the study period. For fatal cases, the search was extended till 1996. From 1979–1981 to 1991–1993, the total age-adjusted incidence of persons hospitalised under diagnoses ICD 800, 801, 803, 850–854 decreased 41% from 265 to 157 per 100,000 of the population per year. Decreases were 42% for ICD 850, brain concussion, 56% for ICD 800, 801, 803, cranial fractures, and 16% for ICD 851–854, structural brain injury. The percentage of cases with ICD 851–854 increased from 8.4 to 11.7% of the total. From 1979–1981 to 1985–1987 there was a 2% decrease in fatal TBI in and outside hospital (from 14.68 to 14.35 per 100,000), against a total 27% decrease to 10.67 in 1994–1996. For diagnoses ICD 851–854 and for fatal cases, significantly accelerating decreases from 1985–1987 were found only for the younger age groups. Consequently, in the period from 1979 to 1993, the mean age at injury increased by 10 years for persons hospitalised under diagnoses ICD 851–854. Decreases may be explained partly by changing admission and other hospital practices, and partly by the effect of comprehensive national preventive programs launched at the middle of the study period, the effect of which seemed to vary by age group and gender.

Psychosocial consequences of stroke: a long-term population-based follow-up.

Primary objective: To investigate psychosocial status among nationally representative groups of stroke patients at long intervals post-stroke. Methods and procedures: From a Danish national register of hospitalizations, three representative groups of surviving patients were selected who had suffered a stroke 5, 10 and 15 years previously. A follow-up postal questionnaire was sent to them comprising items concerning symptomatology, functioning and social conditions, together with the Nottingham Health Profile (NHP). Main outcomes and results: Longer follow-up intervals were associated with younger age at stroke and better functioning at discharge. At follow-up, the majority of patients reported difficulties with attention, memory and emotional control, irrespective of follow-up interval. Return to employment, social relations and leisure activities were affected, but were comparatively better at longer follow-up intervals, as was self-rated functioning and several NHP symptom scales. However, multi-variate analyses suggest that these positive changes with time appear to be mediated by attrition related to age at stroke and discharge functioning rather than time since stroke itself. Conclusions: Symptomatology, functioning and social conditions remain affected and perhaps stagnant in long-term survivors of stroke.