Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI. Language: en

The Epidemiology and Impact of Traumatic Brain Injury A Brief Overview

Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. Conclusions Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.

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Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

Traumatic brain injury (TBI) is a major health and socioeconomic problem that affects all societies. In recent years, patterns of injury have been changing, with more injuries, particularly contusions, occurring in older patients. Blast injuries have been identified as a novel entity with specific characteristics. Traditional approaches to the classification of clinical severity are the subject of debate owing to the widespread policy of early sedation and ventilation in more severely injured patients, and are being supplemented with structural and functional neuroimaging. Basic science research has greatly advanced our knowledge of the mechanisms involved in secondary damage, creating opportunities for medical intervention and targeted therapies; however, translating this research into patient benefit remains a challenge. Clinical management has become much more structured and evidence based since the publication of guidelines covering many aspects of care. In this Review, we summarise new developments and current knowledge and controversies, focusing on moderate and severe TBI in adults. Suggestions are provided for the way forward, with an emphasis on epidemiological monitoring, trauma organisation, and approaches to management.

https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(08)70164-9.pdf

Moderate and severe traumatic brain injury in adults.

In childhood, traumatic brain injury (TBI) poses the unique challenges of an injury to a developing brain and the dynamic pattern of recovery over time, inflicted TBI and its medicolegal ramifications. The mechanisms of injury vary with age, as do the mechanisms that lead to the primary brain injury. As it is common, and is the leading cause of death and disability in the USA and Canada, prevention is the key, and we may need increased legislation to facilitate this. Despite its prevalence, there is an almost urgent need for research to help guide the optimal management and improve outcomes. Indeed, contrary to common belief, children with severe TBI have a worse outcome and many of the consequences present in teenage years or later. The treatment needs, therefore, to be multifaceted and starts at the scene of the injury and extends into the home and school. In order to do this, the care needs to be multidisciplinary from specialists with a specific interest in TBI and to involve the family, and will often span many decades.

Traumatic brain injury.

Background Trials comparing the effectiveness and safety of weight-loss diets are frequently limited by short follow-up times and high dropout rates. Methods In this 2-year trial, we randomly assigned 322 moderately obese subjects (mean age, 52 years; mean body-mass index [the weight in kilograms divided by the square of the height in meters], 31; male sex, 86%) to one of three diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non–restricted-calorie.

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Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.

Dr. Susan Okie writes about patients who have received traumatic brain injuries while fighting in the war in Iraq.

https://www.nejm.org/doi/pdf/10.1056/NEJMp058102

Traumatic Brain Injury in the War Zone

Dr. Susan Okie writes that Brazil's persistent and aggressive efforts to prevent new HIV infections have played a major role in slowing the spread of the virus and containing the country's epidemic.

https://www.nejm.org/doi/pdf/10.1056/NEJMp068069

Fighting HIV — Lessons from Brazil

ADHD is a diagnosis that is increasingly being applied to adults. Once considered a disorder of the elementary-school years, ADHD is now thought to persist into adulthood, impairing functioning, in about 50 percent of cases. Dr. Susan Okie reports.

ADHD in Adults

For recent immigrants — especially the estimated 12 million who are here illegally — seeking health care often involves daunting encounters with a fragmented, bewildering, and hostile system. Dr. Susan Okie writes that the remedy is not immigrant bashing but health care reform.

https://www.nejm.org/doi/pdf/10.1056/NEJMp078113

Immigrants and Health Care — At the Intersection of Two Broken Systems

Four years after national limits on duty hours for medical residents took effect, conversations with residency directors, attending physicians, health care researchers, and sleep-medicine experts suggest that neither patient care nor medical education is optimal. Dr. Susan Okie reports. Ethan Fried discusses the national limits on residents' duty hours, their mixed effects on patient care and safety as well as medical education, and approaches to improving handoffs. Fried is vice chairman for education at St. Luke's–Roosevelt Hospital Center in New York.

Susan Okie

Papers

Traumatic Brain Injury in the War Zone

Fighting HIV — Lessons from Brazil

ADHD in Adults

Immigrants and Health Care — At the Intersection of Two Broken Systems

An Elusive Balance — Residents' Work Hours and the Continuity of Care