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Coffeng SM, Abdulle AE, van der Horn HJ, de Koning ME, ter Maaten JC, Spikman JM, van der Naalt J. Good Health-Related Quality of Life in Older Patients One Year after mTBI despite Incomplete Recovery: An Indication of the Disability Paradox? J Clin Med 2024; 13:2655. [PMID: 38731184 PMCID: PMC11084863 DOI: 10.3390/jcm13092655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury and to assess the early predictors of HRQoL. Methods: Data from a prospective follow-up study of 164 older (≥60 years) and 289 younger mTBI patients (<60 years) admitted to the emergency department were analyzed. Post-traumatic complaints, emotional distress and coping were evaluated 2 weeks post-injury using standardized questionnaires. At 12 months post-injury, HRQoL and functional recovery were determined with the abbreviated version of the World Health Organization Quality of Life scale and Glasgow Outcome Scale Extended (GOSE), respectively. Results: One year post-injury, 80% (n = 131) of the OA-mTBI rated their HRQoL as "good" or "very good", which was comparable to younger patients (79% (n = 226), p = 0.72). Incomplete recovery (GOSE <8) was present in 43% (n = 69) of OA-mTBI, with 67% (n = 46) reporting good HRQoL. Two weeks post-injury, fewer OA-mTBI had (≥2) post-traumatic complaints compared to younger patients (68% vs. 80%, p = 0.01). In the multivariable analyses, only depression-related symptoms (OR = 1.20 for each symptom, 95% CI = 1.01-1.34, p < 0.01) were predictors of poor HRQoL in OA-mTBI. Conclusions: Similar to younger patients, most OA-mTBI rated their HRQoL as good at one year after injury, although a considerable proportion showed incomplete recovery according to the GOSE, suggesting a disability paradox. Depression-related symptoms emerged as a significant predictor for poor HRQoL and can be identified as an early target for treatment after mTBI.
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Affiliation(s)
- Sophie M. Coffeng
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Amaal Eman Abdulle
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (A.E.A.); (J.C.t.M.)
| | - Harm J. van der Horn
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (H.J.v.d.H.); (J.v.d.N.)
| | - Myrthe E. de Koning
- Department of Neurology, Hospital Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Jan C. ter Maaten
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (A.E.A.); (J.C.t.M.)
| | - Jacoba M. Spikman
- Department of Clinical Neuropsychology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (H.J.v.d.H.); (J.v.d.N.)
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Anderson JFI. Heterogeneity of health-related quality of life after mild traumatic brain injury with systemic injury: a cluster analytic approach. Disabil Rehabil 2024:1-10. [PMID: 38655716 DOI: 10.1080/09638288.2024.2345278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Health-related quality of life (HRQoL) is a key component of evaluating outcome after mild traumatic brain injury (mTBI). As outcome is heterogeneous following mTBI, it is relevant to examine individual differences in HRQoL. This study investigated whether multiple homogenous subgroups could be meaningfully identified, 10 weeks after hospitalised mTBI with systemic injury, on the basis of HRQoL profiles. METHODS Ninety-one adults were assessed for HRQoL, pain, fatigue, sleep quality, psychological distress, cognition and post-concussion symptoms. RESULTS Cluster analyses revealed three separate subgroups based on physical, mental, social and energy HRQoL. One group (42%) demonstrated normative levels of HRQoL on all subdomains. The remaining two groups demonstrated significantly reduced HRQoL on all subdomains. These groups had equivalently poor mental, social and energy HRQoL, but the smallest group (27%) had significantly poorer physical HRQoL. Multinomial logistic regression revealed that pain significantly and independently predicted group membership for the particularly poor physical HRQoL group. Fatigue was the only significant independent predictor of group membership for the remaining group with reduced HRQoL. CONCLUSION These findings suggest more than 50% of hospitalised individuals with mTBI and systemic injury, have reduced HRQoL, 10 weeks after mTBI. Pain and fatigue warrant clinical attention in these individuals.IMPLICATIONS FOR REHABILITATIONMild traumatic brain injury is a common event that has been shown to be associated with persistently reduced health-related quality of life in approximately 50% of individuals 6 to 12 months after injury.Health-related quality of life likely varies between individuals after injuryRelative to the "normal" population, most individuals in this cohort of individuals with mTBI and systemic injury had reduced mental, social and energy quality of life 10 weeks after injury.Fatigue and pain are important factors in reduced health-related quality of life after mTBI with systemic injury.Further research is needed to determine whether these fatigue and pain issues are related to mTBI-factors, such as headache, and/or related to systemic injury factors, which are common in the mTBI population.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
- Senior Clinical Neuropsychologist, Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, Australia
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Cairncross M, Ledoux AA, Greenberg J, Silverberg ND. A Cross-Sectional Investigation of Trait Mindfulness, Concussion Symptom Severity, and Quality of Life in Adults with Persisting Symptoms Postconcussion. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38563801 DOI: 10.1089/jicm.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Individual differences in mindfulness may impact quality of life after concussion. In a cross-sectional analysis, the moderating effect of mindfulness was tested on the association between symptom severity and quality of life in adults with persisting postconcussion symptoms (N = 85). Mindfulness and symptom severity were independently associated with quality of life; however, mindfulness did not moderate this association. "Nonreactivity" was independently associated with quality of life; however, it was not a significant moderator. Taking a nonreactive stance, or allowing experiences to come and go without effort to change them, may be relevant to quality-of-life outcomes after concussion.
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Affiliation(s)
- Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrée-Anne Ledoux
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
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Grieb EJ, Schmid AA, Riggs NR, Stephens JA. Executive Function After Yoga: Adults With Acquired Brain Injury-A Pilot Study. Am J Occup Ther 2024; 78:7802180130. [PMID: 38407977 DOI: 10.5014/ajot.2024.050403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
IMPORTANCE Acquired brain injury (ABI) may result in deficits in executive function (EF), which affects engagement in occupations. OBJECTIVE To explore the impact of group yoga on EF in people with ABI. DESIGN Single-arm pilot study with preyoga assessments and postyoga assessments (after 8 wk of yoga). SETTING Yoga classes and assessments were completed within university buildings on a college campus. PARTICIPANTS Twelve participants with chronic ABI (>6 mo post-ABI) were recruited through convenience and purposive strategies from the local community. INTERVENTION An 8-wk adaptive group yoga intervention was provided by an adaptive yoga specialist. Yoga classes were 60 min and occurred once per week. OUTCOMES AND MEASURES EF was assessed before and after the yoga intervention using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) self-report form. Normative data were analyzed with paired sample t tests. RESULTS Nine participants completed all study procedures. Results from paired sample t tests showed significant improvements on the Behavioral Regulation Index of the BRIEF-A (p = .046). No significant improvements were found on individual EF scales, the Metacognition Index, or the Global Executive Composite (ps > .05). CONCLUSIONS AND RELEVANCE Group-based yoga may improve some aspects of EF for adults with chronic ABI; however, further research with larger sample sizes is needed. Plain-Language Summary: Yoga, an intervention increasingly used in occupational therapy practice, may be beneficial in improving behavioral regulation (an executive function) for adults with acquired brain injury.
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Affiliation(s)
- Emily J Grieb
- Emily J. Grieb, MS, OTR, is Occupational Therapist, Peaks & Bounds, Inc., Fort Collins, CO. At the time this research was completed, Grieb was Occupational Therapy Student, Department of Occupational Therapy, Colorado State University, Fort Collins;
| | - Arlene A Schmid
- Arlene A. Schmid, PhD, OTR, FAOTA, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Nathaniel R Riggs
- Nathaniel R. Riggs, PhD, is Professor, Department of Human Development and Family Studies, Colorado State University, Fort Collins
| | - Jaclyn A Stephens
- Jaclyn A. Stephens, PhD, OTR, is Associate Professor, Department of Health and Exercise Science, Colorado State University, Fort Collins
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Guo NW, Chou W, Kuo JR, Liao YC, Chuang MT, Su BY. The executive functions among patients with an initial Glasgow coma scale score of 15. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37878502 DOI: 10.1080/23279095.2023.2266080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Executive functions (EF) were the critical neuropsychological functions linked to long-term adaptation. Given the heterogeneous prognosis trajectories of mild traumatic brain jury (mTBI), the mildest TBI may not always be benign in the chronic stage. The present study explored the long-term EF in patients with chronic complicated mTBI and a Glasgow Coma Scale (GCS) score of 15. Fifty patients with complicated mTBI and GCS scores of 15 and 35 control participants were recruited in this study. Medical records were retrospectively analyzed, and neuropsychological assessments and subjective measures examined the neuropsychological functions. Compared with healthy controls, complicated mTBI patients with a GCS score of 15 performed significantly worse on most EF assessments, including longer reaction time (RT) and poor cognitive flexibility and abstract reasoning performances. Patients also reported more EF problems and lower quality of life (QoL) than healthy controls. Females and those with subdural hematoma (SDH) had significantly longer reaction times (RT) on executive attention tests. This study found that complicated mTBI with a GCS score of 15 had incomplete recovery of EF, even in the chronic stage. We suggest that early neuropsychological assessment and rehabilitation should be arranged for such patients.
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Affiliation(s)
- Nai-Wen Guo
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Chiali, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yu-Chi Liao
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Ming-Tsung Chuang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Bei-Yi Su
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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Hume CH, Mitra B, Wright BJ, Kinsella GJ. Quality of life and psychological health after mild traumatic brain injury in older people: Three- and six-month follow up. Brain Inj 2023; 37:1262-1271. [PMID: 37470460 DOI: 10.1080/02699052.2023.2237882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 06/03/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Examine quality of life (QoL) and psychological health after mild traumatic brain injury (mTBI) in older people (65+ years) at 3- and 6-month follow-up and explore which injury factors predicted QoL. METHODS mTBI patients were compared to trauma comparison (TC) and community comparison (CC) groups. QoL and psychological health were measured at both timepoints. After accounting for 3-month psychological health, injury severity, neuroimaging, and 3-month neuropsychological performance were assessed as predictors of 6-month QoL. RESULTS Overall 3-month QoL was lower for mTBI (Cohen's d = 0.938) and TC (Cohen's d = 0.485) groups compared to CCs, but by 6 months only mTBI patients continued to report poorer overall QoL (Cohen's d = 0.577) and physical QoL (Cohen's d = 0.656). Despite group differences, QoL for most (~92%) was within normative limits. 3-month psychological health predicted QoL 6-months postinjury (β = -.377, 95% CI -.614, -.140) but other proposed risk factors (GCS <15, neuroimaging, 3-month neuropsychological performance) did not uniquely predict QoL. CONCLUSIONS Older adults following mTBI reported lower QoL up to 6-months postinjury compared to non-injured peers, indicating that mTBI patients were particularly susceptible to ongoing differences in QoL 6-months postinjury.
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Affiliation(s)
- Camilla H Hume
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- National Trauma Research Institute, The Alfred, Melbourne, Victoria, Australia
| | - Bradley J Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Glynda J Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Levy AM, Saling MM, Anderson JFI. Frequency and extent of cognitive complaint following adult civilian mild traumatic brain injury: a systematic review and meta-analysis. BRAIN IMPAIR 2023; 24:309-332. [PMID: 38167200 DOI: 10.1017/brimp.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cognitive symptoms are associated with return to work, healthcare use and quality of life after mild traumatic brain injury (mTBI). Additionally, while overall 'post-concussion' symptoms are often present at similar levels in mTBI and control groups, cognitive complaints may be specifically elevated in mTBI. A systematic review and meta-analysis was conducted to investigate the frequency and extent of cognitive complaints following adult civilian mTBI, and compare it to the frequency and extent of complaints in control populations (PROSPERO: CRD42020151284). METHOD This review included studies published up to March 2022. Thirteen studies were included in the systematic review, and six were included in the meta-analysis. Data extraction and quality assessment were conducted by two independent reviewers. RESULTS Cognitive complaints are common after mTBI, although reported rates differed greatly across studies. Results suggested that mTBI groups report cognitive complaints to a significantly greater extent than control groups (Hedges' g = 0.85, 95% CI 0.31-1.40, p = .0102). Heterogeneity between studies was high (τ2 = 0.20, 95% CI 0.04-1.58; I2 = 75.0%, 95% CI 43.4%-89.0%). Between-group differences in symptom reporting were most often found when healthy rather than injured controls were employed. CONCLUSIONS Cognitive complaints are consistently reported after mTBI, and are present at greater levels in mTBI patients than in controls. Despite the importance of these complaints, including in regards to return to work, healthcare use and quality of life, there has been limited research in this area, and heterogeneity in research methodology is common.
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Affiliation(s)
- Arielle M Levy
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
| | - Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC3010, Australia
- Psychology Department, The Alfred Hospital, Melbourne, VIC3004, Australia
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Quality of life after epilepsy surgery: How domain-specific cognitive changes impact QOL within the context of seizure outcome. Epilepsy Behav 2022; 137:108948. [PMID: 36283290 DOI: 10.1016/j.yebeh.2022.108948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/27/2022] [Accepted: 10/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Neurosurgery is an effective treatment option for pharmacoresistant epilepsy. Although post-surgical seizure freedom is considered the primary goal of epilepsy surgery, other factors that impact Quality of Life (QOL) are also important to consider, including post-surgical cognitive changes. This study aimed to examine the impact of post-surgical cognitive changes on QOL in the context of seizure outcomes. METHODS Participants were 196 adults with focal epilepsy who underwent either frontal (n = 27) or temporal (n = 169) lobe resection. Each participant completed pre- and post-surgical neuropsychological evaluations, and cognitive composites were constructed for the following domains: language, attention/processing speed, memory, executive function, and visuospatial skill. The Quality of Life in Epilepsy (QOLIE-10) questionnaire was used to assess QOL. Seizure outcome was determined by seizure status six months post-surgery. RESULTS Eighty-one percent of patients were seizure-free post-surgery and generally reported improved QOL. While a significant portion of patient's demonstrated declines in language and verbal memory following surgery, only a decline in verbal memory was associated with worse QOL; however, this relationship was no longer significant after controlling for seizure outcome. Instead, reduced post-surgical QOL was primarily observed in those who experienced both seizure recurrence and a decline in executive function. Notably, depression was a significant covariate in all of the models. CONCLUSIONS The findings from this study improve our ability to counsel patients about the trade-off between cognitive decline and seizure remittance in the greater context of overall QOL. Reassuringly, it appears that QOL is improved regardless of cognitive changes when patients have good seizure outcomes. However, for those that experience a "double hit" (i.e., cognitive decline without seizure remission), post-surgical QOL may be reduced. Changes in depression also appear to play a crucial role in QOL outcomes.
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Chung JW, Liu D, Wei L, Wen YT, Lin HY, Chen HC, Chiu HY. Postconcussion Symptoms After an Uncomplicated Mild Traumatic Brain Injury in Older Adults: Frequency, Risk Factors, and Impact on Quality of Life. J Head Trauma Rehabil 2022; 37:278-284. [PMID: 34698683 DOI: 10.1097/htr.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postconcussion symptoms (PCSs) are common complaints reported by patients after a mild traumatic brain injury (TBI), and these symptoms may lower quality of life. Previous investigations have primarily focused on PCSs in children, adults, and athletes. The frequency, and risk factors, and effects of PCSs for older adults with mild TBIs are unclear. PURPOSE To investigate the frequency and risk factors of PCSs, and investigate their effects on quality of life over time after mild TBI in older adults. METHODS A prospective longitudinal study was performed. All participants were enrolled from the emergency department or neurosurgical outpatient clinics of a medical center. The measurement tools were the Rivermead Post-Concussion Symptoms Questionnaire and the Quality of Life after Traumatic Brain Injury. Measurements were performed on the seventh day, at the first month, and at the sixth month after the head injury. A generalized estimating equation model was used for data analyses. RESULTS One hundred and one older adults (mean age of 76.0 years) with mild TBIs with negative neuroimaging findings were included. Overall, 32.7%, 4%, and 15.8% of the sample reported PCS after 7 days, 1 month, and 6 months of head injury, respectively, revealing a U-shaped trend. We observed that comorbidity measured using the modified Charlson Comorbidity Index was associated with differences in PCSs ( P < .05). PCSs were an independent predictor of changes in postinjury quality of life ( P < .001). CONCLUSIONS The results indicate that PCS after a mild TBI in older adults is prevalent, even in the chronic phase after a TBI, and PCSs significantly affected the quality of life of our cohort. Therefore, to improve patient quality of life, healthcare providers should employ effective interventions to manage PCSs at different phases after a TBI.
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Affiliation(s)
- Jia-Wei Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan (Mr Chung and Dr Chiu); Departments of Nursing (Mr Chung and Dr Liu) and Neurosurgery (Drs Wei, Wen, Lin, and Chen), Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan (Dr Wei); and Research Center of Sleep Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan (Dr Chiu)
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Lozano-García A, Hampel KG, Gutiérrez A, Villanueva V, Cano-López I, González-Bono E. Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-12. [PMID: 35148237 DOI: 10.1080/23279095.2022.2036990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To assess whether performance in attention and executive functions evaluated with the Epitrack screening tool before surgery can differentiate memory and quality of life (QOL) profiles, and detect different post-surgical change patterns in these variables in patients with epilepsy. METHODS This is a longitudinal study. Seventy-seven patients with drug-resistant epilepsy (mean age = 37.91) underwent a neuropsychological assessment before and one year after surgery. Epitrack, a screening tool that exclusively evaluates attention and executive functioning, was administered in the pre-surgical assessment, and verbal and visual memory and QOL were assessed before and after surgery. RESULTS Patients with impaired Epitrack performance had poorer verbal and visual memory than those with intact Epitrack performance, regardless of the time point (for all, p < 0.0001). They also showed a post-surgical decline in immediate verbal recall (p = 0.04) and discriminability (p = 0.001). Patients with intact Epitrack performance did not exhibit this decline. Epitrack total score significantly contributed to 13 and 11% of the variance of post-surgical changes in immediate verbal recall and discriminability, respectively. Epitrack groups did not differ in QOL profiles or changes, but post-surgical immediate verbal recall improvements were related to post-surgical QOL improvements. CONCLUSION Our findings underline the utility of Epitrack screening tool to detect different patterns of verbal and visual memory dysfunction, as well as to predict post-surgical verbal memory decline in patients with drug-resistant epilepsy. Patients with lower pre-surgical Epitrack scores appear to be at increased risk for post-surgical memory decline.
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Affiliation(s)
- Alejandro Lozano-García
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Antonio Gutiérrez
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Valencia, Spain
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Yousefzade-Chabok S, Azari S, Kouchakinejad-Eramsadati L, Rad EH, Hosseinnia M, Khodadadi-Hassankiadeh N. A study of students' use of restraint systems in school transportation services in primary and secondary schools in northern Iran: an observational study. BMC Pediatr 2021; 21:574. [PMID: 34911478 PMCID: PMC8672521 DOI: 10.1186/s12887-021-03048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background Traffic accidents are one of the leading causes of death and severe injury among child occupants of vehicles in most countries. This has led to the consideration of how to use restraint systems for students in school buses. The purpose of the present study was to determine the percentage of students’ use of restraint systems in school transportation services in 2020. Methods In the present cross-sectional observational study, seatbelt use was assessed in 400 students in school transport vehicles using a checklist. The observation team sat at their vehicle, at the nearest location on one of the three sides of the school’s entrance: they had by manually registering the variable in the checklist. They focused on exactly the first vehicle parked next to the school entrance. There were two other observers to validate the observations. Data were analyzed by SPSS software (version 21). Results The rate of using restraint systems was 11.3%, use of restraint systems in the Sport Utility Vehicles (SUVs) was significantly higher (P < 0.03), in areas with medium income (P < 0.009) and low income (p < 0.012) as well as when the students were sitting in the rear seats, using the seatbelt were significantly lower (P < 0.001). Seatbelt use in students was less in services driven by drivers over the age of 40 (P < 0.01) and more in vehicles driven by female drivers (P < 0.003) and newer vehicles (p < 0.001). Conclusion School authorities must enforce traffic safety rules for school transportation services. These rules should be taught to drivers, families, and students. A restraint system must be mandatory for all students. School officials must equip their buses with seatbelts and employ school bus assistants to encourage wearing seatbelts and prevent students from standing.
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Affiliation(s)
| | - Samira Azari
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Marjan Hosseinnia
- School of pharmacy, Department of Clinical and Administrative Sciences, Notre Dame of Maryland University, Baltimore, Maryland, USA
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Factors Associated with Quality of Life in Adults with Persistent Post-Concussion Symptoms. Can J Neurol Sci 2021; 49:109-117. [PMID: 33766169 DOI: 10.1017/cjn.2021.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess demographic, clinical, and injury characteristics associated with health-related quality of life (HRQOL) in adults with persistent post-concussion symptoms (PPCS). METHODS Adults with PPCS presenting to a specialized brain injury clinic completed demographic, injury, and clinical outcome questionnaires at the initial clinic assessment. Clinical outcome measures were collected including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and the Fatigue Severity Scale (FSS). HRQOL was measured using the Quality of Life after Brain Injury (QOLIBRI) questionnaire. Stepwise hierarchical multiple regression analysis adjusting for age, sex, and months since injury was used to determine associations between quality of life and clinical outcome measures. RESULTS Overall, 125 participants were included. The PHQ-9, FSS, and GAD-7 were significant predictors of QOLIBRI scores (R2 = 0.481, p < .001), indicating that participants with higher levels of depressive symptoms, fatigue, and anxiety reported poorer HRQOL. The PHQ-9 score was the strongest predictor, accounting for 42.0% of the variance in QOLIBRI scores. No demographic or injury characteristics significantly predicted QOLIBRI scores. There was a high prevalence of depressive symptoms with 72.8% of participants having PHQ-9 scores ≥ 10. CONCLUSION Among patients with PPCS, mental health and fatigue are important contributors to HRQOL. As there is a high burden of mood disorders and fatigue in this population, targeted treatments for these concerns may impact the quality of life.
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Yanchar NL, Lockyer L, Ball CG, Assen S. Pediatric versus adult paradigms for management of adolescent injuries within a regional trauma system. J Pediatr Surg 2021; 56:512-519. [PMID: 32933764 DOI: 10.1016/j.jpedsurg.2020.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We aimed to examine process and outcome indicators for adolescents with specific injury patterns managed in pediatric versus adult paradigms within the same trauma system. METHODS Adolescents (15-17 years old) admitted to the region's adult trauma center (ATC) or pediatric trauma center (PTC) with an abdominal injury, femur fracture or traumatic brain injury (TBI) were reviewed retrospectively. Global and injury-specific process and outcome indicators were compared. RESULTS Of 141 ATC and 69 PTC patients, injury patterns differed significantly with more TBI and abdominal injuries at the ATC and femur fractures at the PTC. Overall injury severity was greater at the ATC. Patients with solid organ injuries appeared more likely to undergo embolization or splenectomy at the ATC; however, higher injury grade and later time period were the only variables significantly associated with this. Computed tomography (CT) was used significantly more frequently at the ATC overall, most notable with panscanning and head CTs for major TBI. Time to operative management did not differ for patients with isolated femur fractures. Neuropsychological follow up after minor TBI was documented more often at the PTC than the ATC; there was no difference for those with more severe TBIs. CONCLUSIONS Management varies for adolescents between PTCs and ATCs with more exposure to radiation and less neuropsychological follow-up of less severe TBIs at the ATC. This presents distinct opportunities to identify best policies for triage and sharing of management practices within a single regional inclusive trauma system in order to optimize short and long-term outcomes for this population. TYPE OF STUDY Retrospective cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Natalie L Yanchar
- Alberta Children's Hospital Trauma Program, 28 Oki Drive NW, Calgary, Alberta, Canada, T3B6A8; Department of Surgery, University of Calgary, 3333 Hospital Drive NW, Calgary, Alberta, Canada, T2N4N1.
| | - Lisette Lockyer
- Alberta Children's Hospital Trauma Program, 28 Oki Drive NW, Calgary, Alberta, Canada, T3B6A8
| | - Chad G Ball
- Foothills Medical Center Trauma Program, 1403 29 St NW, Calgary, Alberta, Canada, T2N2T9; Department of Surgery, University of Calgary, 3333 Hospital Drive NW, Calgary, Alberta, Canada, T2N4N1
| | - Scott Assen
- Department of Surgery, University of Calgary, 3333 Hospital Drive NW, Calgary, Alberta, Canada, T2N4N1
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Federico A, Mantovani E, Casari R, Bertoldi A, Lugoboni F, Tamburin S. Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug. J Neural Transm (Vienna) 2020; 128:1109-1119. [PMID: 33331955 PMCID: PMC8295124 DOI: 10.1007/s00702-020-02285-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022]
Abstract
High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD−) to ADHD screening tool; (c) executive function was significantly worse in ADHD+ than ADHD− patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD.
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Affiliation(s)
- Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Anna Bertoldi
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy.
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