Predictors of Post-concussive Symptoms in Young Children: InjuryversusNon-injury Related Factors

AbstractObjectives:A notable minority of children will experience persistent post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI), likely maintained by a combination of injury and non-injury related factors. Adopting a prospective longitudinal design, this study aimed to investigate the relative influence of child, family, and injury factors on both acute and persistent PCS in young children.Methods:Participants were 101 children aged 2–12 who presented to an Emergency Department, with either mTBI or minor bodily trauma (control). PCS were assessed at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors included injury and demographic variables, premorbid child behavior, sleep hygiene, and parental stress. Random effects ordinal logistic regression models were used to analyze the relative influence of these predictors on PCS at early (acute – 1 week) and late (1–3 month) post-injury phases.Results:Presence of mTBI was a stronger predictor of PCS in the early [odds ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at injury and pre-existing learning difficulties were significant predictors of PCS beyond 1 month post-injury. Family factors, including higher levels of parental stress, higher socio-economic status, and being of Anglo-Saxon descent, consistently predicted greater PCS.Conclusions:Injury characteristics were significantly associated with PCS for 3 months following mTBI but the association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Follow-up for these “at-risk” children which also addresses family stress may minimize longer-term complications. (JINS, 2016,22, 793–803)

Download Full-text

ACADEMIC CONCERNS, REQUESTED AND RECEIVED SUPPORT AMONG ADOLESCENTS IN THE FOUR WEEKS FOLLOWING CONCUSSION: A PILOT STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00279 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0027

Author(s):

Traci Snedden ◽

Eric Post ◽

Christian Schmidt ◽

Alison Brooks

Keyword(s):

Academic Success ◽

Pilot Study ◽

Longitudinal Design ◽

Academic Support ◽

Legal Guardian ◽

Academic Effects ◽

Time Points ◽

Community Based Design ◽

Prospective Longitudinal ◽

Over Time

Background: Even short-term cognitive challenges place adolescents at risk for successful achievement of academic success and attainment of career goals. Studies that have examined subjects receiving follow-up at a concussion or other specialty clinic have noted cognitive issues that cause learning problems upon return to the classroom. However, a gap exists specific to the types of academic concerns and needs for academic support using a prospective longitudinal design in a general sample. Purpose: The purpose of this pilot study was to describe the scope of academic concerns, requested and received academic support over time among adolescents in the four weeks following a concussion injury. Methods: Prospective longitudinal pilot study. Adolescents, aged 13-18 years, and their parent/legal guardian were enrolled within 7 days of concussion injury using a community-based design. Academic effects, requested and received support were assessed by electronic completion of the Concussion Learning Assessment and School Survey (CLASS) of both adolescent and their parent/legal guardian at 4 time points across 28 days, each one week apart. Results: Overall, 37 adolescents (51.4% female, mean age: 16.4±1.4 years) and their parent/legal guardian, provided sufficient data for analysis. A decrease in the frequency of academic concerns over time was noted across the 4 weeks following injury with 37.8% (n=14) reporting challenges in one or more of their classes in the first week after their concussion, compared to 10.8% (n=4) at 28 days. A decrease in requested supports was also noted, with 48.6% (n=18) requesting some form of academic support in the first week compared to 13.5% (n=5) at 28 days. Most commonly requested supports across all time points included extra time to complete work, reduced homework, reduced or waived makeup work, and a shortened school day. Received academic support was also greatest in the first week following concussion (40.5%, n=15) and declined to 16.2% (n=6) at 28 days. Grades were reported as worse since their concussion across all time points with 18.9% reporting this concern at 14 and 21 days. Conclusion: High rates of academic concerns and requested supports were reported in the first week following concussion. In addition, a consistent proportion of students reported a worsening of grades and continued to report academic concerns and needs for academic support four weeks after they sustained a concussion. These pilot findings support the need for greater attention to the academic effects of concussion and related support needs in the classroom for all students. [Table: see text][Table: see text]

Download Full-text

A longitudinal assessment of treatment-related differences in quality of life among prostate cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15605 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15605-15605

Author(s):

A. Giedzinska-Simons ◽

K. M. Christie ◽

B. E. Meyerowitz ◽

M. Gross ◽

D. B. Agus

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Negative Affect ◽

Disease Severity ◽

Longitudinal Design ◽

Gradual Decline ◽

Prospective Longitudinal ◽

The Impact ◽

Over Time

15605 Background: Physicians increasingly are asked about changes in quality of life (QOL) following treatment. This is especially relevant for prostate cancer (PC), a disease for which different primary treatments expose patients to differing risks of adverse effect with similar expected benefits in terms of survival. Few studies have compared QOL for the major treatment approaches in a prospective, longitudinal design. Methods: 53 PC patients completed mailed questionnaires assessing general, emotional, social, functional, physical, and prostate-specific QOL with the FACT; stress with the Impact of Events Scale-R (IES-R); and mood with the Positive and Negative Affect Schedule. Data were collected prior to treatment and at 1 month and 6 months post-primary disease treatment. Patients’ primary treatments were radical prostatectomy (RP; N=22), radiation (N=16), or conservative therapy (androgen deprivation treatment only (ADT); N=15). Responses were compared in a mixed-factorial ANCOVA design, controlling for disease severity (Gleason score) and age. Results: Although there were no main effect differences by treatment group, treatment by time interactions emerged for physical QOL (p=.002), stress (p=.04), and negative affect (p=.01). Examination of patterns of response indicated that physical difficulties remained fairly consistent for RP and radiation patients over time, whereas ADT patients showed a gradual decline in physical QOL. For stress and negative affect, RP patients reported highest levels of distress prior to treatment and experienced a gradual recovery over time. Radiation patients followed a similar, although less dramatic, trajectory for stress but showed little change in negative affect. ADT patients had relatively low levels of stress at each time point. Their levels of negative affect were similar to those of radiation patients. Conclusions: Even after controlling for age and disease severity, this examination of patient QOL over time suggests the pre-treatment period is especially stressful for RP patients, and that ADT patients exhibit a gradual decline in physical QOL over time. These results may help physicians anticipate and discuss treatment-specific trends in QOL with their patients, thus enhancing patient care. No significant financial relationships to disclose.

Download Full-text

Changes in working memory-related cortical responses following pediatric mild traumatic brain injury: A longitudinal fMRI study

Journal of Concussion ◽

10.1177/20597002211006541 ◽

2021 ◽

Vol 5 ◽

pp. 205970022110065

Author(s):

Athena Stein ◽

Kartik K Iyer ◽

Aneesh M Khetani ◽

Karen M Barlow

Keyword(s):

Traumatic Brain Injury ◽

Working Memory ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Task Difficulty ◽

Data Quality Control ◽

Post Injury ◽

Cortical Responses ◽

Prospective Longitudinal ◽

Over Time

Persistent post-concussion symptoms (PPCS) lasting longer than 4 weeks affect 25% of children with mild traumatic brain injury (mTBI) or concussion. Working memory (WM) problems are a common complaint in children with PPCS. Despite normal function on traditional neuropsychological tests, these children exhibit aberrant cortical responses within the dorsolateral prefrontal cortex (dlPFC) and default mode network (DMN) regions – both of which are implicated in WM. Using a prospective, longitudinal cohort study design, we investigated changes in cortical fMRI responses within the dlPFC and DMN during an nback WM task at two timepoints: one and two months post-injury. Across these timepoints, the primary outcome was change in cortical activations (increase in BOLD) and deactivations (decrease in BOLD) of both dlPFC and DMN. Twenty-nine children (mean age 15.49 ± 2.15; 48.3% male) with fMRI scans at both timepoints were included, following data quality control. Student’s t-tests were used to examine cortical activations across time and task difficulty. ANCOVA F-tests examined cortical responses after removal of baseline across time, task difficulty and recovery. Volumes of interest (5 mm sphere) were placed in peak voxel regions of the DMN and dlPFC to compare cortical responses between recovered and unrecovered participants over time (one-way ANOVA). Between one and two months post-injury, we found significant increases in dlPFC activations and significant activations and deactivations in the DMN with increasing task difficulty, alongside improved task performance. Cortical responses of the DMN and bilateral dlPFC displayed increased intensity in recovered participants, together with improved attention and behavioural symptoms. Overall, our findings suggest evidence of neural compensation and ongoing cognitive recovery from pediatric TBI over time between one and two months post injury in children with PPCS. These results highlight the wider and persisting implications of mTBI in children, whose maturing brains are particularly vulnerable to TBI.

Download Full-text

Distinguishing between enduring and dynamic concussion symptoms: applying Generalisability Theory to the Rivermead Post Concussion Symptoms Questionnaire (RPQ)

PeerJ ◽

10.7717/peerj.5676 ◽

2018 ◽

Vol 6 ◽

pp. e5676 ◽

Cited By ~ 5

Author(s):

Oleg N. Medvedev ◽

Alice Theadom ◽

Suzanne Barker-Collo ◽

Valery Feigin ◽

Keyword(s):

Traumatic Brain Injury ◽

Measurement Error ◽

Longitudinal Design ◽

Dynamic Aspect ◽

Symptom Change ◽

Symptom Experience ◽

Post Injury ◽

A Minor ◽

Generalisability Theory ◽

Over Time

Background The Rivermead Post Concussion Symptoms Questionnaire (RPQ) is a widely-used, 16-item measure of concussion symptoms yet its ability to assess change in the symptom experience over time has come under criticism. We applied Generalisability theory to differentiate between dynamic and enduring aspects of post-concussion symptoms and to examine sources of measurement error in the RPQ. Materials and Methods Generalisability theory was applied using the longitudinal design with persons as the object of measurement. Patients with a traumatic brain injury (n = 145; aged ≥16 years) were assessed at three time occasions (1, 6 and 12 months post-injury) using the RPQ. Results The RPQ showed overall strong generalisability of scores (G = .98) across persons and occasions with a minor proportion of variance attributed to the dynamic aspect of symptoms reflected by interaction between person and occasion. Items measuring concentration, fatigue, restlessness and irritability reflected more dynamic patterns compared to more enduring patterns of sensitivity to noise, impatience, nausea and sleep disturbance. Conclusion The RPQ demonstrated strong reliability in assessing enduring post-concussion symptoms but its ability to assess dynamic symptoms is limited. Clinicians should exercise caution in use of the RPQ to track dynamic symptom change over time. Further investigation is necessary to enhance the RPQ’s ability to assess dynamic symptoms and to address measurement error associated with individual items.

Download Full-text

Marked progress in AL amyloidosis survival: a 40-year longitudinal natural history study

Blood Cancer Journal ◽

10.1038/s41408-021-00529-w ◽

2021 ◽

Vol 11 (8) ◽

Author(s):

Andrew Staron ◽

Luke Zheng ◽

Gheorghe Doros ◽

Lawreen H. Connors ◽

Lisa M. Mendelson ◽

...

Keyword(s):

Standards Of Care ◽

Al Amyloidosis ◽

Unexpected Death ◽

Related Factors ◽

Term Survival ◽

Natural History Study ◽

Boston University ◽

Disease Outcomes ◽

Patient Subgroups ◽

Over Time

AbstractThe recent decades have ushered in considerable advancements in the diagnosis and treatment of systemic light chain (AL) amyloidosis. As disease outcomes improve, AL amyloidosis-unrelated factors may impact mortality. In this study, we evaluated survival trends and primary causes of death among 2337 individuals with AL amyloidosis referred to the Boston University Amyloidosis Center. Outcomes were analyzed according to date of diagnosis: 1980-1989 (era 1), 1990-1999 (era 2), 2000-2009 (era 3), and 2010-2019 (era 4). Overall survival increased steadily with median values of 1.4, 2.6, 3.3, and 4.6 years for eras 1–4, respectively (P < 0.001). Six-month mortality decreased over time from 23% to 13%. Wide gaps in survival persisted amid patient subgroups; those with age at diagnosis ≥70 years had marginal improvements over time. Most deaths were attributable to disease-related factors, with cardiac failure (32%) and sudden unexpected death (23%) being the leading causes. AL amyloidosis-unrelated mortality increased across eras (from 3% to 16% of deaths) and with longer-term survival (29% of deaths occurring >10 years after diagnosis). Under changing standards of care, survival improved and early mortality declined over the last 40 years. These findings support a more optimistic outlook for patients with AL amyloidosis.

Download Full-text

The Chicken and Egg of Pride and Social Rank

Social Psychological and Personality Science ◽

10.1177/19485506211023619 ◽

2021 ◽

pp. 194855062110236

Author(s):

Zachary Witkower ◽

Eric Mercadante ◽

Jessica L. Tracy

Keyword(s):

Longitudinal Design ◽

Social Rank ◽

Causal Direction ◽

Authentic Pride ◽

Longitudinal Relationships ◽

Over Time

Prior research has found an association between pride experiences and social rank outcomes. However, the causal direction of this relationship remains unclear. The current research used a longitudinal design ( N = 1,653) to investigate whether pride experiences are likely to be a cause, consequence, or both, of social rank outcomes, by tracking changes in individuals’ pride and social rank over time. Prior research also has uncovered distinct correlational relationships between the two facets of pride, authentic and hubristic, and two forms of social rank, prestige and dominance, respectively. We therefore separately examined longitudinal relationships between each pride facet and each form of social rank. Results reveal distinct bidirectional relationships between authentic pride and prestige and hubristic pride and dominance, suggesting that specific kinds of pride experiences and specific forms of social rank are both an antecedent and a consequence of one another.

Download Full-text

The Impact of Intervention-Related Risk Factors on the Risk of Ventilator-Associated Pneumonia Is High in a Neurosurgical Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1059 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s407-s409

Author(s):

Ksenia Ershova ◽

Oleg Khomenko ◽

Olga Ershova ◽

Ivan Savin ◽

Natalia Kurdumova ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Negative Slope ◽

Infection Prevention And Control ◽

Ventilator Associated Pneumonia ◽

Related Factors ◽

Icu Patients ◽

The Impact ◽

Adf Test ◽

Over Time

Background: Ventilator-associated pneumonia (VAP) represents the highest burden among all healthcare-associated infections (HAIs), with a particularly high rate in patients in neurosurgical ICUs. Numerous VAP risk factors have been identified to provide a basis for preventive measures. However, the impact of individual factors on the risk of VAP is unclear. The goal of this study was to evaluate the dynamics of various VAP risk factors given the continuously declining prevalence of VAP in our neurosurgical ICU. Methods: This prospective cohort unit-based study included neurosurgical patients who stayed in the ICU >48 consecutive hours in 2011 through 2018. The infection prevention and control (IPC) program was implemented in 2010 and underwent changes to adopt best practices over time. We used a 2008 CDC definition for VAP. The dynamics of VAP risk factors was considered a time series and was checked for stationarity using theAugmented Dickey-Fuller test (ADF) test. The data were censored when a risk factor was present during and after VAP episodes. Results: In total, 2,957 ICU patients were included in the study, 476 of whom had VAP. Average annual prevalence of VAP decreased from 15.8 per 100 ICU patients in 2011 to 9.5 per 100 ICU patients in 2018 (Welch t test P value = 7.7e-16). The fitted linear model showed negative slope (Fig. 1). During a study period we observed substantial changes in some risk factors and no changes in others. Namely, we detected a decrease in the use of anxiolytics and antibiotics, decreased days on mechanical ventilation, and a lower rate of intestinal dysfunction, all of which were nonstationary processes with a declining trend (ADF testP > .05) (Fig. 2). However, there were no changes over time in such factors as average age, comorbidity index, level of consciousness, gender, and proportion of patients with brain trauma (Fig. 2). Conclusions: Our evidence-based IPC program was effective in lowering the prevalence of VAP and demonstrated which individual measures contributed to this improvement. By following the dynamics of known VAP risk factors over time, we found that their association with declining VAP prevalence varies significantly. Intervention-related factors (ie, use of antibiotics, anxiolytics and mechanical ventilation, and a rate of intestinal dysfunction) demonstrated significant reduction, and patient-related factors (ie, age, sex, comorbidity, etc) remained unchanged. Thus, according to the discriminative model, the intervention-related factors contributed more to the overall risk of VAP than did patient-related factors, and their reduction was associated with a decrease in VAP prevalence in our neurosurgical ICU.Funding: NoneDisclosures: None

Download Full-text

Decline of ovarian function in patients with rheumatoid arthritis: serum anti-Müllerian hormone levels in a longitudinal cohort

RMD Open ◽

10.1136/rmdopen-2020-001307 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001307

Author(s):

Jenny Brouwer ◽

Radboud J E M Dolhain ◽

Johanna M W Hazes ◽

Nicole S Erler ◽

Jenny A Visser ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Mixed Model ◽

Linear Mixed Model ◽

Ovarian Function ◽

Reproductive Function ◽

Related Factors ◽

Original Cohort ◽

Primordial Follicles ◽

Age At Menopause ◽

Over Time

ObjectiveRheumatoid arthritis (RA) often affects women in their fertile age, and is known to compromise female fertility. Serum anti-Müllerian hormone (AMH) levels are a proxy for the total number of primordial follicles, and a reliable predictor of the age at menopause. Our objective was to study the longitudinal intra-individual decline of serum AMH levels in female RA patients.MethodsFemale RA patients from a nationwide prospective cohort (2002–2008) were re-assessed in 2015–2016. Serum AMH levels were measured using the picoAMH assay and compared with healthy controls. A linear mixed model (LMM) was built to assess the effect of RA-related clinical factors on the decline of AMH levels.ResultsA group of 128 women were re-assessed at an age of 42.6±4.4 years, with a median disease duration of 15.8 (IQR 12.7–21.5) years. The time between first and last AMH assessments was 10.7±1.8 (range 6.4–13.7) years. Participants represented a more fertile selection of the original cohort. At follow-up, 39% of patients had AMH levels below the 10th percentile of controls (95% CI 31% to 48%), compared with 16% (95% CI 9.3% to 22%) at baseline. The LMM showed a significant decline of AMH with increasing age, but no significant effect of RA-related factors on AMH.ConclusionAMH levels in RA patients showed a more pronounced decline over time than expected, supporting the idea that in chronic inflammatory conditions, reproductive function is compromised, resulting in a faster decline of ovarian function over time and probably an earlier age at menopause.

Download Full-text

The Longitudinal Link between Organizational Citizenship Behaviors and Three Different Models of Happiness

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126387 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6387

Author(s):

Wenceslao Unanue ◽

Eduardo Barros ◽

Marcos Gómez

Keyword(s):

Organizational Citizenship ◽

Longitudinal Design ◽

Well Being ◽

Organizational Citizenship Behaviors ◽

Citizenship Behaviors ◽

Broad Perspective ◽

Typical Sample ◽

Eudaimonic Happiness ◽

Over Time

A growing body of research conducted in general life settings has found positive associations between happiness and prosocial behavior. Unfortunately, equivalent studies in the workplace are lacking. Organizational citizenship behaviors (OCBs), the prosocial behaviors at work, have not been properly studied in relation to happiness, despite the positive consequences of both constructs for workers and companies. In response, our research aims to better understand this relationship from several angles. First, using a three-wave longitudinal design, we explored how OCBs and happiness are related to each other over time. Second, happiness was measured from a broad perspective, and three conceptualizations were adopted: the hedonic (e.g., positive affect and life satisfaction), the eudaimonic (e.g., relatedness and autonomy), and the flourishing (e.g., meaning and engagement) approaches. Thus, not only the prospective link between OCBs and happiness was tested, but it was also explored using the three models of happiness previously mentioned. Third, we conducted this longitudinal design in a less typical sample than previous research (i.e., Chile). We found results that supported our main hypotheses: (1) OCBs are prospective positive predictors of hedonic happiness, eudaimonic happiness, and flourishing; (2) the three models of happiness also prospectively predict OCBs. Our findings suggest that OCBs foster a broad range of happiness facets, which in turn fosters back the emergence of more OCBs, leading to a virtuous circle of prosociality and well-being in the workplace. This positive spiral benefits not only workers’ quality of life, but also organizations’ profitability and sustainability. Theoretical and applied implications for the field of Positive Organizational Psychology are discussed.

Download Full-text

Frailty and Autonomy among the Oldest Old: Evidence from the Multicenter Prospective AgeCoDe-AgeQualiDe Study

Gerontology ◽

10.1159/000514170 ◽

2021 ◽

pp. 1-8

Author(s):

André Hajek ◽

Christian Brettschneider ◽

Tina Mallon ◽

Hanna Kaduszkiewicz ◽

Birgitt Wiese ◽

...

Keyword(s):

Old Age ◽

Service Use ◽

Oldest Old ◽

Strong Association ◽

Total Sample ◽

Sociodemographic Factors ◽

Related Factors ◽

Clinical Frailty Scale ◽

Related Quality ◽

Health Related

Introduction: There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap. Methods: Data were used from the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe; follow-up [FU] wave 9; n = 510 observations in the analytical sample). The average age was 90.3 years (SD: 2.7 years). The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to assess frailty. Socioeconomic and health-related covariates were included in our regression model. The autonomy scale developed by Schwarzer was used to assess perceived autonomy in old age. Results: Adjusting for various confounders, multiple linear regressions showed that lower perceived autonomy was associated with increased levels of frailty (total sample: β = −0.13, p < 0.001; women: β = −0.14, p < 0.001; and men: β = −0.12, p < 0.001). Furthermore, lower perceived autonomy was associated with more depressive symptoms, higher cognitive impairment, and being institutionalized (except for men) in the total sample and in both sexes, but it was not significantly associated with age, sex, marital status, educational level, and social support. Conclusion: Findings indicate that frailty is associated with lower autonomy among the oldest old. More generally, while health-related factors were consistently associated with autonomy, sociodemographic factors (except for being institutionalized) were not associated with autonomy among the oldest old. We should be aware of the strong association between autonomy and physical as well as mental health in very old age.

Download Full-text