First Year Of Recovery Research Articles

Neuroblastoma with spinal cord compression: is there an emergency treatment of choice?

injury and to injury prevention efforts in general. Examining the changes in levels of participation observed during the first year of recovery after brain injury is an exciting area of research. Indeed these changes are influenced by child factors (injury severity) and family factors (socio-economic status and function). It is hoped that the study by Anaby et al. encourages others to pursue research into improving our understanding of the phenomenon of participation post pediatric brain injury.

Abstract P73: Social Support and Adherence to Cardiac Risk Factor Management Instructions during the First Year after Acute Myocardial Infarction

Background: Adherence to risk factor management (RFM) instructions after AMI can promote recovery. The prognostic importance of social support for adherence is not well understood. We examined the relationship between baseline social support and post-AMI RFM adherence, and tested whether depression moderates this association. Methods: Using data from 2202 AMI patients enrolled in the 19-site PREMIER study, we longitudinally examined whether low baseline social support (index hospitalization; score <=18 on 5 items from ENRICHD Social Support Inventory) is associated with poor adherence to 13 RFM instructions (medication adherence, warfarin use, follow-up plan/appointments, whom to call, cholesterol monitoring and therapy, diabetes management, weight monitoring and loss, smoking cessation, diet, exercise, cardiac rehabilitation) within the first year of recovery. Patients were asked at 1, 6, and 12 months if they received any of the RFM instructions since their last interview. Poor adherence was defined a priori as adhering “very carefully” to less than 50% of the patient-appropriate instructions. Hierarchical repeated-measures Poisson regression evaluated the association between support and adherence, with adjustment for site, sociodemographics, clinical history and presentation, hospital and outpatient care, and depression. Whether depression (PHQ-9 score >=10) modified the association was evaluated by stratifying the risk-adjusted model by depression status and including a support*depression interaction term. Results: Patients with low social support had greater unadjusted risk of poor adherence than patients with high social support (RR 1.46, 95% CI 1.27-1.67). This association did not vary with time and remained significant after full risk adjustment (RR 1.24, 95% CI 1.05-1.47). In depression-stratified analyses, the risk-adjusted association of low support with poor adherence was significant among nondepressed (RR 1.44, 95% CI 1.26-1.66) but not depressed (RR 1.03, 95% CI 0.79-1.33) patients (p<0.001 for support*depression interaction). Conclusion: Good social support may improve adherence among nondepressed AMI patients, but more research is needed to understand the role of social support among depressed patients.

Recovery of soil nitrogen pools in species-rich grasslands after 12 years of simulated pollutant nitrogen deposition: a 6-year experimental analysis

Nitrogen (N) deposition from anthropogenic sources is a global problem that can reduce biodiversity and impair ecosystem functioning through effects on soil eutrophication and acidification. While increasing controls on emissions of oxides of nitrogen (NOx) have reduced European N deposition rates from their peak in the late 20th Century, little is known about the legacy effects of N deposition in soils or the reversibility of N-induced shifts in ecosystem processes. We studied species-rich limestone and acidic grasslands, located in a highly polluted region that received over 3000 kg N deposition ha−1 throughout the 20th Century, followed by a decline of ∼50% in NOx deposition rate in the past two decades. We investigated the effects on seasonal and annual mean concentrations of soil mineral N in experimental plots established in 1990 receiving simulated enhanced N deposition (0–140 kg N ha−1 yr−1) until 2002, both in the final year of treatment, and the subsequent 5 years of ‘recovery’ following cessation of treatments. Winter–summer cycles of N mineralization–immobilization were strongly amplified by simulated N deposition rates through the final year of treatments and into the first year of recovery, with winter concentrations of ammonium-N in the acidic grassland and nitrate in the limestone grassland enhanced by up to 360% and 450%, respectively. Both the magnitude of the seasonal variations and the residual effects of the treatments on soil mineral N concentrations decreased progressively in the first 5 years after treatments ceased, although dose-dependent trends remained in the acidic grassland. This study establishes that reducing N deposition rates in species-rich grasslands can reverse eutrophication, even in soils that have experienced prolonged high rates of deposition. It provides new insight into the rates of recovery following, and effects of, declining N deposition rates with implications for restoration of species-rich grasslands.

Changes in Neuropsychological Performance after Traumatic Brain Injury from Inpatient Rehabilitation to 1-Year Follow-Up in Predicting 2-Year Functional Outcomes

The present study explored the predictive value of interval change in neuropsychological performance at three time-points following moderate-to-severe TBI (inpatient rehabilitation, 1-year, and 2-year follow-up) on functional outcome measures collected at 2-year follow-up. Symmetrized percent change scores were calculated and used to predict scores on functional measures using linear regression while controlling for age and injury severity. Results showed that change in performance from inpatient to 1-year on total list learning (CVLT-II or RAVLT) and oral SDMT significantly predicted 2-year ratings of functional status. By comparison, most neuropsychological measures taken at 1-year follow-up also accounted for unique variance in 2-year functional outcomes. These results indicate that changes in learning and processing speed during the first year of recovery are sensitive indicators when predicting long-term disability and degree of functional independence, though absolute performance at 1 year is also highly associated with functional outcome at 2 years post-injury.

The role of seedlings and seed bank viability in the recovery of Chesapeake Bay, USA, Zostera marina populations following a large-scale decline

The objective of this study was to quantify the spatial and temporal recolonization characteristics of Zostera marina beds in the lower Chesapeake Bay following large scale declines in the late summer of 2005. Transects were established and monitored monthly for changes in eelgrass abundance at three sites (two downriver, one upriver) in the York River from April–October 2006 and 2007. Measurements included percent bottom cover, above ground biomass, shoot density, shoot origin (seedling or vegetative), seed bank abundance and seed viability. During 2006, the eelgrass beds at all sites recovered with seedlings providing the largest proportion of the total shoot abundance. This trend shifted in 2007 and surviving vegetative shoots were the dominant component of shoot standing crop. A second consecutive decline related to low light conditions occurred during the summer of 2006 in the upriver site and recovery there was minimal in 2007. These results highlight that after a single die off event, seed germination with subsequent seedling growth is the principal method for revegetation in lower Chesapeake Bay Z. marina beds. However, no viable seeds remain in the seed bank during this first year of recovery and shoots produced by the seedling growth do not flower and produce seeds until their second year of growth. Therefore the seed-bank density is low and is not immediately replenished. This suggests that the resiliency of perennial Chesapeake Bay Z. marina populations to repeated disturbances is restricted and repeated annual stress may result in much longer term bed loss.

The Role of Social Support in Health Status and Depressive Symptoms After Acute Myocardial Infarction

Prior studies have associated low social support (SS) with increased rehospitalization and mortality after acute myocardial infarction. However, relatively little is known about whether similar patterns exist for other outcomes, such as health status and depressive symptoms, and whether these patterns vary by sex. Using data from 2411 English- or Spanish-speaking patients with acute myocardial infarction enrolled in a 19-center prospective study, we examined the association of SS (low, moderate, high) with health status (angina, disease-specific quality of life, general physical and mental functioning) and depressive symptoms over the first year of recovery. Overall and sex-stratified associations were evaluated using mixed-effects Poisson and linear regression, adjusting for site, baseline health status, baseline depressive symptoms, and demographic and clinical factors. Patients with the lowest SS (relative to those with the highest) had increased risk of angina (relative risk, 1.27; 95% confidence interval [CI], 1.10, 1.48); lower disease-specific quality of life (mean difference [beta]=-3.33; 95% CI, -5.25, -1.41), lower mental functioning (beta=-1.72; 95% CI, -2.65, -0.79), and more depressive symptoms (beta=0.94; 95% CI, 0.51, 1.38). A nonsignificant trend toward lower physical functioning (beta=-0.87; 95% CI, -1.95, 0.20) was observed. In sex-stratified analyses, the relationship between SS and outcomes was stronger for women than for men, with a significant SS-by-sex interaction for disease-specific quality of life, physical functioning, and depressive symptoms (all P<0.02). Lower SS is associated with worse health status and more depressive symptoms over the first year of acute myocardial infarction recovery, particularly for women.

Displaced New Orleans Residents in the Aftermath of Hurricane Katrina: Results from a Pilot Survey

This article introduces us to the complexities of conducting social scientific research in a major urban disaster zone and reports on results from the most systematic survey at the time aimed at tracking the whereabouts of pre-Katrina residents during the first year of recovery, the Displaced New Orleans Residents Pilot Survey. This survey drew an area-probability sample of pre-Katrina residents and set out to interview them approximately twelve months after the storm, when educated guesses placed the New Orleans's city population at roughly half its pre-Katrina total. Results confirm that early returnees tended to be disproportionately white, elderly, better educated, and far less likely to have homes rendered uninhabitable by the disaster. These patterns begin to show how demographic processes triggered by the disaster exacerbated existing inequalities in the region, allowing more advantaged residents to return while leaving less advantaged residents dispersed across numerous destinations.

In for the Long Haul

In 2005, Hurricane Katrina and the subsequent levee breaks left 80% of New Orleans under water for weeks. Within 4 short weeks, the Louisiana State University Health Sciences Center at New Orleans had relocated its campus temporarily to Baton Rouge and resumed operations. Many lessons were learned in the first year of recovery and disseminated to the field regarding emergency and disaster preparedness and response. As we approach the second anniversary of the nation's most devastating natural disaster, we reflect on the long haul of rebuilding and offer new insights and lessons for sustaining operations and enhancing long-term rebuilding efforts.

The Burden of Stroke Scale (BOSS) provided valid, reliable, and responsive score estimates of functioning and well-being during the first year of recovery from stroke

To examine the reliability, validity, and responsiveness of the Burden of Stroke Scale (BOSS). A prospective cohort of stroke survivors were assessed at 3 (T1, T2), 6 (T3), and 12 (T4) months post onset (MPO) of stroke. Test-retest reliability was evaluated by calculating intra-class correlation coefficients (ICCs) between T1 and T2 scale scores. Convergent validity was evaluated by calculating Pearson product moment correlation coefficients between T1 BOSS, Stroke Impact Scale and MOS SF-36 scale scores assessing similar health concepts. Responsiveness was evaluated using a repeated measures ANOVA and the linear trend test in the full study sample and by calculating standardized response means (SRM) and a probability of change statistic, p between T1, T3, and T4 scale scores in participants demonstrating change on external criteria. ICCs ranged from 0.78 to 0.94. Pearson coefficients ranged from -0.57 to -0.86. Moderate to high responsiveness estimates were obtained for 9 of 12 subscales with SRM (p) values ranging from .497 (.690) to 1.161 (.877). Composite scale SRM (p) values ranged from .661 (.746) to 1.192 (.883). The BOSS provided valid and reliable score estimates that were responsive to positive changes in functioning and well-being during the first year of recovery from stroke.

Prolonged cognitive dysfunction in survivors of critical illness

A prospective study using neuropsychological testing explored cognitive performance, and specifically executive function, in survivors of critical illness during the first year of recovery. Fifty-one patients who had survived 3 days or more in the intensive care unit were studied approximately 3 months after discharge; 45 of them were studied again 6 months later. General health was assessed using the Short-Form 36. Cognitive and executive functions were measured using Raven's Progressive Matrices, the Hayling Sentence completion test and the Six-Element Test. Three months after discharge from intensive care, all eight domains of Short-Form 36 were impaired among survivors; by 9 months, four of the eight domains showed significant improvement. At 3 months, 35% of patients scored at or below a level equivalent to the lowest performing 5% of a normal population (i.e. the fifth percentile) on two or more tests of cognitive function; by 9 months only 4% of patients were impaired to this extent. Although cognitive performance improved with time, it remained below normal.

Impact of complete gastric fundus mobilization on outcome after laparoscopic total fundoplication

With the objective of further optimizing the outcome of antireflux surgery, we have studied the importance of dividing the short gastric vessels when performing a laparoscopic total fundoplication. Ninety-nine consecutive patients with chronic gastroesophageal reflux disease (GERD) were enrolled in the trial. Forty-seven patients (25 men, age 52 ± 1.6 years [mean ± standard error]) were randomized to undergo a laparoscopic Nissen-Rossetti total fundic wrap with intact short gastric vessels, whereas 52 patients (29 men, 48 ± 1.4 years) had complete division of these vessels. Quality of life was assessed by means of the psychological general well-being and gastrointestinal symptom rating scale indices. The 6- and 12-month follow-up data are reported. Two patients were converted to open surgery. Mobilization of the fundus significantly prolonged the operative time (120 vs. 104 minutes, P = 0.05); otherwise the complication rates were similar in the two groups. Both procedures were equally effective in controlling gastroesophageal reflux at 6 and 12 months' postoperatively. Division of the short gastric vessels had no significant impact on the point prevalence of postfundoplication complaints at the given follow-up time points. Quality of life was significantly improved by both operative procedures and remained “normal” throughout the follow-up period. Dividing all short gastric vessels had no impact on the functional outcome during the first year of recovery after a total laparoscopic fundoplication.

Changes in quality of life over the first year after stroke: Findings from the sunnybrook stroke study

The purpose of this study was to investigate the longitudinal patterns of recovery of quality of life over the first year after stroke to understand the factors that are influential in this process. A sample of 116 stroke survivors with mild to moderate impairment was followed-up at 3 months and at 1 year after stroke onset. Changes in scores on a quality of life measure were assessed in association with changes in impairment and disability over this 9-month period. The use of rehabilitation services over the first year was also documented. The quality of life of these survivors improved over the first year after stroke. Improvements in motor disability and depressive symptoms were found to be associated with improvements in quality of life. Additionally, survivors receiving rehabilitation therapy reported an improvement in quality of life that was independent of changes in disability and depressive symptoms. Opportunities to enhance the quality of life of stroke survivors exist throughout the first year of recovery. Improvements in functional ability and depression are important for long-term improvements in quality of life. Rehabilitation therapy is a potentially important resource.

Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation

PURPOSE: The purpose of the study was to explore individual and family experiences after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation during the first year of recovery. This report specifically addresses the domains of concern expressed and helpful strategies used by participants that are relevant to the development of future intervention programs.DESIGN: A grounded theory approach was used to gain an understanding of areas of concern of sudden cardiac arrest survivors and families that could be used when designing future nursing interventions. Semistructured interviews were conducted with both sudden cardiac arrest survivors and 1 family member each at 5 points during the first year of recovery (hospitalization; 1, 3, 6, and 12 months after hospitalization). Participants were asked to identify those specific areas that most concerned them and that they would like assistance with during the first year. A total of 150 interviews were conducted with 176 hours of data generated.SETTING: The study focused on 10 northwest urban community medical centers and participants' homes within a 50-mile driving distance from the medical centers.SAMPLE: The sample included 15 first-time sudden cardiac arrest survivors (13 men and 2 women) and 1 family member each between the ages of 31 and 72 years.RESULTS: Domains of concern identified by participants that can be used to design future nursing intervention programs included preventive care, dealing with automatic internal cardioverter defibrillator shocks, emotional challenges, physical changes, activities of daily living, partner relationships, and dealing with health care providers. Suggestions of helpful strategies used by participants during the first year are outlined.IMPLICATIONS: Domains of concern and helpful strategies identified by participants provide a framework for the development and testing of nursing intervention programs to enhance recovery following sudden cardiac arrest for survivors and their families.

Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation

The purpose of the study was to explore individual and family experiences after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation during the first year of recovery. This report specifically addresses the domains of concern expressed and helpful strategies used by participants that are relevant to the development of future intervention programs. A grounded theory approach was used to gain an understanding of areas of concern of sudden cardiac arrest survivors and families that could be used when designing future nursing interventions. Semistructured interviews were conducted with both sudden cardiac arrest survivors and 1 family member each at 5 points during the first year of recovery (hospitalization; 1, 3, 6, and 12 months after hospitalization). Participants were asked to identify those specific areas that most concerned them and that they would like assistance with during the first year. A total of 150 interviews were conducted with 176 hours of data generated. The study focused on 10 northwest urban community medical centers and participants' homes within a 50-mile driving distance from the medical centers. The sample included 15 first-time sudden cardiac arrest survivors (13 men and 2 women) and 1 family member each between the ages of 31 and 72 years. Domains of concern identified by participants that can be used to design future nursing intervention programs included preventive care, dealing with automatic internal cardioverter defibrillator shocks, emotional challenges, physical changes, activities of daily living, partner relationships, and dealing with health care providers. Suggestions of helpful strategies used by participants during the first year are outlined. Domains of concern and helpful strategies identified by participants provide a framework for the development and testing of nursing intervention programs to enhance recovery following sudden cardiac arrest for survivors and their families.

Handicap in stroke survivors

Background and purpose: As survival following stroke improves, individuals are more likely to live with the aftermath of stroke rather than immediately die from it. The purpose of this study was to examine the consequences of stroke on the life activities of survivors in the social realm (stroke handicap) using the framework of the World Health Organization's International Classification of Impairments, Disabilities and Handicaps. Methods: Multivariate analysis of variance was applied to cross-sectional data from a clinical study to investigate the correlates of handicap in a cohort of hemispheric stroke survivors at 3 months (n= 145) and at 1 year (n= 135) after stroke onset. Handicap was assessed with the Reintegration to Normal Living Index, impairment by the Adams' Hemispheric Stroke Scale and Zung Depression Scale, and disability by the Functional Independence Measure. Environmental variables in the model included marital status and receipt of rehabilitation therapy. Results: Physical disability and post-stroke depressive symptoms were associated with handicap at both follow-up periods (p<0.05). Cognitive disability and impairments from a previous stroke were also associated with handicap (p<0.01), but only at 1 year. The presence of a spouse was found to benefit male survivors at 1 year. Conclusions: Disability and depressive symptoms restrict the meaningful life activities of stroke survivors in the first year of recovery. Social supports may be influential in reducing their impact.

The development and application of a questionnaire to assess the changing personalities of substance addicts during the first year of recovery.

The Addiction Recovery Index, a 60 item questionnaire, was developed and administered to 889 recovering substance addicts with a view to measuring levels of the primary trait of Neuroticism as well as six accompanying subtraits during the first 12 months of recovery. Good reliability and validity scores were achieved for the ARI and results indicated that recovering addict's overall Neuroticism scores reduced as a function of Substance Free Time (F(11,877) = 338.37, p < .0001). It was also noted that the individual sub-trait scores decreased, but various anomalies, particularly with Anxiety, were recorded.

Lithium and recurrence in a long-term follow-up of bipolar affective disorder

Though previous studies have clearly shown that lithium affords prophylaxis in bipolar affective disorder, these studies have not demonstrated the persistence of this prophylactic effect beyond the first year of recovery. One hundred and eighty-one patients with bipolar affective disorder recovered during 5 years of semi-annual follow-up. After 8 weeks of recovery, 139 were taking lithium prophylaxis and 42 were not. Analyses used drug status (lithium v. no-lithium) as a censoring variable to compare these two groups by interval-specific probabilities of recurrence. Recurrence was initially less likely in the lithium group but interval-specific probabilities of recurrence did not consistently favour either group after the first 32 weeks of recovery. Biases in treatment decisions may have both reduced the size and altered the specificity of the lithium effects seen here. Nevertheless, the apparent transience of lithium prophylactic effects is unexplained and may reflect important, physiological differences between relapse and recurrence. This possibility invites a controlled lithium discontinuation study, with gradual taper, of patients who have had at least 8 months of sustained euthymia.

Psychological reactions and family adjustment in shock versus no shock groups after implantation of internal cardioverter defibrillator

The purpose of this study was to compare psychological reactions and family adjustment after sudden cardiac arrest (SCA) and internal cardioverter defibrillator (ICD) implantation in survivors who did and did not experience defibrillatory shocks the first year of recovery. Data were collected as part of a longitudinal prospective study that examined patient and family adjustment after SCA. SCA survivors and one family member per patient were interviewed and completed questionnaires three times within the first year (hospital discharge, 6 months, and 12 months) after SCA. Fifteen SCA survivors (13 men and 2 women) between the ages of 30 and 74 (mean 57 years) and one respective family member, usually the spouse, (mean age 53 years) participated. All SCA survivors had had primary ventricular fibrillation outside the hospital, had automatic defibrillators implanted while hospitalized, and were monitored for 1 year. Participants were divided into shock and no shock groups based on activation of their ICD the first year. The mean number of shocks received in the shock group survivors was 26, with a range of 3 to 100. Anxiety, depression, anger, and stress levels were higher for both survivors and their family members in the group that received defibrillator shocks. Denial was high throughout the entire year in all survivors. Dyadic adjustment and family coping were not found to be significantly different between the no shock and shock groups. A trend toward reduction in family social support and dyadic satisfaction was noted in both groups with time. Both SCA survivors and their family members experience more psychological distress in the first year after ICD implantation if the defibrillator fires. Families in both shock and no shock groups report lower levels of family support and marital satisfaction the first year after SCA and ICD implantation.

Longitudinal recovery following sudden cardiac arrest and internal cardioverter defibrillator implantation: survivors and their families

To describe psychological reactions, neurological sequelae, and family adjustment following sudden cardiac arrest during the first year of recovery. 15 sudden cardiac arrest survivors and 1 member of each family were interviewed and completed questionnaires five times within the first year following sudden cardiac arrest (hospital discharge, 1, 3, 6, and 12 months). Psychological reactions assessed included anxiety, depression, anger, denial, and global stress. Neurological sequelae assessed included confusion and neurocognitive functioning. Family adjustment assessed included marital adjustment and family coping. All sudden cardiac arrest survivors suffered primary ventricular fibrillation outside the hospital and had an internal cardioverter defibrillator implanted during hospitalization. Anxiety, depression, anger, stress, and confusion were highest at hospital discharge and decreased over 1 year, with survivors reporting higher levels than spouses. Denial was high throughout the entire year in survivors. Memory and construction ability were impaired throughout the entire year in survivors. Family coping and dyadic satisfaction were highest at hospital discharge and decreased throughout 1 year. Spouses reported fewer coping strategies and lower dyadic satisfaction than survivors. Family social support was lower than previously established norms at all periods during the first year of recovery. To develop intervention programs to aid adjustment, healthcare providers need to take into account psychological reactions, neurological deficits, and family coping of sudden cardiac arrest survivors and their family members.

The London Business School with Gower Publishing

Suddenly the recovery is with us. After two months in which manufacturing output rose 2.5 per cent, there are few who doubt that a sustainable recovery is under way. While it is unlikely in the extreme that manufacturing will continue to grow at the rate of January‐February, an annual rate of 15 per cent, and equally likely that there will still be some bad months, almost no one is dismissing the recent experience as another ‘false dawn’. With retail sales rising steadily, and industrial surveys registering a marked upturn in business confidence, it would appear that the Chancellor's green shoots' are finally with us. Indeed, when the CSO conies to date the trough of the present cycle, it is likely to put it in the second quarter of last year. If this is the case, the first year of recovery will have been particularly weak, reminiscent of the experience in 1981‐2 when the trough of the cycle was in February 1981 but it was not until late 1982 that a convincing recovery was under way. Given the apparent similarity between these two episodes, we draw comfort from the fact that (non‐oil) GDP rose 1.3 per cent in 1982 and 2.8 per cent in 1983, in line with our February forecast of 1.3 per cent growth this year followed by 3.2 per cent in 1994.