Objective—The aim was to study characteristics of traffic accident victims before and after the implementation of the new Brazilian traffic code, in January 1998. Subjects and methods—The study population was car and motorcycle occupants seen in a pre-hospital care service in Londrina, Paraná State (Brazil) before the introduction of the new Brazilian traffic code, from 22 January to 21 July 1997, and after its implementation during the same period in 1998. Victims were analyzed over the time periods according to helmet and seat belt use, gender, underage driving, and alcohol on the breath. Results—Use of seat belts increased from 45% to 62.6% and of helmets from 31.2% to 66.2% after the introduction of the new Brazilian code. The proportion driving under age 18 and with perceptible alcoholic breath declined significantly only among motorcycle riders. There was a 20% decline in car occupant injuries along with a 9% reduction in motorcycle related injuries after the change of the law. Conclusion—Results favor the hypothesis that rigorous legislation increases safer practices in traffic, at least during the first months of its implementation.

The nature of employees' psychological contracts has gained relevance in the last decade due to changes in the employment relationship. However, little research has been conducted in Australia. The present study examined the psychological contracts of 90 MBA students in two Australian universities and the effects of contract violation on indices of organisational behaviour. Survey batteries, consisting of the Psychological Contract Scale, measures of commitment and trust, and of perceptions of contract violation, were administered. Findings indicated that the perception of contract violation was associated with lower organisational commitment and trust. Significantly, it was found that the impact of contract violation on commitment and trust was mediated by relational, but not by transactional, contract scores.

Recombinant Bone Morphogenetic Protein 7 (OP-1) has been available in the UK since 2001, but there has been little published data on its use in the upper limb. In our institution OP-1 has been used in the management of 23 upper limb patients between 2001–2005, including 10 humeral non-unions. We believe this represents one of the largest single-unit cohorts of humeral fractures treated with OP-1. We reviewed the 10 humeral patients, who were all tertiary referrals with established non-unions. Two had been treated non-operatively before referral. The remaining eight had undergone a mean of 2.1 operations before OP-1 was used, with autologous bone grafting used in the majority of cases. Surgery occurred at a mean of 70.5 months following initial fracture. Seven patients underwent revision of the fracture fixation, and autologous bone graft was used with the OP-1 in 8 cases. Clinical union was established in 8 patients (80%) within a mean of 7.4 months. Radiological union was achieved in 8 patients (80%) within a mean of 9.1 months. No complications or adverse effects from the use of OP-1 were encountered. Both cases which failed to unite had a definite history of deep infection prior to index surgery, despite initial treatment with a staged revision procedure before OP-1 use. This study shows that OP-1 can be used successfully in the treatment of recalcitrant non-unions of the humerus following failure of traditional fracture management methods.

The case of Julia, a young woman with a severe memory impairment following an anterior communicating artery aneurism, is presented. Her case demonstrates the effective use to which compensatory strategies can be put and the improved level of independence that can be achieved. The development of her strategies is described and the question of why some people are much more successful than others in utilising such strategies is addressed. It is proposed that characteristics of the original injury, awareness (particularly early awareness) of deficit, the nature of the strategies used, the nature of rehabilitation, the role played by the family, and premorbid experience and personality are all important variables in this process. Implications are drawn for the rehabilitation of those who cannot be helped in this way.

An in depth study of 18 heterosexual couples investigated the quality of the marital and sexual relationships 1-7 years after the male partner had suffered a severe head injury. Both quantitative and qualitative methods were employed and the focus was on the perspective of the uninjured female partner. The female partners reported both marital and sexual satisfaction as lower following injury. They rated their current marital satisfaction as significantly less than their brain injured partners. The quantitative part of the study revealed major role changes experienced by the women, with many comparing their new role to that of a parent with total decision making responsibility. The incompatibility of this role with that of sexual partner was mentioned by many. A tendency for the males to express gratitude but not to communicate their feelings was described by many women. Most women were resigned to the expectation that there would be little change in the future and, for most, the only positive aspect of the relationship was a sense of commitment and continuing companionship. The implications of the findings for rehabilitation and couple therapy are discussed.

designed for head-injured survivors because these patients represent a large population whose needs have been described in detail by many authors.9-11 Such a service could also include other young adults with acquired brain damage and additional groups with partially overlapping needs, such as those with progressive conditions or spinal injuries, where appropriate. Alternatively, by incorporating additional features, the service could be widened to encompass a greater range such as those groups frequently referred to as the ’young physically handicapped’.’2 Historically, the rehabilitation of head-injured people has consisted of physiotherapy, occupational therapy and speech therapy in decreasing order of emphasis. Whilst these three elements are clearly vital, head injury outcome studies over the last twenty years have repeatedly emphasized the problems posed by cognitive and behavioural changes, particularly over the longer term. In this paper a service is

The relationship between employment status and psychological well-being is investigated in a longitudinal study of 16-year-old school leavers. Significant differences between employed, unemployed and government training scheme groups on a number of measures of well-being were found, these differences persisting after adjustment for individual differences and for other factors known to affect mental health. Implications for clinical practice and public health are considered and possible explanations for the poorer psychological health of the unemployed group are discussed.

A group of severely head injured patients were reassessed 7 years after injury. This group was the same as that previously reported 2 years after injury. There was no change in their physical or cognitive status; personality problems were still commonly reported but the less disabled had made further progress in returning to their former level of vocational and social activity.

There is currently a strong emphasis on an early return to school in the management of school refusers . However, many of the studies in this area show a certain similarity in that the efficacy of treatment is measured by the disappearance of school avoidance rather than the long-term adjustment of the child. Very few studies have followed the school refuser into adulthood and even fewer have looked at the prognostic implications of a return to school. This paper reports a study of 34 young people all of whom had been admitted to an in-patient adolescent unit because of school refusal. Half had returned to school and the other half had never done so. The influence of this return on their emotional and social adjustment in young adulthood was assessed.

The increasing rates of youth unemployment have given rise to concern in academic and political circles as well as amongst the general public. So much so that successive governments have introduced employment schemes specifically for this age group. Although a variety of opinions have been expressed concerning the value of such schemes and much thought and planning has gone into the design of successive generations of schemes, there appears to be little hard evidence concerning the effects they have on the well-being of young people. In the course of a study of the wider aspects of unemployment amongst school leavers, the authors collected evidence which they believe bears directly on this question.

Young people are particularly vulnerable to unemployment and the consequences of this for psychosocial development and mental health are not well understood.This study is an investigation of some of these consequences.The psychological well‐being and mental health of employed and unemployed school‐leavers of both sexes was investigated.Those school‐leavers who were unemployed were found to be more depressed and more anxious than those in work and showed a higher incidence of minor psychiatric morbidity. Unemployed young people had lower self‐esteem than their employed peers and poorer subjective wellbeing. They were also found to be less well socially adjusted. Young women showed poorer psychological well‐being than young men, irrespective of employment status.The psychological impact of unemployment for young people is discussed in relation to individual and sex differences and the question of whether poor mental health is a cause or a consequence of unemployment is considered.

The literature on occupational resettlement after head injury is confounded by varying standards of clinical severity and social outcome. A comparison of eleven key studies in the light of the authors' own research yielded a success rate ranging from 50 to 99 per cent, but this was based on superficial evidence. A more searching enquiry is needed, using objective methods and avoiding the technical inadequacies of most previous work. This would be unlikely to challenge the importance of age and length of post-traumatic amnesia as determinants of return to work, but should lead to a better understanding of other factors such as previous occupational status, cognitive deficits and personality changes.

A group of 54 patients who had suffered severe closed head injury (PTA >24 hours) were followed from the time of their injury for a period of two years. Relatives were interviewed within the first four weeks to assess the patient's previous personality and social adjustment. Patients and relatives were then assessed personally six and 12 months later and by postal questionnaires after two years. Only six patients were still not back at work after two years but more had not resumed all their leisure activities. Family relationships appeared to have settled down again by this stage but social contacts were still less frequent. Personality changes were associated with prior family relationships, cognitive changes with diminished social contacts whilst premorbid personality and physical deficits were associated with time taken to return to work.

Forty-four young adults, admitted to a rehabilitation centre after very severe head injury, were followed-up 2 years after their accident. Comparison with a control group showed that the head injuried had experienced marked changes in work, leisure activities, contact with friends and family life. Though these changes still created problems, the majority of patients and relatives appeared to have made a number of successful adaptations to their altered situation. Neurophysical status, personality change and memory loss all affected work capacity, while presence of personality changes was especially important in the loss of pre-accident friendships.