Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 36-45
Author(s):  
Katie Truss ◽  
Stephen J C Hearps ◽  
Franz E Babl ◽  
Michael Takagi ◽  
Gavin A Davis ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Multinomial Logistic Regression ◽  
Internalizing Behavior ◽  
Parental Distress ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Postconcussive Symptoms ◽  
Chi Squared ◽  
Symptom Recovery ◽  
Prospective Longitudinal

Abstract BACKGROUND Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. OBJECTIVE To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. METHODS This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. RESULTS We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. CONCLUSION This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.

scholarly journals Factors Associated with Frailty According to Gender of Older Adults Living Alone

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 475
Author(s):  
Hye-Young Jang ◽  
Ji-Hye Kim
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Nutritional Status ◽  
Chronic Diseases ◽  
Multinomial Logistic Regression ◽  
Living Alone ◽  
Factors Associated ◽  
Chi Squared ◽  
Korean Elderly

This study was conducted to identify the factors associated with frailty according to gender of older adults living alone in Korea. Data from the National Survey of the Living Conditions of Korean Elderly in 2017 were used. Participants were 2340 older adults who live alone. Frailty was determined based on the frailty criteria developed by van Kan et al. that consist of fatigue, resistance, ambulation, and illness. The collected data were analyzed using descriptive statistics, chi-squared test, t-test, Jonckheere–Terpstra test and multinomial logistic regression. Among the older men living alone, 47.7% were in the pre-frail and 5.1% were in the frail. On the other hand, 51.8% were in the pre-frail and 12.2% were in the frail among the older women living alone. The factors associated with frailty according to gender are as follows. In males, depressive symptoms, limitation in IADL, and number of medications in pre-frail; BMI, limitation in IADL, and number of chronic diseases in frail. In females, depressive symptoms, number of chronic diseases, age, and nutritional status in pre-frail; limitation in IADL, depressive symptoms, age, number of chronic diseases, number of medications, nutritional status in frail. Based on the findings of this study, it is considered necessary to approach frailty management considering gender as well as the classification of frailty.

scholarly journals Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

2019 ◽  
Vol 74 (7) ◽  
pp. 2003-2008
Author(s):  
Jennifer L Grant ◽  
Patricia Agaba ◽  
Placid Ugoagwu ◽  
Auwal Muazu ◽  
Jonathan Okpokwu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Stiffness ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Hiv Care ◽  
Inverse Association ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Art Initiation ◽  
Prospective Longitudinal

Abstract Background There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- and HIV/HBV-infected individuals. Objectives To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- and HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods We included ART-naive HIV- and HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cut-offs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We used multivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results A total of 106 HIV- and 71 HIV/HBV-infected patients [70.5% female and median age = 34 years (IQR = 29–42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV- versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P < 0.01); LSM scores at year 3 were not significantly different between HIV- and HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4+ T cells ≥200 (versus <200) cells/mm3 and lower BMIs were more likely to experience LSM stage decline. Conclusions HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

scholarly journals Association between Breastfeeding Duration and Type of Birth Attendant

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jordyn T. Wallenborn ◽  
Saba W. Masho
Keyword(s):  
Multinomial Logistic Regression ◽  
Family Doctor ◽  
Healthcare Providers ◽  
Breastfeeding Duration ◽  
Breastfeeding Support ◽  
Prospective Longitudinal Study ◽  
Breastfeeding Education ◽  
Nurse Midwife ◽  
Integral Role ◽  
Prospective Longitudinal

Introduction. Healthcare providers play an integral role in breastfeeding education and subsequent practices; however, the education and support provided to patients may differ by type of provider. The current study aims to evaluate the association between type of birth attendant and breastfeeding duration. Methods. Data from the prospective longitudinal study, Infant Feeding Practices Survey II, was analyzed. Breastfeeding duration and exclusive breastfeeding duration were defined using the American Academy of Pediatrics’ national recommendations. Type of birth attendant was categorized into obstetricians, other physicians, and midwife or nurse midwife. If mothers received prenatal care from a different type of provider than the birth attendant, they were excluded from the analysis. Multinomial logistic regression was conducted to obtain crude and adjusted odds ratios and 95% confidence intervals. Results. Compared to mothers whose births were attended by an obstetrician, mothers with a family doctor or midwife were twice as likely to breastfeed at least six months. Similarly, mothers with a midwife birth attendant were three times as likely to exclusively breastfeed less than six months and six times more likely to exclusively breastfeed at least six months compared to those who had an obstetrician birth attendant. Conclusions. Findings from the current study highlight the importance of birth attendants in breastfeeding decisions. Interventions are needed to overcome barriers physicians encounter while providing breastfeeding support and education. However, this study is limited by several confounding factors that have not been controlled for as well as by the self-selection of the population.

scholarly journals Factors associated with the use of physical restraint in intensive care patients

2020 ◽  
Vol 54 ◽  
Author(s):  
Luana Rosas Zulian ◽  
Satomi Mori ◽  
Eliana Cavalari Teraoka ◽  
Vanessa Yukie Kita Miyasaki ◽  
Suely Sueko Viski Zanei ◽  
...  
Keyword(s):  
Intensive Care ◽  
Multinomial Logistic Regression ◽  
Physical Restraint ◽  
Female Gender ◽  
Factors Associated ◽  
Restraint Use ◽  
Chi Squared ◽  
Ventilation Weaning ◽  
And Gender ◽  
Mechanical Ventilation Weaning

Abstract Objective: To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. Method: An observational and prospective study on the use of restraint in patients observed over two days, considering the variables: age and gender, personal and clinical characteristics, devices, adverse event and restraint use. The frequency was verified in three groups of patients with different conditions by applying the Chi-Squared, Likelihood Ratio or Kruskal-Wallis tests. The association of the variables was verified with the Multinomial Logistic Regression. Results: Eighty-four (84) patients participated. Restraint was observed in 77.4% of the 84 analyzed patients, and was more frequent in the presence of sedation, agitation and invasive devices. The chance of being restrained was at least five times higher in sedation conditions, whether in weaning or daily awakening, mechanical ventilation weaning, agitation or the presence of invasive devices. Conclusion: Restraint use was high and was associated with female gender, sedation, agitation and invasive airway. It is emphasized and important to apply policies to reduce restraint use in intensive care.

scholarly journals Factors associated with changes in creatine phosphokinase (CPK) in trauma patients submitted to the “Red Wave”, with evolution to rhabdomyolysis

2018 ◽  
Vol 45 (2) ◽  
Author(s):  
MARIO PASTORE NETO ◽  
RAFAEL VALÉRIO GONÇALVES ◽  
CARLA JORGE MACHADO ◽  
VIVIAN RESENDE
Keyword(s):  
Compartment Syndrome ◽  
Blunt Trauma ◽  
Renal Injury ◽  
Creatine Phosphokinase ◽  
Statistical Significance ◽  
Thoracic Injury ◽  
Acute Renal Injury ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Prospective Longitudinal

ABSTRACT Objective: to identify and analyze factors associated with plasma creatine phosphokinase (CPK) levels in trauma victims with progression to rhabdomyolysis. Methods: we conducted a prospective, longitudinal study, with 50 patients submitted to the “Red Wave” protocol, with evolution to rhabdomyolysis after hospital admission. We studied the variables age, gender, trauma scores, mechanism and outcome, CPK at admission and final, intervals of days between laboratory evaluations, surgery and complications. We stratified CPK values in <500U/L, ≥500 - <1000 U/L, and ≥1000U/L, with calculation of the difference between the initial and final values. Results: at admission, 83% of patients (n=39) had CPK≥1000U/L, with predominance of blunt trauma and thoracic injury (p<0.05), as well as orthopedic fracture, acute renal failure and gastrointestinal bleeding, CPK being lower in those without acute renal injury, with a trend towards statistical significance. There were no differences in final CPK stratification. Factors that were independently associated with the greater CPK variation were, positively, hospitalization time greater than one week and compartment syndrome, and negatively, acute renal injury. Conclusion: the CPK level of 1000U/L remains the lower limit, with importance for early intervention in worsening conditions such as digestive hemorrhage, acute renal injury and compartment syndrome, which implied greater absolute differences between initial and final CPK, in addition to blunt trauma, thoracic injury and orthopedic fracture.

scholarly journals Dimensions of postconcussive symptoms in children with mild traumatic brain injuries

2009 ◽  
Vol 15 (1) ◽  
pp. 19-30 ◽  
Author(s):  
LAUREN K. AYR ◽  
KEITH OWEN YEATES ◽  
H. GERRY TAYLOR ◽  
MICHAEL BROWNE
Keyword(s):  
Brain Injuries ◽  
Common Factor ◽  
Traumatic Brain Injuries ◽  
Behavioral Symptoms ◽  
Parent Ratings ◽  
Prospective Longitudinal Study ◽  
Postconcussive Symptoms ◽  
Target Matrix ◽  
Mild Traumatic Brain Injuries ◽  
Prospective Longitudinal

AbstractThe dimensions of postconcussive symptoms (PCS) were examined in a prospective, longitudinal study of 186 8 to 15 year old children with mild traumatic brain injuries (TBI). Parents and children completed a 50-item questionnaire within 2 weeks of injury and again at 3 months after injury, rating the frequency of PCS on a 4-point scale. Common factor analysis with target rotation was used to rotate the ratings to four hypothesized dimensions, representing cognitive, somatic, emotional, and behavioral symptoms. The rotated factor matrix for baseline parent ratings was consistent with the target matrix. The rotated matrix for baseline child ratings was consistent with the target matrix for cognitive and somatic symptoms but not for emotional and behavioral symptoms. The rotated matrices for ratings obtained 3 months after injury were largely consistent with the target matrix derived from analyses of baseline ratings, except that parent ratings of behavioral symptoms did not cluster as before. Parent and child ratings of PCS following mild TBI yield consistent factors reflecting cognitive and somatic symptom dimensions, but dimensions of emotional and behavioral symptoms are less robust across time and raters. (JINS, 2009, 15, 19–30.)

scholarly journals Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury

2009 ◽  
Vol 16 (1) ◽  
pp. 94-105 ◽  
Author(s):  
TARYN B. FAY ◽  
KEITH OWEN YEATES ◽  
H. GERRY TAYLOR ◽  
BARBARA BANGERT ◽  
ANN DIETRICH ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Ability ◽  
Mild Traumatic Brain Injury ◽  
Hierarchical Linear Modeling ◽  
Cognitive Reserve ◽  
Mild Tbi ◽  
Prospective Longitudinal Study ◽  
Postconcussive Symptoms ◽  
Prospective Longitudinal

AbstractThe occurrence of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children may depend on cognitive reserve capacity. This prospective, longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability, which served as a proxy for cognitive reserve. Participants included 182 children with mild TBI and 99 children with orthopedic injuries (OI), ranging from 8 to 15 years of age when injured. Mild TBI were classified as complicated (n = 32) or uncomplicated (n = 150) depending on whether they were associated with trauma-related intracranial abnormalities on magnetic resonance imaging. PCS were assessed initially within 3 weeks of injury, and again at 1, 3, and 12 months post injury. The initial assessment also included standardized tests of children’s cognitive skills and retrospective parent ratings of pre-injury symptoms. Hierarchical linear modeling indicated that ratings of PCS were moderated jointly by cognitive ability and injury severity. Children of lower cognitive ability with a complicated mild TBI were especially prone to cognitive symptoms across time according to parents and to high acute levels of PCS according to children’s self-ratings. Cognitive reserve is an important moderator of the outcomes of mild TBI in children and adolescents. (JINS, 2010, 16, 94–105.)

scholarly journals PSV-1 A prospective longitudinal study of the incidence and risk factors associated with footrot in feedlot lambs in Southern Alberta

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 227-227
Author(s):  
Karen S Schwartzkopf-Genswein ◽  
Wiolene M Nordi ◽  
Désirée Gellatly ◽  
Daniela M Meléndez ◽  
Timothy D Schwinghamer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Southern Alberta ◽  
Unit Increase ◽  
Feedlot Lambs ◽  
Potential Strategy ◽  
Associated Risk Factors ◽  
Prospective Longitudinal

Abstract Lameness in sheep caused by footrot (FR) is a significant health, welfare, and economic concern worldwide. To date, no studies have documented the incidence of FR or associated risk factors in feedlot lambs in Alberta. The objectives of this study were to determine 1) FR incidence and 2) animal, managerial and environmental risk factors associated with FR in one Southern Alberta, lamb feedlot. Assessments were conducted biweekly (average of 10 pens per visit) by 2 experienced observers. A total of 73,150 lambs were assessed between October 2017 and March 2019. All lame lambs were scored according to a 3-point mobility scale (1 = mild, 2 = moderate, and 3 = severe lameness) and physically examined to diagnose the cause of lameness. Risk factors associated with FR were documented and included gender, days on feed (DOF), diet composition, and season. Multivariable regression models (SAS PROC GLIMMIX) were used to determine significant risk factors. A total of 473 lambs were identified as lame, 107 of which were diagnosed with FR (incidence of 22.6%). Footrot affected lambs had greater mobility scores (≥ 2; P &lt; 0.0001) than all other lame diagnoses. Footrot was 4.40 and 0.10 times more likely (P &lt; 0.0001) in female and wether than ram lambs, and 0.60 and 0.23 times more likely (P &lt; 0.0001) in fall and summer than winter and spring seasons. The odds of being diagnosed with FR increased for each additional DOF and each unit increase of barley in the diet (P = 0.0268), while the odds decreased (P = 0.0016) for each additional unit of supplement in the diet. Based on our findings, footrot is an issue to lambs in Alberta, and further studies are still necessary to understand the risk factors associated with potential strategy for mitigating FR in feedlot lambs.

Indicators of rearrest among male court mandated substance use treatment patients

2016 ◽  
Vol 2 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Albert M. Kopak ◽  
Steven L. Proctor ◽  
Norman G. Hoffmann
Keyword(s):  
Substance Use ◽  
Criminal Justice ◽  
Multinomial Logistic Regression ◽  
Post Treatment ◽  
Substance Use Treatment ◽  
Prospective Longitudinal Study ◽  
Content Type ◽  
Male Patients ◽  
Demographic Risk ◽  
Prospective Longitudinal

Purpose – Effective substance use treatment is a viable way to reduce criminal justice contact among drug-involved offenders, but there is still a lot to learn about which indicators have the greatest impact on treatment outcomes. The purpose of this paper is to determine which clinical indicators influenced the likelihood of rearrest among male drug-involved offenders. Design/methodology/approach – This prospective longitudinal study examined indicators of 12-month post-treatment rearrest for male criminal justice-involved substance use treatment patients. Multinomial logistic regression results drawn from a sample of 1,531 adult male patients who were mandated to substance use treatment indicated that there were different factors related to the likelihood of one as well as multiple post-treatment arrests. Findings – Demographic risk factors, such as age and unemployment, were associated with significant increases in the probability of experiencing an arrest within 12-months of treatment discharge. Substance use relapse was also a significant indicator of the likelihood of rearrest and contributed to an increase in the odds of one post-treatment rearrest as well as multiple rearrests. A drug dependence diagnosis, relative to a diagnosis for alcohol dependence, was associated with an increased likelihood of rearrest. Participation in outpatient treatment was associated with a lower likelihood of rearrest. Practical implications – These findings emphasize the need for treatment providers to concentrate heavily on demographic risk reduction to minimize the chance that male patients are rearrested after treatment. Relapse prevention, on the other hand, is critical in the effort to minimize the number of post-treatment rearrests in this population. Originality/value – The results from this study provide evidence to empirically support the refinement of substance treatment programs for male patients involved in the criminal justice system.

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