Indicators and predictors of return to work or education following traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology

The leading cause of brain damage in previously healthy young adults, many of whom are of working age, is traumatic brain injury (TBI). Research to date generally agrees that TBI can lead to unemployment. However, knowledge about the determinants of return to work following TBI in the New Zealand context is minimal. This is remarkable given that failure to return to work following TBI is associated with tremendous costs. These include economic implications such as contribution to the economy through work Vs the necessity of financial support through government and community funding (i.e. invalids benefits or long-term care facilities). Furthermore, work affects an individual's self-concept; it represents a major social role, offering self-esteem, social contact and social support. Therefore, a need exists to understand various predictors and indicators and their influence on a client's ability to return to work or education following TBI. The present study was divided into two parts. Part one, was a retrospective analysis of a pre-existing database. In this part, the predictors: pre-injury employment status, job classification at TBI, age at TBI, years of post primary education at TBI, ethnicity, substance abuse after TBI and motor impairments, significantly influenced return to work/education and non return to work/education following TBI. The predictors: age at time of assessment, gender, substance abuse prior to TBI, injury severity, epilepsy, visual difficulties, hearing difficulties and speech difficulties, however, did not. In addition, the indicators: verbal IQ, verbal memory, attention, information processing speed and executive functioning, significantly influenced return to work/education and non return to work/education following TBI, however, the indicators: performance IQ, full scale IQ and visual memory did not. Part two of the present study was a planned analysis. In this part, the predictors: pre-injury job classification, pre-injury job stability, tertiary qualifications and alcohol use after TBI, significantly influenced a persons job classification following TBI and/or the number of hours they were able to work per week following TBI. However, the predictors: pre-injury employment status, age, years of post primary education, ethnicity, gender, substance use before TBI, criminal offending, injury severity, early post trauma sequelae, did not. In addition, the indicators; attention, services of a General Practitioner, the length of time a General Practitioners service was received, cognitive ability and activities of daily living as reported by a relative or close other, significantly influenced a persons job classification following TBI and/or the number of hours they were able to work per week following TBI. However, the remaining cognitive sequelae, rehabilitation information, emotional, behavioural sequelae, participant and relative/close other reports, did not. Qualitative information was also provided by the participant and a relative or close other and the results presented. In conclusion, the findings of both parts of the present study are discussed in relation to the findings of previous research, together with recommendations for future research

Territorial cooperation and regional economic development: a case study

Cooperation may be defined as the collaboration between two or more parties which fuels initiatives that have shared, or converging interests and objectives. In the European Union territorial cohesion has recently been included in the draft of the European Constitution and is complementary to the EU drive towards economic and social cohesion. This adds a new dimension to European integration which clearly recognises that considering things from a territorial dimension is a tool for reducing the territorial disparity currently present in the EU. In fact, well before its enlargement, significant disparities in prosperity levels existed both between and within member states: prosperity levels in the ten most dynamic regions of the EU, based on GDP per capita, were nearly three times higher than that of the ten least developed regions and regional differences have widened with enlargement. In this context, the territorial cooperation objective aims to: improve cross-border cooperation through joint, local and regional initiatives; strengthen trans-national cooperation by means of actions conducive to integrated territorial development linked to Community priorities as well as to strengthen interregional cooperation and the exchange of experience at the appropriate territorial level. Three different typologies of territorial cooperation have been identified with the European territory: cross-border cooperation, trans-national cooperation and Interregional cooperation. The paper focuses on the territorial cooperation objective and presents a case study with large and strong economic, social and environmental disparities. It includes EU members and non EU members. More specifically, the IPA (Instrument for Pre-Accession Assistance) Adriatic Cross Border Cooperation (CBC) Program, which includes three EU Member States, one Candidate Country, and three Potential Candidates Countries.cooperation, regional disparities, european external instruments

Is binge eating experienced as an addiction

Abstract To ascertain to what degree binge eating is experienced as an addiction, this study examined the proportion of women with bingeeating disorder (BED) whose symptoms met criteria for an addiction. Women (N ¼ 79) with current BED completed a structured telephone interview to assess for symptoms of a modified version of DSM-IV substance dependence and Goodman's [(1990). Addiction: Definition and implications. British Journal of Addiction, 85, 1403-1408] proposed diagnosis of 'addictive disorder'. Most binge eaters (92.4%) met modified DSM-IV criteria for substance dependence, whereas many fewer (40.5%) met Goodman's more restrictive criteria for addictive disorder. Women meeting criteria for addictive disorder had more frequent eating binges than those who did not. Despite certain observed similarities between binge eating and addictions, we argue that BED should remain classified as an eating disorder.

Meeting Students Where They Are: Educating Students with Varying Life Experiences About the Health Care Needs of Persons with Disabilities

Purpose: Medical students enter preclinical years with varying levels of experience with individuals with disabilities. Previous experience has been shown to have a significant impact on attitudes toward this population and, hence, has the potential to impact patient care (Tervo et. al, 2002). This study examined the impact of a one-day Interclerkship on students’ self-reports regarding specific components of their attitudes, by level and type of previous disability experience. Methodology: Students met with individuals with physical or cognitive disabilities and their families in small groups to discuss their health care needs and experiences. Students also viewed a short film regarding effective methods of communication with and modifications to the clinical encounter for individuals with physical disabilities. Afternoon workshops covered a wide array of topics including assistive technology, sexuality/childbirth, mental health, community resources and bladder management. Students reported levels of experience cognitive/physical: friends, relatives, schoolmates k-12 and college. 153 (77%) students over two years completed pre-and post-Interclerkship self-assessments that rated attitudes about medical care for patients with disabilities, using a 14-item 5-point Likert scale; means were compared by paired t-test. Students also provided course feedback. Results: There was a highly significant (pConclusions: A single-day Interclerkship improved the attitudes of students’ reporting all levels and types of disability experience

Meeting Challenges in Caring for Patients with Disabilities: An Interclerkship Course

Purpose: People with disabilities use healthcare services more than those without disabilities, yet healthcare systems often fail these individuals. Understanding the needs of those with physical and cognitive disabilities is crucial in providing them with appropriate healthcare. A one-day Interclerkship introduced third-year medical students to key challenges for physicians who care for disabled patients: (1) building trust and confidence, (2) communication, (3) anticipating secondary medical conditions, (4) appropriately modifying clinical encounters, and (5) identifying appropriate community resources. Methodology: Essential elements of patient-centered care for disabled individuals were presented in plenary sessions. In small groups, students met with individuals with physical or development disabilities, their families and their community advocates, discussing healthcare and access concerns. Other workshops, taught by clinical and community experts, addressed assistive technology, parenting challenges, mental health, community resources, sexuality, and end-of-life care. Sixty-seven (69%) students completed pre-and post-Interclerkship self-assessments that rated knowledge, skills, and attitudes about medical care for disabled patients, using a 14-item 5-point Likert scale; means were compared by paired t-test. Students also provided course feedback. Results: There was a highly significant (p80% of the students agreed or strongly agreed that the Interclerkship addressed a topic essential to physician training, providing knowledge and skills not obtained elsewhere. Conclusions: A single-day Interclerkship successfully improved third year medical students self-assessed knowledge, attitudes and skills on providing appropriate medical care for disabled patient. Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2006

One Year Clinical Outcomes of Renal Artery Stenting: The Results of ODORI Registry

The safety, efficacy and long term clinical benefits of renal artery revascularization by stenting are still a matter of debate. The aim of our study was to define the safety and efficacy of renal artery stenting with the Tsunami peripheral stent (Terumo Corporation, Tokyo, Japan). The ODORI was a prospective, multicentre registry which enrolled 251 consecutive patients, (276 renal arteries) in 36 centres across Europe. The primary endpoint was acute procedural success defined as <30% residual stenosis after stent placement. Secondary endpoints included major adverse events, blood pressure control, serum creatinine level, and target lesion revascularization (TLR) at 6 and 12 months. Patients were 70 ± 10 years old, 59% were male, 33% had diabetes, and 96% hypertension. The main indications for renal stent implantation were hypertension in 83% and renal salvage in 39%. Direct stent implantation was performed in 76% of the cases. Acute success rate was 100% with residual stenosis of 2.5 ± 5.4%. Systolic/diastolic blood pressure decreased from a mean of 171/89 at baseline to 142/78 mmHg at 6 months (p < 0.0001 vs. baseline), and 141/80 mmHg at 12 months (p < 0.0001 vs. baseline). Mean serum creatinine concentration did not change significantly in the total population. However, there was significant improvement in the highest tercile (from 283 μmol/l at baseline to 205 and 209 μmol/l at 6 and 12 months respectively). At 12-months, rates of restenosis and TLR were 6.6 and 0.8% respectively. The 12 month cumulative rate of all major clinical adverse events was 6.4% while the rate of device or procedure related events was 2.4%. In hypertensive patients with atherosclerotic renal artery stenosis Tsunami peripheral balloon-expandable stent provides a safe revascularization strategy, with a potential beneficial impact on hypertension control and renal function in the highest risk patients

Teaching anatomy in a modern medical course: an integrated approach at Vialba Medical School in Milan

Introduction The course of Anatomy in Vialba Medical School \u2013 University of Milan, integrates systemic, topographic and development anatomy, dissection laboratory, peer-teaching, flipped classroom, clinical correlation to radiology and surgery. Methods An anonymous questionnaire based on a five-point Likert scale was submitted to 162 students who had passed the exam of Anatomy. Students evaluated the importance given during study to morphology, relations and variations of organs, the usefulness of different tools in preparing the exam of anatomy. Finally, the impact of the new design course of Anatomy on students\u2019 progress was assessed. Results The results showed that most of the students found very useful dissections, multimedia sources and 3D virtual models. 3D virtual models, dissections and physical models were indicated as the most important tools that should be available for learning Anatomy; instead, medical imaging received a low score. Students focused the study on morphology and relations between organs much more than anatomical variations. Lastly, students who followed the new design course of anatomy showed a significant better performance when compared to students of the previous academic years, in particular on the anatomy of neck, thoracic and abdominopelvic cavity, and neuroanatomy. Conclusions Our study underlines the positive impact of the integration of traditional methods and innovative solutions in learning anatomy, but also the critical approach to radiologic imaging and anatomical variability

Beta-Thalassaemia Intermedia: Evaluation of Endocrine and Bone Complications

Objective. Data about endocrine and bone disease in nontransfusion-dependent thalassaemia (NTDT) is scanty. The aim of our study was to evaluate these complications in -TI adult patients. Methods. We studied retrospectively 70 -TI patients with mean followup of 20 years. Data recorded included age, gender, haemoglobin and ferritin levels, biochemical and endocrine tests, liver iron concentration (LIC) from 2 * , transfusion regimen, iron chelation, hydroxyurea, splenectomy, and bone mineralization by dual X-ray absorptiometry. Results. Thirty-seven (53%) males and 33 (47%) females were studied, with mean age 41±12 years, mean haemoglobin 9.2 ± 1.5 g/dL, median ferritin 537 (range 14-4893), and mean LIC 7.6 ± 6.4 mg Fe/g dw. Thirty-three patients (47%) had been transfused, occasionally (24/33; 73%) or regularly (9/33; 27%); 37/70 (53%) had never been transfused; 34/70 patients had been splenectomized (49%); 39 (56%) were on chelation therapy; and 11 (16%) were on hydroxyurea. Endocrinopathies were found in 15 patients (21%): 10 hypothyroidism, 3 hypogonadism, 2 impaired glucose tolerance (IGT), and one diabetes. Bone disease was observed in 53/70 (76%) patients, osteoporosis in 26/53 (49%), and osteopenia in 27/5

Relationship of morpho-sedimentological variations to the fate of Hg- and Zn-polluted sediments in the contaminated site of Porto Marghera, Lagoon of Venice, Italy.

New data collected from twenty-six sites during 2008 in the contaminated Site of National Interest (SIN) of Porto Mar- ghera within the Lagoon of Venice (Italy), which has been affected by the presence of an industrial zone for the last 80 years, were compared with data from a campaign performed in the same site 30 years before (1976-1978). The SIN was found to be heavily polluted in the earlier study, and several tons of Hg and Zn are still stored in soils and industrial channel sediments, potentially affecting the lagoon part of the SIN. Bathymetric variations, grain-size, Hg and Zn con- tent in sediments were analysed. The severe contamination of the late 1970s (Hg 1.7 µg/g; Zn 754 µg/g) had fallen by the late 2000s (Hg 0.9 µg/g; Zn 225 µg/g). The fall in Hg and Zn contamination over the 30-year period was mainly linked to the patterns of geomorphological change inside the SIN that affected two distinct sub-areas: 1) a stable-depo- sitional (SD) area in the Northern part, which exerted a “dilution” effect on contaminants, with significant deposition (~11%) of coarse-grained sediments (63 - 8 µm), and 2) an area characterised by moderate-to-severe-erosion (MSE) to the South, which saw the loss (~13%) of pollutant-bearing fine-grained sediments (<8 µm). A budget calculation in the MSE sub-area showed a loss of ~2.5 tons for Hg and ~700 tons for Zn over three decades, most of which was exported to other parts of the LV or at the open sea. A similar amount is still stored in the SD area, which will be subject to ero- sion if hydrodynamic conditions change in the future. This study provides useful support to decision-making systems by helping to select hot-spots for remediation measures