Assessing the Impact of Military Service on Patient Health Literacy in an Otolaryngology Clinic

2021 ◽  
Author(s):  
Danielle A Morrison ◽  
Charles A Riley ◽  
Anthony M Tolisano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Health Literacy ◽  
Military Service ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
History Of ◽  
The Impact ◽  
Inadequate Health Literacy

ABSTRACT Objective To examine the impact of military service on health literacy. Study Design Prospective, cross-sectional study. Subjects and Methods The validated Brief Health Literacy Screen (BHLS) with military supplement was administered to sequential adult patients (military and civilian) treated at two outpatient academic military otolaryngology clinics between November and December 2019. Inadequate health literacy, defined by a BHLS score ≤9, was the primary outcome measure. Secondary outcome measures included comparisons of inadequate BHLS scores with patient demographics and history of military service. Results Three hundred and eighty-two patients were evaluated during the study period. The median age was 48-57 years, with a majority being male (230, 60.2%), White (264, 69.1%), married (268, 70.2%), and active duty military (303, 79.3%). A minority reported history of PTSD (39, 13%) or traumatic brain injury (29, 9.6%). Overall, very few subjects (10, 2.6%) demonstrated inadequate health literacy. Patients with prior (1.6% vs 6.3%, P < .05) or current (0% vs 5.0%, P < .05) military service had lower rates of inadequate health literary as compared to civilians. Gender, race, marital status, history of PTSD, and history of traumatic brain injury did not significantly impact health literacy. In a multivariate regression model exploring history of military service, age was not predictive of inadequate health literacy. Conclusions Both history of and current military service predict higher health literacy rates for patients treated at military otolaryngology clinics. Widely accessible health care and mandatory health evaluations for service members to maintain deployment readiness may contribute to this finding but warrant additional study.

The impact of hypopituitarism on function and performance in subjects with recent history of traumatic brain injury and aneurysmal subarachnoid haemorrhage

Brain Injury ◽  
2009 ◽  
Vol 23 (7-8) ◽  
pp. 639-648 ◽  
Author(s):  
Lakshmi Srinivasan ◽  
Brian Roberts ◽  
Tamara Bushnik ◽  
Jeffrey Englander ◽  
David A. Spain ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Recent History ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
History Of ◽  
And Performance ◽  
The Impact

scholarly journals A-116 Predicting Chronic Neurobehavioral Symptoms based on Acute Injury Characteristics and Symptoms in U.S. Military Service Members with and without history of TBI

2020 ◽  
Vol 35 (6) ◽  
pp. 909-909
Author(s):  
Lippa S ◽  
Bailie J ◽  
Brickell T ◽  
French L ◽  
Hungerford L ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Military Service ◽  
Service Members ◽  
Injury Characteristics ◽  
Military Service Members ◽  
History Of ◽  
Neurobehavioral Symptoms ◽  
Severe Tbi

Abstract Objective Recovery following traumatic brain injury (TBI) is complex. Often following mild TBI, recovery occurs within days or weeks, though this is not always the case. Following more severe TBI, some recover quickly, while many never fully recover. This study examines acute predictors of chronic neurobehavioral symptoms in U.S. military service members (Age: M = 33.9 years, SD = 10.2) without injury (n = 86), or with history of uncomplicated mild traumatic brain injury (TBI; n = 56), complicated mild, moderate, or severe TBI (mod-sev TBI; n = 43), or bodily injury (n = 25). Method Participants completed the Neurobehavioral Symptom Inventory (NSI), Posttraumatic Stress Disorder Checklist, Alcohol Use Disorder Checklist, Combat Exposure Scale, and TBI Quality of Life and passed symptom validity tests at 0–8 months and ≥ 2 years post-injury. Forward stepwise logistic regression included 26 potential predictors (demographics, injury characteristics, military characteristics, and self-report measures at baseline) of International Statistical Classification of Diseases and Related Health Problems-10 Postconcussional Syndrome (PCSy) at follow-up. Results Cognitive Concerns (Exp(B) = .896, p = .001), Sleep (Exp(B) = 1.874, p < .001), Somatosensory Symptoms (Exp(B) = 1.194, p = .012), and mod-sev TBI (Exp(B) = 2.959, p = .045) significantly predicted follow-up PCSy. When baseline NSI symptoms were removed from the model, Cognitive Concerns (Exp(B) = .902, p < .001), Post-traumatic stress (Exp(B) = 1.173, p = .001), and Resilience (Exp(B) = .950, p < .031) significantly predicted PCSy. For all included measures in both models, higher symptoms at baseline predicted increased likelihood of follow-up PCSy. Both models correctly classified 81.3% of participants. Conclusion Findings suggest patients reporting psychological distress and cognitive concerns acutely should be targeted for treatment to mitigate prolonged neurobehavioral symptoms.

Mild Traumatic Brain Injury and Postconcussive Symptom Endorsement: A Parallel Comparison Between Two Nonclinical Cohorts

2020 ◽  
Author(s):  
R Elisabeth Cornwell ◽  
Jorge I Arango ◽  
C B Eagye ◽  
Candace Hill-Pearson ◽  
Karen Schwab ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Epidemiological Studies ◽  
Emergency Department Visits ◽  
Survey Study ◽  
Military Health ◽  
History Of ◽  
The Military ◽  
The Impact

ABSTRACT Introduction The prevalence of mild traumatic brain injury (mTBI) is commonly estimated based on indirect metrics such as emergency department visits and self-reporting tools. The study of postconcussive symptoms faces similar challenges because of their unspecific character and indistinct causality. In this article, we compare two nonclinical, epidemiological studies that addressed these two elements and were performed within a relatively narrow period in the state of Colorado. Materials and Methods De-identified datasets were obtained from a random digit-dialed survey study conducted by the Craig Hospital and a study surveying soldiers returning from deployment by Defense and Veteran Traumatic Brain Injury Center. Information pertinent to participants’ demographics, a history of mTBI, and symptom endorsement was extracted and homogenized in order to establish a parallel comparison between the populations of the two studies. Results From the 1,558 (Warrior Strong, 679; Craig Hospital, 879) records selected for analysis, 43% reported a history of at least one mTBI. The prevalence was significantly higher among individuals from the Defense and Veteran Traumatic Brain Injury Center study independent of gender or race. Repetitive injuries were reported by 15% of the total combined cohort and were more prevalent among males. Symptom endorsement was significantly higher in individuals with a positive history of mTBI, but over 80% of those with a negative history of mTBI endorsed at least one of the symptoms interrogated. Significant differences were observed between the military and the civilian populations in terms of the types and frequencies of the symptoms endorsed. Conclusions The prevalence of mTBI and associated symptoms identified in the two study populations is higher than that of previously reported. This suggests that not all individuals sustaining concussion seek medical care and highlights the limitations of using clinical reports to assess such estimates. The lack of appropriate mechanisms to determine symptom presence and causality remains a challenge. However, the differences observed in symptom reporting between cohorts raise questions about the nature of the symptoms, the impact on the quality of life for different individuals, and the effects on military health and force readiness.

scholarly journals APOE-ε4 Genotype is Associated with Elevated Post-Concussion Symptoms in Military Veterans with a Remote History of Mild Traumatic Brain Injury

2018 ◽  
Vol 34 (5) ◽  
pp. 706-712 ◽  
Author(s):  
Victoria C Merritt ◽  
Kristina M Lapira ◽  
Alexandra L Clark ◽  
Scott F Sorg ◽  
Madeleine L Werhane ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Military Veterans ◽  
Primary Outcome Measure ◽  
Apoe Ε4 ◽  
Stress Symptoms ◽  
History Of ◽  
Ε4 Allele

Abstract Objective We evaluated the influence of the APOE-ε4 allele on post-concussive symptoms in military Veterans with a remote history of mild traumatic brain injury (mTBI). Method Participants (N = 77) were administered neuropsychiatric measures, on average, approximately 5 years following their most recent mTBI and provided a DNA sample for APOE genotyping. Veterans were divided into two groups based on their ε4 status (n = 14 ε4+, n = 63 ε4–). The Neurobehavioral Symptom Inventory (NSI) was the primary outcome measure, from which a total score was derived, as well as three symptom clusters (somatic, cognitive, and affective). Results ANCOVAs showed a significant main effect of ε4 genotype on the NSI total score and somatic symptom cluster after adjusting for posttraumatic stress symptoms and mTBI history (p = .019–.028, ηp2 = .064–.073), such that ε4+ Veterans endorsed significantly greater symptoms than ε4– Veterans. Conclusions Our findings suggest that genetic risk may help to explain the poorer long-term outcomes often observed in this population.

scholarly journals Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 148-154 ◽  
Author(s):  
Jan E Kennedy ◽  
Lisa H Lu ◽  
Matthew W Reid ◽  
Felix O Leal ◽  
Douglas B Cooper
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Military Service ◽  
Depressive Disorders ◽  
Service Members ◽  
Data Repository ◽  
Military Health ◽  
Increased Risk ◽  
History Of ◽  
Combat Deployments

AbstractObjectivesPost-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4–1/2 years prior to evaluation.MethodsRetrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center.ResultsOne-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments.ConclusionsResults confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.

scholarly journals Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e040550
Author(s):  
Jean-Francois Payen ◽  
Marion Richard ◽  
Gilles Francony ◽  
Gérard Audibert ◽  
Emmanuel L Barbier ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Life Assessment ◽  
Secondary Outcome ◽  
Trauma Patients ◽  
Brain Tissue Oxygenation ◽  
Severe Tbi ◽  
Randomised Controlled ◽  
The Impact

IntroductionIntracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI.Methods and analysisMulticentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2 group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2 group is managed to maintain PbtO2 ≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze.Ethics and disseminationThis study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrials NCT02754063 on 28 April 2016 (pre-results).

scholarly journals Mild traumatic brain injury affects the features of migraine

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ryotaro Ishii ◽  
Todd J. Schwedt ◽  
Meesha Trivedi ◽  
Gina Dumkrieger ◽  
Melissa M. Cortez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Physical Abuse ◽  
Mild Traumatic Brain Injury ◽  
Clinical Course ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Lack Of Sleep ◽  
History Of ◽  
The Impact

Abstract Background Headache is one of the most common symptoms after concussion, and mild traumatic brain injury (mTBI) is a risk factor for chronic migraine (CM). However, there remains a paucity of data regarding the impact of mTBI on migraine-related symptoms and clinical course. Methods Of 2161 migraine patients who participated in the American Registry for Migraine Research between February 2016 and March 2020, 1098 completed questions assessing history of TBI (50.8%). Forty-four patients reported a history of moderate to severe TBI, 413 patients reported a history of mTBI. Patients’ demographics, headache symptoms and triggers, history of physical abuse, allodynia symptoms (ASC-12), migraine disability (MIDAS), depression (PHQ-2), and anxiety (GAD-7) were compared between migraine groups with (n = 413) and without (n = 641) a history of mTBI. Either the chi-square-test or Fisher’s exact test, as appropriate, was used for the analyses of categorical variables. The Mann-Whitney test was used for the analyses of continuous variables. Logistic regression models were used to compare variables of interest while adjusting for age, gender, and CM. Results A significantly higher proportion of patients with mTBI had CM (74.3% [307/413] vs. 65.8% [422/641], P = 0.004), had never been married or were divorced (36.6% [147/402] vs. 29.4% [187/636], P = 0.007), self-reported a history of physical abuse (24.3% [84/345] vs. 14.3% [70/491], P <  0.001), had mild to severe anxiety (50.5% [205/406] vs. 41.0% [258/630], P = 0.003), had headache-related vertigo (23.0% [95/413] vs. 15.9% [102/640], P = 0.009), and difficulty finding words (43.0% [174/405] vs. 32.9% [208/633], P <  0.001) in more than half their attacks, and headaches triggered by lack of sleep (39.4% [155/393] vs. 32.6% [198/607], P = 0.018) and reading (6.6% [26/393] vs. 3.0% [18/607], P = 0.016), compared to patients without mTBI. Patients with mTBI had significantly greater ASC-12 scores (median [interquartile range]; 5 [1–9] vs. 4 [1–7], P < 0.001), MIDAS scores (42 [18–85] vs. 34.5 [15–72], P = 0.034), and PHQ-2 scores (1 [0–2] vs. 1 [0–2], P = 0.012). Conclusion Patients with a history of mTBI are more likely to have a self-reported a history of physical abuse, vertigo, and allodynia during headache attacks, headaches triggered by lack of sleep and reading, greater headache burden and headache disability, and symptoms of anxiety and depression. This study suggests that a history of mTBI is associated with the phenotype, burden, clinical course, and associated comorbid diseases in patients with migraine, and highlights the importance of inquiring about a lifetime history of mTBI in patients being evaluated for migraine.

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