Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED.

PubMed

Zemek, Roger; Barrowman, Nick; Freedman, Stephen B; Gravel, Jocelyn; Gagnon, Isabelle; McGahern, Candice; Aglipay, Mary; Sangha, Gurinder; Boutis, Kathy; Beer, Darcy; Craig, William; Burns, Emma; Farion, Ken J; Mikrogianakis, Angelo; Barlow, Karen; Dubrovsky, Alexander S; Meeuwisse, Willem; Gioia, Gerard; Meehan, William P; Beauchamp, Miriam H; Kamil, Yael; Grool, Anne M; Hoshizaki, Blaine; Anderson, Peter; Brooks, Brian L; Yeates, Keith Owen; Vassilyadi, Michael; Klassen, Terry; Keightley, Michelle; Richer, Lawrence; DeMatteo, Carol; Osmond, Martin H

2016-03-08

Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n = 2006 in the derivation cohort; n = 1057 in the validation cohort) and 2584 of whom (n = 1701 [85%] in the derivation cohort; n = 883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n = 510 [30.0%] in the derivation cohort and n = 291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache

Chronic Hypopituitarism Associated with Increased Postconcussive Symptoms Is Prevalent after Blast-Induced Mild Traumatic Brain Injury

PubMed Central

Undurti, Arundhati; Colasurdo, Elizabeth A.; Sikkema, Carl L.; Schultz, Jaclyn S.; Peskind, Elaine R.; Pagulayan, Kathleen F.; Wilkinson, Charles W.

2018-01-01

The most frequent injury sustained by US service members deployed to Iraq or Afghanistan is mild traumatic brain injuries (mTBI), or concussion, by far most often caused by blast waves from improvised explosive devices or other explosive ordnance. TBI from all causes gives rise to chronic neuroendocrine disorders with an estimated prevalence of 25–50%. The current study expands upon our earlier finding that chronic pituitary gland dysfunction occurs with a similarly high frequency after blast-related concussions. We measured circulating hormone levels and accessed demographic and testing data from two groups of male veterans with hazardous duty experience in Iraq or Afghanistan. Veterans in the mTBI group had experienced one or more blast-related concussion. Members of the deployment control (DC) group encountered similar deployment conditions but had no history of blast-related mTBI. 12 of 39 (31%) of the mTBI participants and 3 of 20 (15%) veterans in the DC group screened positive for one or more neuroendocrine disorders. Positive screens for growth hormone deficiency occurred most often. Analysis of responses on self-report questionnaires revealed main effects of both mTBI and hypopituitarism on postconcussive and posttraumatic stress disorder (PTSD) symptoms. Symptoms associated with pituitary dysfunction overlap considerably with those of PTSD. They include cognitive deficiencies, mood and anxiety disorders, sleep problems, diminished quality of life, deleterious changes in metabolism and body composition, and increased cardiovascular mortality. When such symptoms are due to hypopituitarism, they may be alleviated by hormone replacement. These findings suggest consideration of routine post-deployment neuroendocrine screening of service members and veterans who have experienced blast-related mTBI and are reporting postconcussive symptoms. PMID:29515515

Post-concussion symptoms in mild traumatic brain injury: findings from a paediatric outpatient clinic.

PubMed

Dillard, Charles; Ditchman, Nicole; Nersessova, Karine; Foster, Nicola; Wehman, Paul; West, Michael; Riedlinger, Brendalin; Monasterio, Eugenio; Shaw, Bill; Neblett, Julie

2017-03-01

Purpose Mild traumatic brain injury (mTBI) is common among children and is associated with a range of symptomatology and clinical presentations. This study uses data from a paediatric outpatient TBI clinic to (1) investigate characteristics associated with more severe post-concussive symptoms and (2) examine differences in the proportion of individuals endorsing specific post-concussion symptoms based on group (e.g., sex, type of injury, and psychiatric history). Methods Data from the Children's Hospital of Richmond's TBI outpatient programme were analysed (N = 157). Results Gender and sports injury were associated with severity of symptoms. In addition, females endorsed a greater number of overall symptoms than males. A number of specific symptoms were found to be endorsed to a greater extent based on psychiatric history and type of injury; however, overall total number of symptoms endorsed did not differ based on these characteristics. Conclusions Findings from this study provide further evidence that mTBI affects a wide range of youth and that associated symptomatology can indeed be varied. Moreover, results revealed differences in endorsement of specific symptoms and symptom severity based on patient and injury characteristics which have implications for concussion assessment and treatment. Implications for Rehabilitation Symptoms following mild traumatic brain injury (mTBI) in children and adolescents can have varied presentation, ranging from minimal to severe. Females and those with non-sports-related injuries are more likely to endorse greater symptoms following concussion. Symptom evaluation is an essential component of the concussion assessment and treatment of paediatric patients following mTBI, and clinicians should be aware of patient characteristics associated with increased symptoms, especially when baseline symptom data are not available.

Evaluating the test-retest reliability of symptom indices associated with the ImPACT post-concussion symptom scale (PCSS).

PubMed

Merritt, Victoria C; Bradson, Megan L; Meyer, Jessica E; Arnett, Peter A

2018-05-01

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a commonly used tool in sports concussion assessment. While test-retest reliabilities have been established for the ImPACT cognitive composites, few studies have evaluated the psychometric properties of the ImPACT's Post-Concussion Symptom Scale (PCSS). The purpose of this study was to establish the test-retest reliability of symptom indices associated with the PCSS. Participants included 38 undergraduate students (50.0% male) who underwent neuropsychological testing as part of their participation in their psychology department's research subject pool. The majority of the participants were Caucasian (94.7%) and had no history of concussion (73.7%). All participants completed the ImPACT at two time points, approximately 6 weeks apart. The PCSS was the main outcome measure, and eight symptom indices were calculated (a total symptom score, three symptom summary indices, and four symptom clusters). Pearson correlations (r) and intraclass correlation coefficients (ICCs) were computed as measures of test-retest reliability. Overall, reliabilities ranged from low to high (r = .44 to .80; ICC = .44 to .77). The cognitive symptom cluster exhibited the highest test-retest reliability (r = .80, ICC = .77), followed by the positive symptom total (PST) index, an indicator of the total number of symptoms endorsed (r = .71, ICC = .69). In contrast, the commonly used total symptom score showed lower test-retest reliability (r = .67, ICC = .62). Paired-samples t tests revealed no significant differences between test and retest for any of the symptom variables (all p > .01). Finally, reliable change indices (RCI) were computed to determine whether differences observed between test and retest represented clinically significant change. RCI values were provided for each symptom index at the 80%, 90%, and 95% confidence intervals. These results suggest that evaluating additional symptom

Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial.

PubMed

Weaver, Lindell K; Wilson, Steffanie H; Lindblad, Anne S; Churchill, Susan; Deru, Kayla; Price, Robert C; Williams, Chris S; Orrison, William W; Walker, James M; Meehan, Anna; Mirow, Susan

2018-01-01

In prior military randomized trials, participants with persistent symptoms after mild traumatic brain injury (TBI) reported improvement regardless of receiving hyperbaric oxygen (HBO₂) or sham intervention. This study's objectives were to identify outcomes for future efficacy trials and describe changes by intervention. This Phase II, randomized, double-blind, sham-controlled trial enrolled military personnel with mild TBI and persistent post-concussive symptoms. Participants were randomized to receive 40 HBO₂ (1.5 atmospheres absolute (ATA), ⟩99% oxygen, 60 minutes) or sham chamber sessions (1.2 ATA, room air, 60 minutes) over 12 weeks. Participants and evaluators were blinded to allocation. Outcomes assessed at baseline, 13 weeks and six months included symptoms, quality of life, neuropsychological, neurological, electroencephalography, sleep, auditory, vestibular, autonomic, visual, neuroimaging, and laboratory testing. Participants completed 12-month questionnaires. Intention-to-treat results are reported. From 9/11/2012 to 5/19/2014, 71 randomized participants received HBO₂ (n=36) or sham (n=35). At baseline, 35 participants (49%) met post-traumatic stress disorder (PTSD) criteria. By the Neurobehavioral Symptom Inventory, the HBO₂ group had improved 13-week scores (mean change -3.6 points, P=0.03) compared to sham (+3.9 points). In participants with PTSD, change with HBO₂ was more pronounced (-8.6 vs. +4.8 points with sham, P=0.02). PTSD symptoms also improved in the HBO₂ group, and more so in the subgroup with PTSD. Improvements regressed at six and 12 months. Hyperbaric oxygen improved some cognitive processing speed and sleep measures. Participants with PTSD receiving HBO₂ had improved functional balance and reduced vestibular complaints at 13 weeks. By 13 weeks, HBO₂ improved post-concussive and PTSD symptoms, cognitive processing speed, sleep quality, and balance function, most dramatically in those with PTSD. Changes did not persist

Postconcussive symptoms (PCS) following combat-related traumatic brain injury (TBI) in Veterans with posttraumatic stress disorder (PTSD): Influence of TBI, PTSD, and depression on symptoms measured by the Neurobehavioral Symptom Inventory (NSI).

PubMed

Porter, Katherine E; Stein, Murray B; Martis, Brian; Avallone, Kimberly M; McSweeney, Lauren B; Smith, Erin R; Simon, Naomi M; Gargan, Sean; Liberzon, Israel; Hoge, Charles W; Rauch, Sheila A M

2018-07-01

Mild traumatic brain injury (mTBI) is commonly reported in recent combat Veterans. While the majority resolve, some Veterans develop postconcussive symptoms (PCS). Previous research suggests these symptoms are not specific to head injury and are often associated with psychiatric symptoms. The current study examines the relative contributions of posttraumatic stress, depressive symptoms, and TBI on postconcussive symptoms, and explores whether the relationship remains after controlling for symptom overlap. Two hundred eighteen combat Veterans from Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) provided the data for this study as part of a baseline evaluation for inclusion into larger treatment study for posttraumatic stress disorder (PTSD). Participants completed the Brief Traumatic Brain Injury Screen (BTBIS), Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Stressor Version (PCL-S), Beck Depression Inventory-II (BDI-II). Significant differences in NSI total score between individuals with and without history of TBI were not found. A series of regression analyses demonstrated that Depression and PTSD were significant predictors of NSI score even after removal of NSI symptoms that overlap with PTSD or depression. TBI status was also a significant predictor of PCS in most models, but its relative contribution was much smaller than that of depression and PTSD. Within PTSD symptoms, hyperarousal cluster was a significant predictor of NSI scores. Findings demonstrate that depression and PTSD are related to PCS beyond similarities in construct. Further, within a primarily PTSD treatment-seeking population, these psychiatric symptoms appear to be a stronger contributor than TBI. Copyright © 2018. Published by Elsevier Ltd.

Can Post mTBI Neurological Soft Signs Predict Postconcussive and PTSD Symptoms: A Pilot Study

DTIC Science & Technology

2013-06-01

BC-PSI, and MPAI -4 at Day 90). Early depressive mood was highly predictive of later post-concussive symptoms and functional incapacity (Appendix C...BDI-II at Day 4 correlated with RPG, BC-PSI, and MPAI -4, at Day 90). Depressive mood also improved over time: F(2,28)=5.6, pɘ.009. Results

Dimensions of postconcussive symptoms in children with mild traumatic brain injuries.

PubMed

Ayr, Lauren K; Yeates, Keith Owen; Taylor, H Gerry; Browne, Michael

2009-01-01

The 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.).

Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers.

PubMed

Dretsch, Michael N; Silverberg, Noah D; Iverson, Grant L

2015-09-01

The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs(®)) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.

The Impact of Multiple Concussions on Emotional Distress, Post-Concussive Symptoms, and Neurocognitive Functioning in Active Duty United States Marines Independent of Combat Exposure or Emotional Distress

PubMed Central

Lathan, Corinna E.; Bleiberg, Joseph; Tsao, Jack W.

2014-01-01

Abstract Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is because of the effects of brain trauma or purely to emotional factors such as post-traumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobehavioral Assessment, a clinical decision support tool, was used to assess neurobehavioral functioning in 646 United States Marines, all of whom were fit for duty. Marines were assessed for concussion history, post-concussive symptoms, emotional distress, neurocognitive functioning, and deployment history. Results showed that a recent concussion or ever having experienced a concussion was associated with an increase in emotional distress, but not with persistent post-concussive symptoms (PPCS) or neurocognitive functioning. Having had multiple lifetime concussions, however, was associated with greater emotional distress, PPCS, and reduced neurocognitive functioning that needs attention and rapid discrimination, but not for memory-based tasks. These results are independent of deployment history, combat exposure, and symptoms of post-traumatic stress disorder and depression. Results supported earlier findings that a previous concussion is not generally associated with post-concussive symptoms independent of covariates. In contrast with other studies that failed to find a unique contribution for concussion to PPCS, however, evidence of recent and multiple concussion was seen across a range of emotional distress, post-concussive symptoms, and neurocognitive functioning in this study population. Results are discussed in terms of implications for assessing concussion on return from combat. PMID:25003552

Can Post mTBI Neurological Soft Signs Predict Postconcussive and PTSD Symptoms : A Pilot Study

DTIC Science & Technology

2014-02-01

disorders , including post - traumatic stress disorder ( PTSD ), but they have scarcely been studied in TBI. The present study measured NSS in the...including post - traumatic stress disorder ( PTSD ), but they have scarcely been studied in TBI. The present study measured NSS in the acute aftermath of...Can Post mTBI Neurological Soft Signs Predict Postconcussive and PTSD Symptoms?: A Pilot Study 5a. CONTRACT NUMBER E-Mail:

Differences in Symptom Reporting Between Males and Females at Baseline and After a Sports-Related Concussion: A Systematic Review and Meta-Analysis.

PubMed

Brown, Dana A; Elsass, Julie A; Miller, Ashley J; Reed, Lauren E; Reneker, Jennifer C

2015-07-01

Concussion literature and treatment guidelines are inconclusive regarding the role of sex in symptom reporting at baseline and post-concussion. Although empirical evidence is lacking, it is generally regarded that females have a more severe symptomatic presentation than males at all time-points on the concussion spectrum. Our objective was to determine whether differences exist between males and females at baseline (pre-season/before concussion) or post-concussion for self-reported (1) prevalence of individual symptoms and (2) total symptom scores in high school and college athletes. Systematic review and meta-analysis of observational cohort studies; level of evidence, 1. A computerized search of the PubMed, SPORTDiscus, CINAHL, and Scopus databases was performed. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Criteria for inclusion were (1) self-report of symptoms at any time within the concussion spectrum, including baseline and after concussion, (2) study sample included high school and/or collegiate athletes aged 12-26 years, (3) concussions occurred during participation in sport, and (4) symptom reporting was separated by sex. The Quality Assessment Tool for Cohort Studies, Q-Coh, was utilized for quality assessment. Twenty-one studies met the criteria for inclusion: seventeen had good quality and four, acceptable quality. At baseline, females had significantly higher odds than males of reporting the individual symptoms of vision/hearing problems, headache/migraine, difficulty concentrating, energy/sleep disturbances, and emotional disturbances. Post-concussion, only one symptom demonstrated significant differences between males and females, with females demonstrating lower odds of reporting confusion than males. Statistically, at baseline and post-concussion, females had significantly higher total symptom scores on the Post-Concussion Scale (PCS) and the Sport Concussion Assessment Tool 2 (SCAT2), but when the

A Preliminary Study of the Effectiveness of an Allostatic, Closed-Loop, Acoustic Stimulation Neurotechnology in the Treatment of Athletes with Persisting Post-concussion Symptoms.

PubMed

Tegeler, Charles H; Tegeler, Catherine L; Cook, Jared F; Lee, Sung W; Gerdes, Lee; Shaltout, Hossam A; Miles, Christopher M; Simpson, Sean L

2016-12-01

Effective interventions are needed for individuals with persisting post-concussion symptoms. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is an allostatic, closed-loop, acoustic stimulation neurotechnology, designed to facilitate relaxation and self-optimization of neural oscillations. Fifteen athletes (seven females, mean age 18.1 years, SD 2.6) with persisting post-concussion symptoms received 18.7 (SD 6.0) HIRREM sessions over a mean of 29.6 (SD 23.2) days, including 11.3 (SD 4.6) in office days. Pre- and post-HIRREM measures included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ, n = 12), the Insomnia Severity Index (ISI, n = 15), the Center for Epidemiologic Studies Depression Scale (CES-D, n = 10), short-term blood pressure and heart rate recordings for measures of autonomic cardiovascular regulation (n = 15), and reaction time by the drop-stick method (n = 7). All participants were asked about their physical activity level and sports participation status at their post-HIRREM data collection visit and 1 to 3 months afterward. At the post-HIRREM visit, subjects reported improvements in all three inventories (RPQ mean change 19.7, SD 11.4, Wilcoxon p = 0.001; ISI mean change -4.1, SD 4.1, Wilcoxon p = 0.003; CES-D mean change -12.0, SD 10.0, Wilcoxon p = 0.004), including statistically significant reductions in 14 of the 16 individual items of the RPQ. There were also statistically significant improvements in baroreflex sensitivity, heart rate variability in the time domain (SDNN), and drop-stick reaction testing (baseline mean distance of 23.8 cm, SD 5.6, decreased to 19.8 cm, SD 4.6, Wilcoxon p = 0.016). Within 3 months of the post-HIRREM data collection, all 15 had returned to full exercise and workouts, and ten had returned to full participation in their athletic activity. The use of HIRREM by a series of athletes with persisting post-concussion symptoms was

Is State Anxiety, Trait Anxiety, or Anxiety Sensitivity a Clinical Predictor of Symptoms in Those Presenting With Mild Traumatic Brain Injury or Concussion?

PubMed

Hixson, Krista M; Allen, Alex N; Williams, Andrew S; McLeod, Tamara C Valovich

2017-11-01

Clinical Scenario: Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms. Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion? Summary of Key Findings: A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development. Clinical Bottom Line: There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion. Strength of Recommendation: There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion

Premorbid IQ Predicts Postconcussive Symptoms in OEF/OIF/OND Veterans with mTBI.

PubMed

Stewart-Willis, Jada J; Heyanka, Daniel; Proctor-Weber, Zoe; England, Heather; Bruhns, Maya

2018-03-01

Extant literature has demonstrated that symptoms of postconcussive syndrome (PCS) persist well beyond the expected 3-month post-injury recovery period in a minority of individuals with mild traumatic brain injury (mTBI). Suboptimal performance on validity measures and pre- and post-injury psychosocial stressors - rather than actual mTBI or current cognitive functioning - have been identified as predictors of chronic PCS. Whether premorbid IQ has any influence on chronic PCS has been understudied, in the context of established psychogenic etiologies. The sample included 31 veterans, who underwent mTBI neuropsychological evaluations six or more months post-injury in a VA outpatient neuropsychology clinic. A two-step multiple linear regression was conducted to examine the effects on the outcome variable, PCS (Neurobehavioral Symptom Inventory), of the following predictors: cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status; Attention, Immediate Memory, and Delayed Memory Indices), performance validity, depression (Beck Depression Inventory-Second Edition), posttraumatic stress disorder (PTSD Checklist, Civilian Version), quality of sleep (Pittsburgh Sleep Quality Index), pain (Brief Pain Inventory), education, and Premorbid IQ (Wechsler Test of Adult Reading). The overall regression model containing all nine predictor variables was statistically significant. Depression (p < .05) and premorbid IQ (p < .05) were the most salient predictors of chronic PCS; in that lower premorbid IQ and greater endorsed symptoms of depression were associated with higher PCS scores. In Step 2 of the multiple linear regression, the WTAR explained an additional 6.7% of the variance in PCS after controlling for psychosocial stressors and current cognitive ability. The findings support premorbid IQ as a unique and relevant predictor of chronic PCS, with significance variance accounted for beyond education, cognitive functioning, and psychosocial

Self-reported balance status is not a reliable indicator of balance performance in adolescents at one-month post-concussion.

PubMed

Rochefort, Coralie; Walters-Stewart, Coren; Aglipay, Mary; Barrowman, Nick; Zemek, Roger; Sveistrup, Heidi

2017-11-01

To determine if self-reported balance symptoms can be used as a proxy for measures of the center of pressure (COP) to identify balance deficits in a group of concussed adolescents. Case-control. Thirteen adolescents 1-month post-concussion who reported ongoing balance problems (Balance+), 20 adolescent 1-month post-concussion who reported no balance problems (Balance-), and 30 non-injured adolescents (control) completed a series of balance tests. Participants completed two 2-min trials standing on a Nintendo Wii Balance Board™ during which the COP under their feet was recorded: i) double-leg stance, eyes open; ii) double-leg stance, eyes closed. Participants also completed a dual-task condition combining a double-leg stance and a Stroop Colour-word test. Participants in both the Balance+ and Balance- group swayed over a larger ellipse area compared to the control group while completing the Eyes Closed (Balance+, p=0.002; Balance-, p=0.002) and Dual-Task (Balance+, p=0.001; Balance-, p=0.004) conditions and performed the Dual-Task condition with faster medio-lateral velocity (Balance+, p=0.003; Balance-, p=0.009). The participants in the Balance- group also swayed over a larger ellipse area compared to the control group while completing the Eyes Open condition (p=0.005). No significant differences were identified between the Balance+ and Balance- groups. At 1-month post-concussion, adolescents demonstrated balance deficits compared to non-injured adolescents regardless of whether they reported balance problems. These results suggest that self-reported balance status might not be an accurate reflection of balance performance following a concussion in adolescents. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Physical Activity and Intermittent Postconcussion Symptoms After a Period of Symptom-Limited Physical and Cognitive Rest.

PubMed

Sawyer, Quinton; Vesci, Brian; McLeod, Tamara C Valovich

2016-09-01

using the data provided in the original study, even if not presented in the original study); and relevant comments. The search revealed 749 articles evaluating the effects of rest and 1175 articles evaluating the effects of treatment. Of the 749 articles evaluating the effects of rest, only 2 met all the inclusion criteria. Of the 1175 articles evaluating the effects of treatment, only 10 met all the inclusion criteria. Ultimately, the authors were able to identify additional treatment articles that met the inclusion criteria, for a total of 12. The nature of the treatments and the participants differed enough that meta-analysis was not possible.  One of the 2 articles that evaluated rest was a retrospective analysis of athletes that showed those who were prescribed a period of cognitive rest had a longer duration of symptoms. The other study followed athletes postconcussion who were retrospectively assigned to groups based on self-reported activity level after injury. Those who reported moderate levels of cognitive and physical exertion over the first month postinjury appeared to demonstrate improved outcomes compared with those who pursued small or large amounts of activity.  Twelve studies evaluated the effects of treatment on symptoms after sport-related concussion. Various interventions were reviewed, including pharmacotherapy, light aerobic activity, graded exercise treadmill test, hyperbaric oxygen therapy, vestibular physiotherapy, and cervical spine manual therapy. Unfortunately, the authors did not report effect sizes for specific interventions, and due to the varied nature of each study and its respective treatment approach, no pooled data could be analyzed. However, a group of adolescents treated with submaximal aerobic and coordination exercises, visualization, and imagery returned to full normal physical activity at a mean duration of 4.4 weeks (95% confidence interval = 3.1, 5.7 weeks). Furthermore, a randomized controlled trial of patients

Association of symptoms following mild traumatic brain injury with posttraumatic stress disorder vs. postconcussion syndrome.

PubMed

Lagarde, Emmanuel; Salmi, Louis-Rachid; Holm, Lena W; Contrand, Benjamin; Masson, Françoise; Ribéreau-Gayon, Régis; Laborey, Magali; Cassidy, J David

2014-09-01

A proportion of patients experience long-lasting symptoms following mild traumatic brain injury (MTBI). The postconcussion syndrome (PCS), included in the DSM-IV, has been proposed to describe this condition. Because these symptoms are subjective and common to other conditions, there is controversy whether PCS deserves to be identified as a diagnostic syndrome. To assess whether persistent symptoms 3 months following head injury are specific to MTBI or whether they are better described as part of posttraumatic stress disorder (PTSD). We conducted a prospective cohort study of injured patients recruited at the adult emergency department of the University Hospital of Bordeaux from December 4, 2007, to February 25, 2009. At 3-month follow-up, we compared the prevalence and risk factors for PCS and PTSD. Multiple correspondence analyses were used to assess clustering of symptoms and their associations with the type of injury. We included 534 patients with head injury and 827 control patients with other nonhead injuries. Three months following the trauma, 21.2% of head-injured and 16.3% of nonhead-injured patients fulfilled the DSM-IV diagnosis of PCS; 8.8% of head-injured patients fulfilled the diagnostic criteria for PTSD compared with 2.2% of control patients. In multivariate analysis, MTBI was a predictor of PTSD (odds ratio, 4.47; 95% CI, 2.38-8.40) but not of PCS (odds ratio, 1.13; 95% CI, 0.82-1.55). Correspondence analysis suggested that symptoms considered part of PCS behave similarly to PTSD symptoms in the hyperarousal dimension. None of these 22 symptoms showed any pattern of clustering, and no clear proximity with head or nonhead injury status could be found. Persistent subjective symptoms frequently reported 3 months after MTBI are not specific enough to be identified as a unique PCS and should be considered part of the hyperarousal dimension of PTSD.

Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial.

PubMed

Miller, R Scott; Weaver, Lindell K; Bahraini, Nazanin; Churchill, Susan; Price, Robert C; Skiba, Virginia; Caviness, James; Mooney, Scott; Hetzell, Brian; Liu, Jun; Deru, Kayla; Ricciardi, Richard; Fracisco, Susan; Close, Nicole C; Surrett, Gerald W; Bartos, Corinna; Ryan, Margaret; Brenner, Lisa A

2015-01-01

Improvement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date. To compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure. Multicenter, double-blind, sham-controlled clinical trial of 72 military service members with ongoing symptoms at least 4 months after mild traumatic brain injury enrolled at military hospitals in Colorado, North Carolina, California, and Georgia between April 26, 2011, and August 24, 2012. Assessments occurred before randomization, at the midpoint, and within 1 month after completing the interventions. Routine PCS care was provided in specialized clinics. In addition, participants were randomized 1:1:1 to 40 HBO sessions administered at 1.5 atmospheres absolute (ATA), 40 sham sessions consisting of room air at 1.2 ATA, or no supplemental chamber procedures. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) served as the primary outcome measure. A change score of at least 2 points on the RPQ-3 subscale (range, 0-12) was defined as clinically significant. Change scores from baseline were calculated for the RPQ-3 and for the total RPQ. Secondary measures included additional patient-reported outcomes and automated neuropsychometric testing. On average, participants had sustained 3 lifetime mild traumatic brain injuries; the most recent occurred 23 months before enrollment. No differences were observed between groups for improvement of at least 2 points on the RPQ-3 subscale (25% in the no intervention group, 52% in the HBO group, and 33% in the sham group; P = .24). Compared with the no intervention group (mean change score, 0.5; 95% CI, -4.8 to 5.8; P = .91), both groups undergoing supplemental chamber procedures showed improvement in symptoms

Neural Control of Posture in Individuals with Persisting Postconcussion Symptoms.

PubMed

Helmich, Ingo; Berger, Alisa; Lausberg, Hedda

2016-12-01

Postural instability has been shown to characterize individuals who suffered from long-term symptoms after mild traumatic brain injury. However, recordings of neural processes during postural control are difficult to realize with standard neuroimaging techniques. Thus, we used functional nearinfrared spectroscopy to investigate brain oxygenation of individuals with persistent postconcussion symptoms (pPCS) during postural control in altered environments. We compared brain oxygenation and postural sway during balance control in three groups: individuals suffering from pPCS, individuals with a history of mild traumatic brain injury but without pPCS, and healthy controls. Individuals were investigated during postural control tasks with six different conditions: i) eyes opened, ii) eyes closed, and iii) blurred visual input, each while standing a) on a stable and b) an unstable surface. In all groups, during the eyes closed/unstable surface condition as compared with the other conditions, the postural sway increased as well as the brain oxygenation in frontal brain cortices. In the most difficult balance condition, as compared with the other two groups, subjects with pPCS applied more force over time to keep balance as measured by the force plate system with a significantly greater activation in frontopolar/orbitofrontal areas of the right hemisphere. As subjects with pPCS applied more force over time to control balance, we propose that with regard to cognitive processes, the increase of cerebral activation in these individuals indicates an increase of attention-demanding processes during postural control in altered environments.

Relationship of Attention Deficit Hyperactivity Disorder and Postconcussion Recovery in Youth Athletes.

PubMed

Mautner, Kenneth; Sussman, Walter I; Axtman, Matthew; Al-Farsi, Yahya; Al-Adawi, Samir

2015-07-01

To investigate whether attention deficit hyperactivity disorder (ADHD) influences postconcussion recovery, as measured by computerized neurocognitive testing. This is a retrospective case control study. Computer laboratories across 10 high schools in the greater Atlanta, Georgia area. Immediate postconcussion assessment and cognitive testing (ImPACT) scores of 70 athletes with a self-reported diagnosis of ADHD and who sustained a sport-related concussion were compared with a randomly selected age-matched control group. Immediate postconcussion assessment and cognitive testing scores over a 5-year interval were reviewed for inclusion. Postconcussion recovery was defined as a return to equivalent baseline neurocognitive score on the ImPACT battery, and a concussion symptom score of ≤7. Athletes with ADHD had on average a longer time to recovery when compared with the control group (16.5 days compared with 13.5 days), although not statistically significant. The number of previous concussions did not have any effect on the rate of recovery in the ADHD or the control group. In addition, baseline neurocognitive testing did not statistically differ between the 2 groups, except in verbal memory. Although not statistically significant, youth athletes with ADHD took on average 3 days longer to return to baseline neurocognitive testing compared with a control group without ADHD. Youth athletes with ADHD may have a marginally prolonged recovery as indexed by neurocognitive testing and should be considered when prognosticating time to recovery in this subset of student athletes.

[Mild traumatic brain injury and postconcussive syndrome: a re-emergent questioning].

PubMed

Auxéméry, Y

2012-09-01

explorations. The origin of these symptoms questions their organic and psychological aetiologies, which are potentially associated or intricately linked. After a cerebral concussion patients report a cluster of symptoms referred to as postconcussive. Post-concussion syndrome lies within the confines of somatic symptoms (headaches, dizziness, and fatigue), cognitive symptoms (memory and concentration problems) and affective symptoms (irritability, emotional lability, depression, anxiety, trouble sleeping). The nosographical entity of post-concussion syndrome is still in the process of elaboration following the input of new research intended to determine a cluster of specific symptoms. The persistent post-concussion syndrome is believed to be due to the psychological effects of the injury, biological factors, or a combination of both. Considered in isolation, the symptoms of post-concussion syndrome are non-specific and come together with other diagnostic frameworks such as characterised depressive episodes and post-traumatic stress. Post-concussion syndrome is not specific to concussion but can be present in subjects without any previous cranial trauma. Blast trauma can thus be understood as experiencing a shockwave on the brain and as a psycho-traumatic event. The major methodological problem of the studies is the quantification of the functional symptoms present in different nosographical frameworks, which are often co-morbid. Post-traumatic stress disorder is one of several psychiatric disorders that may increase suffering and disability among people with mild traumatic brain injury; in addition mood disorders also seem to be frequent psychiatric complications among these patients. Psychotic disorders after TBI have been associated with several brain regions. The establishment of a causative relationship between TBI and psychiatric disorders is interesting in terms of our understanding of these possible sequelae of TBI. The grey substance of the grey nuclei of the base can

Cascade of Traumatic Brain Injury: A Correlational Study of Cognition, Postconcussion Symptoms, and Quality of Life.

PubMed

Reddy, Rajakumari Pampa; Rajeswaran, Jamuna; Devi, B Indira; Kandavel, Thennarasu

2017-01-01

Traumatic brain injury (TBI) constitutes a significant burden on health care resources in India. TBI is a dynamic process which involves damage to the brain thus leading to behavior cognitive and emotional consequences. To study the cognitive profile, post-concussion symptoms (PCS), quality of life (QOL), and their correlation. A total of 60 patients with TBI were recruited and assessed for neuropsychological profile, PCS, and QOL, the correlation among the variables were analyzed. The results suggest that TBI has series of consequences which is interrelated, and the study has implications for rehabilitation of TBI. The study highlights the deficits of cognition, and its correlation with PCS and QOL, emphasizing integrated rehabilitation approach for patients with TBI.

Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion.

PubMed

Nelson, Lindsay D; Tarima, Sergey; LaRoche, Ashley A; Hammeke, Thomas A; Barr, William B; Guskiewicz, Kevin; Randolph, Christopher; McCrea, Michael A

2016-05-17

To determine the degree to which preinjury and acute postinjury psychosocial and injury-related variables predict symptom duration following sport-related concussion. A total of 2,055 high school and collegiate athletes completed preseason evaluations. Concussed athletes (n = 127) repeated assessments serially (<24 hours and days 8, 15, and 45) postinjury. Cox proportional hazard modeling was used to predict concussive symptom duration (in days). Predictors considered included demographic and history variables; baseline psychological, neurocognitive, and balance functioning; acute injury characteristics; and postinjury clinical measures. Preinjury somatic symptom score (Brief Symptom Inventory-18 somatization scale) was the strongest premorbid predictor of symptom duration. Acute (24-hour) postconcussive symptom burden (Sport Concussion Assessment Tool-3 symptom severity) was the best injury-related predictor of recovery. These 2 predictors were moderately correlated (r = 0.51). Path analyses indicated that the relationship between preinjury somatization symptoms and symptom recovery was mediated by postinjury concussive symptoms. Preinjury somatization symptoms contribute to reported postconcussive symptom recovery via their influence on acute postconcussive symptoms. The findings highlight the relevance of premorbid psychological factors in postconcussive recovery, even in a healthy athlete sample relatively free of psychopathology or medical comorbidities. Future research should elucidate the neurobiopsychosocial mechanisms that explain the role of this individual difference variable in outcome following concussive injury. © 2016 American Academy of Neurology.

Reduced Functional Connectivity in Adults with Persistent Post-Concussion Symptoms: A Functional Near-Infrared Spectroscopy Study

PubMed Central

Hocke, Lia M.; Duszynski, Chris C.; Debert, Chantel T.; Dleikan, Diane

2018-01-01

Abstract Concussion, or mild traumatic brain injury (mTBI), accounts for ∼80% of all TBIs across North America. The majority of mTBI patients recover within days to weeks; however, 14–36% of the time, acute mTBI symptoms persist for months or even years and develop into persistent post-concussion symptoms (PPCS). There is a need to find biomarkers in patients with PPCS, to improve prognostic ability and to provide insight into the pathophysiology underlying chronic symptoms. Recent research has pointed toward impaired network integrity and cortical communication as a biomarker. In this study we investigated functional near-infrared spectroscopy (fNIRS) as a technique to assess cortical communication deficits in adults with PPCS. Specifically, we aimed to identify cortical communication patterns in prefrontal and motor areas during rest and task, in adult patients with persistent symptoms. We found that (1) the PPCS group showed reduced connectivity compared with healthy controls, (2) increased symptom severity correlated with reduced coherence, and (3) connectivity differences were best distinguishable during task and in particular during the working memory task (n-back task) in the right and left dorsolateral prefrontal cortex (DLPFC). These data show that reduced brain communication may be associated with the pathophysiology of mTBI and that fNIRS, with a relatively simple acquisition paradigm, may provide a useful biomarker of this injury. PMID:29373947

Decreased Number of Self-Paced Saccades in Post-Concussion Syndrome Associated with Higher Symptom Burden and Reduced White Matter Integrity.

PubMed

Taghdiri, Foad; Chung, Jonathan; Irwin, Samantha; Multani, Namita; Tarazi, Apameh; Ebraheem, Ahmed; Khodadadi, Mozghan; Goswami, Ruma; Wennberg, Richard; Mikulis, David; Green, Robin; Davis, Karen; Tator, Charles; Eizenman, Moshe; Tartaglia, Maria Carmela

2018-03-01

The aim of this study was to examine the potential utility of a self-paced saccadic eye movement as a marker of post-concussion syndrome (PCS) and monitoring the recovery from PCS. Fifty-nine persistently symptomatic participants with at least two concussions performed the self-paced saccade (SPS) task. We evaluated the relationships between the number of SPSs and 1) number of self-reported concussion symptoms, and 2) integrity of major white matter (WM) tracts (as measured by fractional anisotropy [FA] and mean diffusivity) that are directly or indirectly involved in saccadic eye movements and often affected by concussion. These tracts included the uncinate fasciculus (UF), cingulum (Cg) and its three subcomponents (subgenual, retrosplenial, and parahippocampal), superior longitudinal fasciculus, and corpus callosum. Mediation analyses were carried out to examine whether specific WM tracts (left UF and left subgenual Cg) mediated the relationship between the number of SPSs and 1) interval from last concussion or 2) total number of self-reported symptoms. The number of SPSs was negatively correlated with the total number of self-reported symptoms (r = -0.419, p = 0.026). The number of SPSs were positively correlated with FA of left UF and left Cg (r = 0.421, p = 0.013 and r = 0.452, p = 0.008; respectively). FA of the subgenual subcomponent of the left Cg partially mediated the relationship between the total number of symptoms and the number of SPSs, while FA of the left UF mediated the relationship between interval from last concussion and the number of SPSs. In conclusion, SPS testing as a fast and objective assessment may reflect symptom burden in patients with PCS. In addition, since the number of SPSs is associated with the integrity of some WM tracts, it may be useful as a diagnostic biomarker in patients with PCS.

Somatization in Post-Concussion Syndrome: A Retrospective Study

PubMed Central

Gibaldi, James C

2016-01-01

This is a retrospective study of concussion patient data conducted to analyze the prevalence of somatization in patients presenting with post-concussion symptoms. Patient records from June 2010 to December 2015 were examined for concussion history, psychosocial history, neuropsychological test results, validity scores, and a symptom severity scale. Records meeting inclusion criteria from 33 males and 27 females were located. The sample had an age range of 11–78 years with a mean age of 33.40 (SD +/- 7.5 years). A clinically significant number of patients (55%) were found to be somaticizing their symptoms and a significant majority (78%) of somaticizing patients reported no loss of consciousness, retrograde amnesia, or post-traumatic amnesia but their symptom validity scales were significantly exaggerated. Caution should be exercised by clinicians to ensure that the obtained results of neuropsychological testing are reliable and valid. It is very important for the clinician to take into account the entire patient history, including psychosocial factors (such as pre-existing psychological traits or conditions) and social influences (such as stressors in family dynamics or work/school activities that may be affecting the patient's complaints). PMID:27766190

Predictors of postconcussion syndrome in collegiate student-athletes.

PubMed

Zuckerman, Scott L; Yengo-Kahn, Aaron M; Buckley, Thomas A; Solomon, Gary S; Sills, Allen K; Kerr, Zachary Y

2016-04-01

OBJECTIVE Sport-related concussion (SRC) has emerged as a public health problem, especially among student-athletes. Whereas most concussions resolve by 2 weeks, a minority of patients experience postconcussion syndrome (PCS), in which symptoms persist for months. The objective of this study was to elucidate factors predictive of PCS among a sample of National Collegiate Athletic Association (NCAA) student-athletes in the academic years 2009-2010 to 2014-2015. METHODS The SRC data originated from the NCAA Injury Surveillance Program (ISP) in the 2009-2010 to 2014-2015 academic seasons. The NCAA ISP is a prospective database made up of a convenience sample of schools across all divisions. All SRCs are reported by certified athletic trainers. The PCS group consisted of concussed student-athletes with concussion-related symptoms that lasted ≥ 4 weeks. The non-PCS group consisted of concussed student-athletes with symptom resolution in ≤ 2 weeks. Those with symptoms that resolved in the intermediate area of 2-4 weeks were excluded. Odds ratios (ORs) were estimated using logistic regression. RESULTS During the 2009-2010 to 2014-2015 seasons, 1507 NCAA student-athletes sustained an SRC, 112 (7.4%) of whom developed PCS (i.e., concussion-related symptoms that lasted ≥ 4 weeks). Men's ice hockey contributed the largest proportion of concussions to the PCS group (28.6%), whereas men's football contributed the largest proportion of concussions in the non-PCS group (38.6%). In multivariate analysis, recurrent concussion was associated with increased odds of PCS (OR 2.08, 95% CI 1.28-3.36). Concussion symptoms that were also associated with increased odds of PCS included retrograde amnesia (OR 2.75, 95% CI 1.34-5.64), difficulty concentrating (OR 2.35, 95% CI 1.23-4.50), sensitivity to light (OR 1.97, 95% CI 1.09-3.57), and insomnia (OR 2.19, 95% CI 1.30-3.68). Contact level, sex, and loss of consciousness were not associated with PCS. CONCLUSIONS Postconcussion syndrome

Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions.

PubMed

Hadanny, Amir; Efrati, Shai

2016-08-01

Persistent post-concussion syndrome caused by mild traumatic brain injury has become a major cause of morbidity and poor quality of life. Unlike the acute care of concussion, there is no consensus for treatment of chronic symptoms. Moreover, most of the pharmacologic and non-pharmacologic treatments have failed to demonstrate significant efficacy on both the clinical symptoms as well as the pathophysiologic cascade responsible for the permanent brain injury. This article reviews the pathophysiology of PCS, the diagnostic tools and criteria, the current available treatments including pharmacotherapy and different cognitive rehabilitation programs, and promising new treatment directions. A most promising new direction is the use of hyperbaric oxygen therapy, which targets the basic pathological processes responsible for post-concussion symptoms; it is discussed here in depth.

Laboratory impulsivity and depression in blast-exposed military personnel with post-concussion syndrome.

PubMed

Bjork, James M; Burroughs, Thomas K; Franke, Laura M; Pickett, Treven C; Johns, Sade E; Moeller, F Gerard; Walker, William C

2016-12-30

In military populations, traumatic brain injury (TBI) also holds potential to increase impulsivity and impair mood regulation due to blast injury effects on ventral frontal cortex - to put military personnel at risk for suicide or substance abuse. We assessed a linkage between depression and impaired behavioral inhibition in 117 blast-exposed service members (SM) and veterans with post-concussion syndrome (PCS), where PCS was defined using a Rivermead Postconcussive Symptom Questionnaire (RPQ) modified to clarify whether each symptom worsened compared to pre-blast. Center for Epidemiological Studies-Depression Scale (CES-D) scores, PTSD Checklist 5 (PCL-5) scores, and RPQ raw subscale scores correlated positively with commission and perseverative errors on the continuous performance test II (CPT-II). In contrast, the number of RPQ symptoms ostensibly worsened post-blast did not correlate with impulsive errors on the CPT-II. These data replicate earlier findings that link increased affective symptomatology to impaired behavior inhibition in military TBI populations, but where additional effects on impulsivity from the blast itself remain equivocal. Published by Elsevier Ireland Ltd.

Academic Difficulty and Vision Symptoms Children with Concussion

PubMed Central

Swanson, Mark W.; Weise, Katherine K.; Dreer, Laura E.; Johnston, James; Davis, Richard D.; Ferguson, Drew; Hale, M. Heath; Gould, Sara J.; Christy, Jennifer; Busettini, Claudio; Lee, Sarah D.; Swanson, Erin

2016-01-01

Purpose Academic difficulty is reported in children with prolonged post-concussive symptoms. Despite growing evidence that vestibular-ocular and vision-specific dysfunction are common in children following concussion, vision is rarely mentioned in return-to-learn protocols. The purpose of this project was to evaluate a cohort of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with those reporting academic difficulty. Methods Data was obtained from the Children’s of Alabama Concussion Clinic REDCap dataset from the period January 2007 to October 2013. From this dataset of 1,033 concussion events, a cohort of 276 children aged 5–18 years with three or more concussion-related symptoms present for 10 days or more was identified. A cross-sectional cohort study was undertaken to evaluate the association of concussion symptoms, SCAT2 scores, demographic and concussion severity markers to reported educational difficulty among children with prolonged post-concussive symptoms. Univariate and multivariate logistic regression techniques were used to model the association of reported educational difficulty to self-reported vision abnormalities. Results Mean age was 13.8 years. Median time since the concussive event was 21 days, with 33% (95/276) reporting their concussion more than thirty days prior to data collection. Academic difficulty was reported by 29% (79/270) and vision abnormalities in 46% (128/274). After model reduction, vision symptoms (OR 2.17, 95% CI 1.02, 4.62), hearing disturbance (OR 2.39, 95% CI 1.06, 5.36) and concentration difficulty (OR 21.62, 95% CI 9.50, 44.47) remained associated with academic difficulty. For those with symptoms 30 days or more after concussion, only vision (OR 3.15, 95% CI 1.06, 9.38) and concentration difficulty (OR 15.33, 95% CI 4.99, 47.05) remained statistically significant. Conclusions Vision problems were commonly reported in children with concussions and were independently

Multiple Past Concussions in High School Football Players: Are There Differences in Cognitive Functioning and Symptom Reporting?

PubMed

Brooks, Brian L; Mannix, Rebekah; Maxwell, Bruce; Zafonte, Ross; Berkner, Paul D; Iverson, Grant L

2016-12-01

There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Cross-sectional study; Level of evidence, 3. Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines). In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting. © 2016 The Author(s).

Post-concussion driving behaviors and opinions: A survey of collegiate student-athletes.

PubMed

Schmidt, Julianne D; Lynall, Robert C; Lempke, Landon Bryce; Weber, Michelle L; Devos, Hannes

2018-05-08

Post-concussion driving restrictions are eminent, but we lack understanding of current behaviors and opinions about driving following concussion among populations at risk of concussion. We aimed to describe post-concussion driving behaviors and opinions among collegiate student-athletes. Student-athletes completed a survey (response rate=45.3%, 223/492) regarding their post-concussion driving behaviors and opinions. Response frequencies and percentages are presented. Student-athletes self-reported a total of 169 lifetime concussions (0.76±1.02 each). Of the 169 concussions, 52.1% (88/169) were diagnosed and 52.7% (89/169) occurred while the student-athlete possessed a valid driver's license. Student-athletes refrained from driving following 43.8% (39/89) of the concussive events. Student-athletes that refrained most commonly did so for only 24-48 hours (20.5%, 8/39) and because a health care provider advised them to (33.3%: 13/39). Student-athletes most commonly reported that they would feel "very unsafe" driving a car immediately following injury (38.4%, 84/219). When asked whether driving restrictions would influence your decision to report the injury to a health care provider, 7.9% reported that it "definitely would" (17/214), 26.6% "probably would" (57/214), 17.8% "neutral" (38/214), 24.8% "probably would not" (53/214), and 22.9% "definitely would not" (49/214). Despite generally believing that driving immediately following a concussion is unsafe, a majority of student-athletes did not refrain from driving at any point following their previous concussions. Post-concussion driving restrictions may have some influence on student-athletes' decisions to report the injury to a health care provider. Health care providers play a critical role in post-concussion driving restriction, but lack standardized recommendations to guide their care.

A Multisite Study of the Relationships between Blast Exposures and Symptom Reporting in a Post-Deployment Active Duty Military Population with Mild Traumatic Brain Injury

PubMed Central

Miller, Kelly J.; Lange, Rael T.; Cooper, Douglas B.; Tate, David F.; Bailie, Jason; Brickell, Tracey A.; French, Louis M.; Asmussen, Sarah; Kennedy, Jan E.

2014-01-01

Abstract Explosive devices have been the most frequent cause of traumatic brain injury (TBI) among deployed contemporary U.S. service members. The purpose of this study was to examine the influence of previous cumulative blast exposures (that did or did not result in TBI) on later post-concussion and post-traumatic symptom reporting after sustaining a mild TBI (MTBI). Participants were 573 service members who sustained MTBI divided into four groups by number of blast exposures (1, 2, 3, and 4–10) and a nonblast control group. Post-concussion symptoms were measured using the Neurobehavioral Symptom Inventory (NSI) and post-traumatic stress disorder (PTSD) symptoms using the Post-traumatic Checklist-Civilian version (PCL-C). Results show groups significantly differed on total NSI scores (p<0.001), where symptom endorsement increased as number of reported blast exposures increased. Total NSI scores were significantly higher for the 3– and 4–10 blast groups compared with the 1- and 2-blast groups with effect sizes ranging from small to moderate (d=0.31 to 0.63). After controlling for PTSD symptoms using the PCL-C total score, NSI total score differences remained between the 4–10-blast group and the 1- and 2-blast groups, but were less pronounced (d=0.35 and d=0.24, respectively). Analyses of NSI subscale scores using PCL-C scores as a covariate revealed significant between-blast group differences on cognitive, sensory, and somatic, but not affective symptoms. Regression analyses revealed that cumulative blast exposures accounted for a small but significant amount of the variance in total NSI scores (4.8%; p=0.009) and total PCL-C scores (2.3%; p<0.001). Among service members exposed to blast, post-concussion symptom reporting increased as a function of cumulative blast exposures. Future research will need to determine the relationship between cumulative blast exposures, symptom reporting, and neuropathological changes. PMID:25036531

Low pressure hyperbaric oxygen therapy and SPECT brain imaging in the treatment of blast-induced chronic traumatic brain injury (post-concussion syndrome) and post traumatic stress disorder: a case report

PubMed Central

2009-01-01

A 25-year-old male military veteran presented with diagnoses of post concussion syndrome and post traumatic stress disorder three years after loss of consciousness from an explosion in combat. The patient underwent single photon emission computed tomography brain blood flow imaging before and after a block of thirty-nine 1.5 atmospheres absolute hyperbaric oxygen treatments. The patient experienced a permanent marked improvement in his post-concussive symptoms, physical exam findings, and brain blood flow. In addition, he experienced a complete resolution of post-traumatic stress disorder symptoms. After treatment he became and has remained employed for eight consecutive months. This case suggests a novel treatment for the combined diagnoses of blast-induced post-concussion syndrome and post-traumatic stress disorder. PMID:19829822

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the "post-inflammatory brain syndrome" PIBS.

PubMed

Rathbone, Alasdair Timothy Llewelyn; Tharmaradinam, Surejini; Jiang, Shucui; Rathbone, Michel P; Kumbhare, Dinesh A

2015-05-01

Post-concussion syndrome is an aggregate of symptoms that commonly present together after head injury. These symptoms, depending on definition, include headaches, dizziness, neuropsychiatric symptoms, and cognitive impairment. However, these symptoms are common, occurring frequently in non-head injured controls, leading some to question the existence of post-concussion syndrome as a unique syndrome. Therefore, some have attempted to explain post-concussion symptoms as post-traumatic stress disorder, as they share many similar symptoms and post-traumatic stress disorder does not require head injury. This explanation falls short as patients with post-concussion syndrome do not necessarily experience many key symptoms of post-traumatic stress disorder. Therefore, other explanations must be sought to explain the prevalence of post-concussion like symptoms in non-head injury patients. Many of the situations in which post-concussion syndrome like symptoms may be experienced such as infection and post-surgery are associated with systemic inflammatory responses, and even neuroinflammation. Post-concussion syndrome itself has a significant neuroinflammatory component. In this review we examine the evidence of neuroinflammation in post-concussion syndrome and the potential role systemic inflammation plays in post-concussion syndrome like symptoms. We conclude that given the overlap between these conditions and the role of inflammation in their etiologies, a new term, post-inflammatory brain syndromes (PIBS), is necessary to describe the common outcomes of many different inflammatory insults. The concept of post-concussion syndrome is in its evolution therefore, the new term post-inflammatory brain syndromes provides a better understanding of etiology of its wide-array of symptoms and the wide array of conditions they can be seen in. Copyright © 2015 Elsevier Inc. All rights reserved.

Injury versus non-injury factors as predictors of post-concussive symptoms following mild traumatic brain injury in children

PubMed Central

McNally, Kelly A.; Bangert, Barbara; Dietrich, Ann; Nuss, Kathy; Rusin, Jerome; Wright, Martha; Taylor, H. Gerry; Yeates, Keith Owen

2013-01-01

Objective To examine the relative contributions of injury characteristics and non-injury child and family factors as predictors of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children. Methods Participants were 8- to 15-year-old children, 186 with mild TBI and 99 with mild orthopedic injuries (OI). Parents and children rated PCS shortly after injury and at 1, 3, and 12 months post-injury. Hierarchical regression analyses were conducted to predict PCS from (1) demographic variables; (2) pre-morbid child factors (WASI IQ; WRAT-3 Reading; Child Behavior Checklist; ratings of pre-injury PCS); (3) family factors (Family Assessment Device General Functioning Scale; Brief Symptom Inventory; and Life Stressors and Social Resources Inventory); and (4) injury group (OI, mild TBI with loss of consciousness [LOC] and associated injuries [AI], mild TBI with LOC but without AI, mild TBI without LOC but with AI, and mild TBI without LOC or AI) Results Injury group predicted parent and child ratings of PCS but showed a decreasing contribution over time. Demographic variables consistently predicted symptom ratings across time. Premorbid child factors, especially retrospective ratings of premorbid symptoms, accounted for the most variance in symptom ratings. Family factors, particularly parent adjustment, consistently predicted parent, but not child, ratings of PCS. Conclusions Injury characteristics predict PCS in the first months following mild TBI but show a decreasing contribution over time. In contrast, non-injury factors are more consistently related to persistent PCS. PMID:23356592

Comparison of baseline and post-concussion ImPACT test scores in young athletes with stimulant-treated and untreated ADHD.

PubMed

Gardner, Ryan M; Yengo-Kahn, Aaron; Bonfield, Christopher M; Solomon, Gary S

2017-02-01

Baseline and post-concussion neurocognitive testing is useful in managing concussed athletes. Attention deficit hyperactivity disorder (ADHD) and stimulant medications are recognized as potential modifiers of performance on neurocognitive testing by the Concussion in Sport Group. Our goal was to assess whether individuals with ADHD perform differently on post-concussion testing and if this difference is related to the use of stimulants. Retrospective case-control study in which 4373 athletes underwent baseline and post-concussion testing using the ImPACT battery. 277 athletes self-reported a history of ADHD, of which, 206 reported no stimulant treatment and 69 reported stimulant treatment. Each group was matched with participants reporting no history of ADHD or stimulant use on several biopsychosocial characteristics. Non-parametric tests were used to assess ImPACT composite score differences between groups. Participants with ADHD had worse verbal memory, visual memory, visual motor speed, and reaction time scores than matched controls at baseline and post-concussion, all with p ≤ .001 and |r|≥ 0.100. Athletes without stimulant treatment had lower verbal memory, visual memory, visual motor speed, and reaction time scores than controls at baseline (p ≤ 0.01, |r|≥ 0.100 [except verbal memory, r = -0.088]) and post-concussion (p = 0.000, |r|> 0.100). Athletes with stimulant treatment had lower verbal memory (Baseline: p = 0.047, r = -0.108; Post-concussion: p = 0.023, r = -0.124) and visual memory scores (Baseline: p = 0.013, r = -0.134; Post-concussion: p = 0.003, r = -0.162) but equivalent visual motor speed and reaction time scores versus controls at baseline and post-concussion. ADHD-specific baseline and post-concussion neuropsychological profiles, as well as stimulant medication status, may need to be considered when interpreting ImPACT test results. Further investigation into the effects of ADHD and stimulant use on recovery from

Multimodal impairment-based physical therapy for the treatment of patients with post-concussion syndrome: A retrospective analysis on safety and feasibility.

PubMed

Grabowski, Patrick; Wilson, John; Walker, Alyssa; Enz, Dan; Wang, Sijian

2017-01-01

Demonstrate implementation, safety and feasibility of multimodal, impairment-based physical therapy (PT) combining vestibular/oculomotor and cervical rehabilitation with sub-symptom threshold exercise for the treatment of patients with post-concussion syndrome (PCS). University hospital outpatient sports medicine facility. Twenty-five patients (12-20 years old) meeting World Health Organization criteria for PCS following sport-related concussion referred for supervised PT consisting of sub-symptom cardiovascular exercise, vestibular/oculomotor and cervical spine rehabilitation. Retrospective cohort. Post-Concussion Symptom Scale (PCSS) total score, maximum symptom-free heart rate (SFHR) during graded exercise testing (GXT), GXT duration, balance error scoring system (BESS) score, and number of adverse events. Patients demonstrated a statistically significant decreasing trend (p < 0.01) for total PCSS scores (pre-PT M = 18.2 (SD = 14.2), post-PT M = 9.1 (SD = 10.8), n = 25). Maximum SFHR achieved on GXT increased 23% (p < 0.01, n = 14), and BESS errors decreased 52% (p < 0.01, n = 13). Two patients reported mild symptom exacerbation with aerobic exercise at home, attenuated by adjustment of the home exercise program. Multimodal, impairment-based PT is safe and associated with diminishing PCS symptoms. This establishes feasibility for future clinical trials to determine viable treatment approaches to reduce symptoms and improve function while avoiding negative repercussions of physical inactivity and premature return to full activity. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed Central

Fay, Taryn B.; Yeates, Keith Owen; Taylor, H. Gerry; Bangert, Barbara; Dietrich, Ann; Nuss, Kathryn E.; Rusin, Jerome; Wright, Martha

2010-01-01

The occurrenceof 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. PMID:19835663

Mild Traumatic Brain Injury and Post-concussion Syndrome: Treatment and Related Sequela for Persistent Symptomatic Disease.

PubMed

Bramley, Harry; Hong, Justin; Zacko, Christopher; Royer, Christopher; Silvis, Matthew

2016-09-01

Sport-related concussion typically resolves within a few weeks of the injury; however, persistent symptoms have been reported to occur in 10% to 15% of concussions. These ongoing symptoms can cause significant disability and be frustrating for the patient and family. In addition, factors other than brain injury can cause complications for these patients, such as adjustment disorder or exacerbation of preexisting conditions such as depression or migraine. Individuals with prolonged symptoms of concussion may be classified as having post-concussion syndrome. A careful and thoughtful evaluation is important, as the clinician must determine whether these prolonged symptoms reflect brain injury pathophysiology versus another process. Although there have been numerous studies on the acute management of concussion, much less is available on the treatment of persistent disease. This review will provide an evaluation approach for the patient with prolonged concussion symptoms and review recent literature on treatment strategies.

Baseline vestibular and auditory findings in a trial of post-concussive syndrome

PubMed

Meehan, Anna; Searing, Elizabeth; Weaver, Lindell; Lewandowski, Andrew

2016-01-01

Previous studies have reported high rates of auditory and vestibular-balance deficits immediately following head injury. This study uses a comprehensive battery of assessments to characterize auditory and vestibular function in 71 U.S. military service members with chronic symptoms following mild traumatic brain injury that did not resolve with traditional interventions. The majority of the study population reported hearing loss (70%) and recent vestibular symptoms (83%). Central auditory deficits were most prevalent, with 58% of participants failing the SCAN3:A screening test and 45% showing abnormal responses on auditory steady-state response testing presented at a suprathreshold intensity. Only 17% of the participants had abnormal hearing (⟩25 dB hearing loss) based on the pure-tone average. Objective vestibular testing supported significant deficits in this population, regardless of whether the participant self-reported active symptoms. Composite score on the Sensory Organization Test was lower than expected from normative data (mean 69.6 ±vestibular tests, vestibulo-ocular reflex, central auditory dysfunction, mild traumatic brain injury, post-concussive symptoms, hearing15.6). High abnormality rates were found in funduscopy torsion (58%), oculomotor assessments (49%), ocular and cervical vestibular evoked myogenic potentials (46% and 33%, respectively), and monothermal calorics (40%). It is recommended that a full peripheral and central auditory, oculomotor, and vestibular-balance evaluation be completed on military service members who have sustained head trauma.

Does the cause of the mild traumatic brain injury affect the expectation of persistent postconcussion symptoms and psychological trauma?

PubMed

Sullivan, Karen A; Wade, Christina

2017-05-01

A controlled experiment of the effect of injury cause on expectations of outcome from mild traumatic brain injury (TBI) was conducted. Ninety-three participants were randomly assigned to one of four conditions. The participants read a vignette that described a mild TBI (with fixed injury parameters) from a different cause (sport, domestic assault, fall, or motor vehicle accident). The effect of the manipulation on expectations of persistent postconcussion symptoms and psychological trauma was assessed with standard measures and a novel "threat-to-life" measure. The Kruskal-Wallis H test for group differences revealed a significant but selective effect of group on symptom and trauma outcomes (ŋ 2 s ≥ .10; large effects). Post hoc pairwise tests showed that, in most cases, there was an expectation of a worse outcome following mild TBI from a domestic assault than from the other causes (small-to-medium effects). Expectations were selectively altered by an experimental manipulation of injury cause. Given that expectations of outcome are known to affect mild TBI prognosis, the findings suggest the need for greater attention to injury cause.

Cognitive reserve and persistent post-concussion symptoms--A prospective mild traumatic brain injury (mTBI) cohort study.

PubMed

Oldenburg, Christian; Lundin, Anders; Edman, Gunnar; Nygren-de Boussard, Catharina; Bartfai, Aniko

2016-01-01

Having three or more persisting (i.e. > 3 months) post-concussion symptoms (PCS) affects a significant number of patients after a mild traumatic brain injury (mTBI). A common complaint is cognitive deficits. However, several meta-analyses have found no evidence of long-term cognitive impairment in mTBI patients. The study sought to answer two questions: first, is there a difference in cognitive performance between PCS and recovered mTBI patients? Second, is lower cognitive reserve a risk factor for developing PCS? Prospective inception cohort study. One hundred and twenty-two adult patients were recruited from emergency departments within 24 hours of an mTBI. Three months post-injury, participants completed the Rivermead Post Concussion Symptoms Questionnaire and a neuropsychological assessment. A healthy control group (n = 35) were recruited. The estimate of cognitive reserve was based upon sub-test Information from Wechsler Adult Intelligence Scale and international classifications of educational level and occupational skill level. mTBI patients showed reduced memory performance. Patients with lower cognitive reserve were 4.14-times more likely to suffer from PCS. mTBI may be linked to subtle executive memory deficits. Lower cognitive reserve appears to be a risk factor for PCS and indicates individual vulnerabilities.

Cerebral Perfusion Changes in Post-Concussion Syndrome: A Prospective Controlled Cohort Study

PubMed Central

Marcil, Lorenzo D.; Dewey, Deborah; Carlson, Helen L.; MacMaster, Frank P.; Brooks, Brian L.; Lebel, R. Marc

2017-01-01

Abstract The biology of post-concussive symptoms is unclear. Symptoms are often increased during activities, and have been linked to decreased cerebrovascular reactivity and perfusion. The aim of this study was to examine cerebral blood flow (CBF) in children with different clinical recovery patterns following mild traumatic brain injury (mTBI). This was a prospective controlled cohort study of children with mTBI (ages 8 to 18 years) who were symptomatic with post-concussive symptoms at one month post-injury (symptomatic, n = 27) and children who had recovered quickly (asymptomatic, n = 24). Pseudo continuous arterial spin labeling magnetic resonance imaging (MRI) was used to quantify CBF. The mTBI groups were imaged at 40 days post-injury. Global and regional CBF were compared with healthy controls of similar age and sex but without a history of mTBI (n = 21). Seventy-two participants (mean age: 14.1 years) underwent neuroimaging. Significant differences in CBF were found: global CBF was higher in the symptomatic group and lower in the asymptomatic group compared with controls, (F(2,69) 9.734; p < 0.001). Post-injury symptom score could be predicted by pre-injury symptoms and CBF in presence of mTBI (adjusted R2 = 0.424; p < 0.001). Altered patterns of cerebral perfusion are seen following mTBI and are associated with the recovery trajectory. Symptomatic children have higher CBF. Children who “recovered” quickly, have decreased CBF suggesting that clinical recovery precedes the cerebral recovery. Further longitudinal studies are required to determine if these perfusion patterns continue to change over time. PMID:27554429

Active Rehabilitation of Concussion and Post-concussion Syndrome.

PubMed

Leddy, John J; Baker, John G; Willer, Barry

2016-05-01

Concussion is a physiological brain injury with physical, cognitive, and emotional sequelae. The macrophysiological insult to the brain affects the autonomic nervous system and its control of cerebral blood flow. Most patients recover within 2 weeks, but some do not. Persistence of symptoms beyond the generally accepted time frame for recovery is called post-concussion syndrome (PCS). PCS is not a single entity; it is a group of disorders that requires specific forms of therapy. Rest has been the mainstay of the treatment for concussion and PCS. This article discusses the rationale for the active treatment of concussion and PCS. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of Two Concussions on the Neuropsychological Functioning and Symptom Reporting of High School Athletes.

PubMed

Tsushima, William T; Geling, Olga; Arnold, Monica; Oshiro, Ross

2016-01-01

To assess the effects of two sports-related concussions on neuropsychological functioning and symptom reporting, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was administered to 483 high school athletes. Three groups of athletes were determined based on the number of previous concussions: no concussion (n = 409), 1 concussion (n = 58), and 2 concussions (n = 16). The results showed that the three groups did not differ in terms of their ImPACT composite scores (Verbal Memory, Visual Memory, Reaction Time, and Processing Speed) and the Total Symptom Score. As there are only a few studies that have reported the sequelae of 2 concussions in high school athletes, it is premature to declare that a repeated concussion does not have persistent neurocognitive effects on high school athletes.

Trajectories and associated factors of quality of life, global outcome, and post-concussion symptoms in the first year following mild traumatic brain injury.

PubMed

Chiang, Chia-Chen; Guo, Su-Er; Huang, Kuo-Chang; Lee, Bih-O; Fan, Jun-Yu

2016-08-01

To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI). This was a prospective longitudinal study of 100 participants with mTBI from neurosurgical outpatient departments in Chiayi County District Hospitals in Taiwan. The checklist of post-concussion syndromes (CPCS) was used to assess PCS at enrollment and at 1, 3, and 12 months after mTBI; the glasgow outcome scale extended (GOSE), the quality of life after brain injured (QOLIBRI), Chinese version, and the Short Form 36 Health Survey (SF-36), Taiwan version, were used to assess mTBI global outcome and QoL at 1, 3, and 12 months after mTBI. Latent class growth models (LCGMs) indicated the change trajectories of QOLIBRI, PCS SF-36, MCS SF-36, GOSE, and PCS. Classes of trajectory were associated with age ≥40 years, unemployment at 1 month after injury, and educational level ≤12 years. Univariate analysis revealed that employment status at 1 month post-injury was correlated with the trajectories of QOLIBRI, PCS SF-36, MCS SF-36, and GOSE, but not PCS. Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.

Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury.

PubMed

Leddy, John J; Baker, John G; Merchant, Asim; Picano, John; Gaile, Daniel; Matuszak, Jason; Willer, Barry

2015-05-01

To compare symptoms in patients with physiologic postconcussion disorder (PCD) versus cervicogenic/vestibular PCD. We hypothesized that most symptoms would not be equivalent. In particular, we hypothesized that cognitive symptoms would be more often associated with physiologic PCD. Retrospective review of symptom reports from patients who completed a 22-item symptom questionnaire. University-based concussion clinic. Convenience sample of 128 patients who had symptoms after head injury for more than 3 weeks and who had provocative treadmill exercise testing. Subjects were classified as either physiologic PCD (abnormal treadmill performance and a normal cervical/vestibular physical examination) or cervicogenic/vestibular PCD (CGV, normal treadmill performance, and an abnormal cervical/vestibular physical examination). Self-reported symptoms. Univariate and multivariate methods, including t tests, tests of equivalence, a logistic regression model, k-nearest neighbor analysis, multidimensional scaling, and principle components analysis were used to see whether symptoms could distinguish PCD from CGV. None of the statistical methods used to analyze self-reported symptoms was able to adequately distinguish patients with PCD from patients with CGV. Symptoms after head injury, including cognitive symptoms, have traditionally been ascribed to brain injury, but they do not reliably discriminate between physiologic PCD and cervicogenic/vestibular PCD. Clinicians should consider specific testing of exercise tolerance and perform a physical examination of the cervical spine and the vestibular/ocular systems to determine the etiology of postconcussion symptoms. Symptoms after head injury, including cognitive symptoms, do not discriminate between concussion and cervical/vestibular injury.

Immediate post-concussion assessment and cognitive testing (ImPACT) practices of sports medicine professionals.

PubMed

Covassin, Tracey; Elbin, Robert J; Stiller-Ostrowski, Jennifer L; Kontos, Anthony P

2009-01-01

Computerized neurocognitive testing is becoming popular among clinicians evaluating sport-related concussions across all levels of sport. Baseline neurocognitive testing has been recommended to provide more accurate representation of the preconcussion cognitive status of individual athletes. However, little is known about the use of baseline neurocognitive testing in concussion assessment and management. To examine implementation and practice trends of sports medicine professionals using baseline neurocognitive testing at the high school and collegiate levels. Quantitative survey research. Online survey. Certified athletic trainers (ATs) from approximately 1209 US institutions listed on the ImPACT Web site were recruited. A total of 399 ATs completed the survey, for a response return rate of 32.7%. Survey questions addressed educational level, years of certification, employment setting, percentage of athletes baseline tested, and accuracy of baseline tests. Other items addressed postconcussive neurocognitive testing protocols and scenarios for return-to-play decisions based on neurocognitive testing. Nearly all ATs (94.7%) administered baseline computerized neurocognitive testing to their athletes. However, only 51.9% examined these baseline tests for validity. The majority of ATs indicated that they administer baseline neurocognitive tests most frequently to football players (88.4%), followed by women's soccer players (78.8%) and men's soccer players (71.2%). Nearly all respondents (95.5%) stated that they would not return a symptomatic athlete to play if the athlete's neurocognitive scores were back to baseline. However, when asked if they would return an athlete who is symptom free but who scores below his or her baseline, 86.5% responded no, 9.8% responded yes, and 3.8% indicated that it depended on the importance of the competition. The use of baseline testing, baseline testing readministration, and postconcussion protocols among ATs is increasing. However

A study of the effect of legal settlement on post-concussion symptoms.

PubMed Central

Fee, C R; Rutherford, W H

1988-01-01

Forty-four consecutive patients with concussion for whom a medico-legal report had been written were followed up for 3-4 years after their accidents. Three cases were still pending at the end of the study. Fifty-seven per cent complained of symptoms when the medico-legal reports were written (mean interval from accident 12.9 months), 39% had symptoms at the time of settlement (mean interval 22.1 months) and 34% had symptoms one year later. When these results were compared with a general series from the same department some years earlier, it was found that the symptoms at the time of writing the reports were not significantly different from symptoms at 6 weeks in the earlier series, but the symptoms one year after settlement were almost two-and-a-half times greater than the symptoms at 12 months in the general series. No evidence could be found to suggest any organic basis for the higher symptom rate in the litigation series. It is suggested that the litigation process itself is a factor in the persistence of symptoms and this effect continues after legal settlement has been reached. Early settlement of the cases might significantly reduce morbidity. PMID:3408521

Gender Differences in Symptom Reporting on Baseline Sport Concussion Testing Across the Youth Age Span.

PubMed

Moser, Rosemarie Scolaro; Olek, Lauren; Schatz, Philip

2018-02-06

Little is known regarding gender differences in concussion symptom reporting developmentally across the age span, specifically in pre-adolescent athletes. The present study asks: Do boys and girls differ in symptom reporting across the pre-adolescent to post-adolescent age span? This retrospective study utilized baseline assessments from 11,695 10-22 year-old athletes assigned to 3 independent groups: Pre-adolescent 10-12 year olds (n = 1,367; 12%), Adolescent 13-17 year olds (n = 2,974; 25%), and Late Adolescent 18-22 year olds (n = 7,354; 63%). Males represented 60% of the sample. Baseline ImPACT composite scores and Post-Concussion Symptom Scale scores (Total, Physical, Cognitive, Emotional, Sleep) were analyzed for the effects of age and gender. Statistically significant main effects were found for age and gender on all ImPACT composites, Total Symptoms, and Symptom factors. Significant interaction effects were noted between age and gender for all ImPACT composites, Total Symptoms, and Symptom factors. Total Symptoms and all Symptom factors were highest in adolescents (ages 13-17) for males and females. In the 10-12 age group, females displayed lower Total Symptoms, Physical, and Sleep factors than males. The notion of females being more likely than males to report symptoms does not appear to apply across the developmental age span, particularly prior to adolescence. Females show greater emotional endorsement across the youth age span (10-22 years). Adolescence (13-17 years) appears to be a time of increased symptomatology that may lessen after the age of 18. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Thalamic Functional Connectivity in Mild Traumatic Brain Injury: Longitudinal Associations With Patient-Reported Outcomes and Neuropsychological Tests.

PubMed

Banks, Sarah D; Coronado, Rogelio A; Clemons, Lori R; Abraham, Christine M; Pruthi, Sumit; Conrad, Benjamin N; Morgan, Victoria L; Guillamondegui, Oscar D; Archer, Kristin R

2016-08-01

(1) To examine differences in patient-reported outcomes, neuropsychological tests, and thalamic functional connectivity (FC) between patients with mild traumatic brain injury (mTBI) and individuals without mTBI and (2) to determine longitudinal associations between changes in these measures. Prospective observational case-control study. Academic medical center. A sample (N=24) of 13 patients with mTBI (mean age, 39.3±14.0y; 4 women [31%]) and 11 age- and sex-matched controls without mTBI (mean age, 37.6±13.3y; 4 women [36%]). Not applicable. Resting state FC (3T magnetic resonance imaging scanner) was examined between the thalamus and the default mode network, dorsal attention network, and frontoparietal control network. Patient-reported outcomes included pain (Brief Pain Inventory), depressive symptoms (Patient Health Questionnaire-9), posttraumatic stress disorder ([PTSD] Checklist - Civilian Version), and postconcussive symptoms (Rivermead Post-Concussion Symptoms Questionnaire). Neuropsychological tests included the Delis-Kaplan Executive Function System Tower test, Trails B, and Hotel Task. Assessments occurred at 6 weeks and 4 months after hospitalization in patients with mTBI and at a single visit for controls. Student t tests found increased pain, depressive symptoms, PTSD symptoms, and postconcussive symptoms; decreased performance on Trails B; increased FC between the thalamus and the default mode network; and decreased FC between the thalamus and the dorsal attention network and between the thalamus and the frontoparietal control network in patients with mTBI as compared with controls. The Spearman correlation coefficient indicated that increased FC between the thalamus and the dorsal attention network from baseline to 4 months was associated with decreased pain and postconcussive symptoms (corrected P<.05). Findings suggest that alterations in thalamic FC occur after mTBI, and improvements in pain and postconcussive symptoms are correlated with

Does Game Participation Impact Cognition and Symptoms in Elite Football Players?

PubMed

Mrazik, Martin; Naidu, Dhiren; Manning, David E; Brooks, Brian L

2016-09-01

To measure neurocognitive functioning in college and professional football players after game participation. Retrospective, cross-sectional cohort design. Ninety-four male university and professional football players. All participants completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) testing at baseline, and either at postconcussion (group 1) or postgame (group 2) participation. Results from the 5 ImPACT composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time and Impulse Control) and Total Symptom Score. Repeated-measures analysis of variance demonstrated a significant main effect for time (improvements) in 3 of 5 domains for the postconcussion group, but no improvements in the postgame group. The postconcussion group presented with significantly improved results on 4 of 5 ImPACT domains compared with the postgame group at the follow-up time interval. Participation in a football game with potential cumulative head contacts did not yield increased symptoms or cognitive impairment. However, the absence of improvement in cognitive functioning in noninjured football players, which was found in those players who were returned to play after an injury, may suggest that there is a measureable impact as a result of playing football.

Trajectories and Risk Factors for Post-Traumatic Stress Symptoms following Pediatric Concussion.

PubMed

Truss, Katherine; Godfrey, Celia; Takagi, Michael; Babl, Franz E; Bressan, Silvia; Hearps, Stephen; Clarke, Cathriona; Dunne, Kevin; Anderson, Vicki

2017-07-15

A substantial minority of children experience post-traumatic stress symptoms (PTSS) following injury. Research indicates variation in the trajectory of PTSS following pediatric injury, but investigation of PTSS following concussion has assumed homogeneity. This study aimed to identify differential trajectories of PTSS following pediatric concussion and to investigate risk factors, including acute post-concussive symptoms (PCS), associated with these trajectories. A total of 120 children ages 8-18 years reported PTSS for 3 months following concussion diagnosis using the Child PTSD Symptom Scale, with a score of 16 or above indicating probable post-traumatic stress disorder diagnosis. Age, gender, injury mechanism, loss of consciousness, previous concussions, prior hospitalization, prior diagnosis of depression or anxiety, and acute PCS were assessed as risk factors. Data were analyzed using group-based trajectory modeling. Results revealed 16% of children had clinically significant PTSS 2 weeks post-concussion, declining to 10% at 1 month and 6% at 3 months post-injury. Group-based trajectory modeling identified three trajectories of PTSS post-concussion: "resilient" (70%); "recovering" (25%), in which children experienced elevated acute symptoms that declined over time; and "chronic symptomatology" (5%). Due to small size, the chronic group should be interpreted with caution. Higher acute PCS and prior diagnosis of depression or anxiety both significantly increased predicted probability of recovering trajectory group membership. These findings establish that most children are resilient to PTSS following concussion, but that PTSS do occur acutely in a substantial minority of children. The study indicates mental health factors, particularly PTSS, depression, and anxiety, should be considered integral to models of concussion management and treatment.

Decreased Anticipatory Postural Adjustments During Gait Initiation Acutely Postconcussion.

PubMed

Buckley, Thomas A; Oldham, Jessie R; Munkasy, Barry A; Evans, Kelsey M

2017-10-01

To investigate anticipatory postural adjustments (APAs) during the transitional movement task of gait initiation (GI) in individuals acutely after a concussion. Cohort study. University research center. A population-based sample of participants (N=84) divided into 2 equal groups of acutely postconcussion and healthy student athletes. Participants were tested on 2 occasions: a preinjury baseline test and then the concussion group was retested acutely postconcussion and the healthy student athlete group again at a similar time. All participants completed 5 trials of GI on 4 forceplates. The dependent variables were the displacement and velocity of the center of pressure (COP) during the APA phase and initial step kinematics. Comparisons were made with a 2 (group) × 2 (time) repeated-measures analysis of variance. There was a significant interaction for COP posterior displacement (P<.001) and lateral displacement (P<.001). Posteriorly, post hoc testing identified a significant reduction in the concussion group (pretest: 5.7±1.6cm; posttest: 2.6±2.1cm; P<.001), but no difference in the healthy student athlete group (pretest: 4.0±1.6cm; posttest: 4.0±2.5cm; P=.921). Laterally, post hoc testing identified a significant reduction in the concussion group (pretest: 5.8±2.1cm; posttest: 3.8±1.8cm; P<.001), but no difference in the healthy student athlete group (pretest: 5.0±2.5cm; posttest: 5.2±2.4cm; P=.485). The results of this study suggest difficulty in the planning and execution of GI acutely postconcussion, and posterior APA displacement and velocity are highly effective measures of impaired postural control. Finally, the APA phase is linked to the supplementary motor area, which suggests a supraspinal contribution to postconcussion impaired postural control. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The Association between Dual-Task Gait after Concussion and Prolonged Symptom Duration.

PubMed

Howell, David R; Brilliant, Anna; Berkstresser, Brant; Wang, Francis; Fraser, Joana; Meehan, William P

2017-12-01

Quantitative gait measurements can identify persistent postconcussion impairments. However, their prognostic utility after injury to identify the likelihood of prolonged concussion symptoms remains unknown. Our objective was to examine if dual-task gait performance measures are independently associated with persistent (> 28 days) concussion symptoms among a sample of athletes. Sixty individuals diagnosed with a sport-related concussion were assessed within 10 days of their injury. Each participant completed a postconcussion symptom scale, an injury history questionnaire, and a single/dual-task gait examination. They were followed until they no longer reported symptoms, and the duration of time required for symptom resolution was calculated. A binary multivariable logistic regression model determined the independent association between dual-task gait and symptom duration (≤ 28 days vs. >28 days) while controlling for the effect of gender, age, symptom severity, injury-to-examination time, and history of concussion. Seventeen (28%) participants reported a symptom duration >28 days. The dual-task cost for average gait speed (-25.9 ± 9.5% vs. -19.8 ± 8.9%; p = 0.027) and cadence (-18.0 ± 2.9% vs. -12.0 ± 7.7%; p = 0.029) was significantly greater among participants who experienced symptoms for >28 days. After adjusting for potential confounding variables, greater dual-task average gait speed costs were independently associated with prolonged symptom duration (aOR = 0.908; 95% CI = 0.835-0.987). Examinations of dual-task gait may provide useful information during multifaceted concussion examinations. Quantitative assessments that simultaneously test multiple domains, such as dual tasks, may be clinically valuable after a concussion to identify those more likely to experience symptoms for >28 days after injury.

Sex-Based Differences in Cognitive Deficits and Symptom Reporting Among Acutely Concussed Adolescent Lacrosse and Soccer Players.

PubMed

Sandel, Natalie K; Schatz, Philip; Goldberg, Kenneth B; Lazar, Mary

2017-03-01

Research on the acute effects of a concussion among lacrosse players is limited, and postconcussion patterns between male and female athletes have yet to be clearly established. Differences in the style of play and protective gear worn among male and female lacrosse players potentially confound a direct comparison of sex-based differences in this population. To explore sex-based differences in postconcussive neurocognitive functioning and symptom reporting outcomes in concussed adolescent male and female lacrosse players compared with a group of soccer players. Cohort study; Level of evidence, 3. A total of 224 adolescent lacrosse players (112 male, 112 female) aged 13 to 17 years (mean [±SD] age, 15.43 ± 1.09 years) were included in this study. A comparison group of soccer players was added and matched to lacrosse players based on age and sex to address confounding sport differences in male and female versions of lacrosse. All athletes underwent baseline and postinjury testing within 3 days of an injury using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tool. Data were analyzed at baseline using a multivariate analysis of variance (MANOVA) with sport and sex as between-participant factors. A 2 × 2 × 2 mixed-factorial MANOVA was also conducted for sex and sport comparisons at baseline versus after a concussion. Ancillary analyses evaluated sex-based differences in exceeded reliable change indices (RCIs) using an independent-samples t test and established postinjury cutoff scores reflective of a protracted recovery using chi-square tests. All athletes had a significantly worse cognitive profile and greater endorsement of symptoms after an injury ( F 5,216 = 30.30, P < .001, η ρ 2 = .41). Sport yielded a significant main effect ( F 5,216 = 2.36, P = .04, η ρ 2 = .05), but subsequent univariate analyses were nonsignificant ( P > .05) across all neurocognitive and symptom outcome variables. Likewise, there were no significant

Psychological factors associated with delayed symptom resolution in children with concussion

PubMed Central

Grubenhoff, Joseph A.; Currie, Dustin; Comstock, R. Dawn; Juarez-Colunga, Elizabeth; Bajaj, Lalit; Kirkwood, Michael W.

2016-01-01

Objective To characterize t h e psychological factors associated with persistent symptoms following pediatric concussion. Study design Longitudinal cohort study of 179 concussed children 8–18 years old evaluated in a pediatric emergency department. Participants were followed for one month for delayed symptom resolution defined as ≥3 symptoms that were new/worse than pre-injury symptoms measured using graded symptom inventory. Pre-injury psychological traits were measured by parental report on subscales of the Personality Inventory for Children-2 (maladjustment, cognitive abilities, somatization). Child report of post-injury anxiety and injury perception were measured using State-Trait Anxiety Inventory for Children (STAIC) and Children’s Illness Perception Questionnaire. Psychological instrument scores were compared between those with and without DSR using a Kruskal-Wallis test. Associations between psychological traits and DSR were investigated using logistic regression. Results DSR occurred in 21% of participants. Score distributions were significantly worse on the STAIC [38 (IQR 33–40) vs 35 (IQR 31–39); p=0.04] and somatization subscale [1 (IQR 0–3) vs 1 (IQR 0–1); p=0.01] among children with DSR compared with children with early symptom resolution (ESR). Somatization was associated with DSR [adjusted odds ratio (OR) 1.35, 95% CI: 1.08– 1.69]. The proportion of children with abnormal somatization scores was significantly higher in the DSR group (34.2%) than the ESR group (12.8%; p<0.01). Other psychological measures were not different between groups. Conclusion Somatization is associated with delayed symptom resolution in this cohort of concussed children. Post-concussive symptoms lasting at least one month may warrant referral to a neuropsychologist familiar with post-concussion care. PMID:27079963

Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery.

PubMed

Begasse de Dhaem, Olivia; Barr, William B; Balcer, Laura J; Galetta, Steven L; Minen, Mia T

2017-12-01

Given that post-traumatic headache is one of the most prevalent and long-lasting post-concussion sequelae, causes significant morbidity, and might be associated with slower neurocognitive recovery, we sought to evaluate the use of concussion screening scores in a concussion clinic population to assess for post-traumatic headache. This is a retrospective cross-sectional study of 254 concussion patients from the New York University (NYU) Concussion Registry. Data on the headache characteristics, concussion mechanism, concussion screening scores were collected and analyzed. 72% of the patients had post-traumatic headache. About half (56.3%) were women. The mean age was 35 (SD 16.2). 90 (35%) patients suffered from sport-related concussions (SRC). Daily post-traumatic headache patients had higher Sport Concussion Assessment Tool (SCAT)-3 symptom severity scores than the non-daily post-traumatic headache and the headache-free patients (50.2 [SD 28.2] vs. 33.1 [SD 27.5] vs. 21.6 SD23], p < 0.001). Patients with SRC had lower headache intensity (4.47 [SD 2.5] vs. 6.24 [SD 2.28], p < 0.001) and SCAT symptom severity scores (33.9 [SD 27.4] vs. 51.4 [SD 27.7], p < 0.001) than the other patients, but there were no differences in post-traumatic headache prevalence, frequency, and Standardized Assessment of Concussion (SAC) scores. The presence and frequency of post-traumatic headache are associated with the SCAT-3 symptom severity score, which is the most important predictor for post-concussion recovery. The SCAT-3 symptom severity score might be a useful tool to help characterize patients' post-traumatic headache.

Impact of Exercise on Clinical Symptom Report and Neurocognition after Concussion in Children and Adolescents.

PubMed

Manikas, Vicky; Babl, Franz E; Hearps, Stephen; Dooley, Julian; Anderson, Vicki

2017-06-01

Recovery from concussion in childhood is poorly understood, despite its importance in decisions regarding return to normal activity. Resolution of post-concussive symptoms (PCS) is widely employed as a marker of recovery in clinical practice; however, it is unclear whether subtle impairments persist only to re-emerge in the context of increased physical or cognitive demands. This study aimed to examine the effect of strenuous exercise on clinical symptom report and neurocognition in children and adolescents after PCS resolution after concussion. We recruited children and adolescents with concussion (n = 30) on presentation to an Emergency Department (ED). At Day 2 and Day 10 post-self-reported symptom resolution, participants completed a strenuous exercise protocol, and pre- and post-exercise assessment of PCS and neurocognition. Results demonstrated an overall reduction in PCS from Day 2 to Day 10 post-symptom resolution, with no evidence of symptom increase after strenuous exercise at either time point. Neurocognitive performance was linked to task complexity: on less cognitively demanding tasks, processing speed was slower post-exercise and, unexpectedly, slower on Day 10 than Day 2, while for more demanding tasks (new learning), Day 2 exercise resulted in faster responses, but Day 10 processing speed post-exercise was slower. In summary, we found the expected recovery pattern for PCS, regardless of exercise, while for neurocognition, recovery was dependent on the degree of cognitive demand, and there was an unexpected reduction in performance from Day 2 to Day 10. Findings provide some suggestion that premature return to normal activities (e.g., school) may slow neurocognitive recovery.

Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: pilot randomized controlled trial.

PubMed

Twamley, Elizabeth W; Jak, Amy J; Delis, Dean C; Bondi, Mark W; Lohr, James B

2014-01-01

Traumatic brain injury (TBI) can result in cognitive impairments and persistent postconcussive symptoms that limit functional recovery, including return to work. We evaluated a 12 wk compensatory cognitive training intervention (Cognitive Symptom Management and Rehabilitation Therapy [CogSMART]) in the context of supported employment for Veterans with mild to moderate TBI. Participants were randomly assigned to receive 12 wk of supported employment plus CogSMART or enhanced supported employment that controlled for therapist attention (control). CogSMART sessions were delivered by the employment specialist and included psychoeducation regarding TBI; strategies to improve sleep, fatigue, headaches, and tension; and compensatory cognitive strategies in the domains of prospective memory, attention, learning and memory, and executive functioning. Compared with controls, those assigned to supported employment plus CogSMART demonstrated significant reductions in postconcussive symptoms (Cohen d = 0.97) and improvements in prospective memory functioning (Cohen d = 0.72). Effect sizes favoring CogSMART for posttraumatic stress disorder symptom severity, depressive symptom severity, and attainment of competitive work within 14 wk were in the small to medium range (Cohen d = 0.35-0.49). Those who received CogSMART rated the intervention highly. Results suggest that adding CogSMART to supported employment may improve postconcussive symptoms and prospective memory. These effects, as well as smaller effects on psychiatric symptoms and ability to return to work, warrant replication in a larger trial.

The effect of preinjury sleep difficulties on neurocognitive impairment and symptoms after sport-related concussion.

PubMed

Sufrinko, Alicia; Pearce, Kelly; Elbin, R J; Covassin, Tracey; Johnson, Eric; Collins, Michael; Kontos, Anthony P

2015-04-01

Researchers have reported that sleep duration is positively related to baseline neurocognitive performance. However, researchers have yet to examine the effect of preinjury sleep difficulties on postconcussion impairments. To compare neurocognitive impairment and symptoms of athletes with preinjury sleep difficulties to those without after a sport-related concussion (SRC). Cohort study; Level of evidence, 3. The sample included 348 adolescent and adult athletes (age, mean ± SD, 17.43 ± 2.34 years) with a diagnosed SRC. The sample was divided into 2 groups: (1) 34 (10%) participants with preinjury sleep difficulties (sleeping less as well as having trouble falling asleep; SLEEP SX) and (2) 231 (66%) participants without preinjury sleep difficulties (CONTROL). The remaining 84 (24%) participants with minimal sleep difficulties (1 symptom) were excluded. Participants completed the Immediate Postconcussion Assessment and Cognitive Test (ImPACT) and Postconcussion Symptom Scale (PCSS) at baseline and 3 postinjury intervals (2, 5-7, and 10-14 days after injury). A series of repeated-measures analyses of covariance with Bonferroni correction, controlling for baseline non-sleep-related symptoms, were conducted to compare postinjury neurocognitive performance between groups. Follow-up exploratory t tests examined between-group differences at each time interval. A series of analyses of variance were used to examine total PCSS score, sleep-related, and non-sleep-related symptoms across time intervals between groups. Groups differed significantly in PCSS scores across postinjury intervals for reaction time (P < .001), with the preinjury SLEEP SX group performing worse than controls at 5-7 days (mean ± SD, 0.70 ± 0.32 [SLEEP SX], 0.60 ± 0.14 [CONTROL]) and 10-14 days (0.61 ± 0.17 [SLEEP SX]; 0.57 ± 0.10 [CONTROL]) after injury. Groups also differed significantly on verbal memory performance (P = .04), with the SLEEP SX (68.21 ± 18.64) group performing worse than the

Sensitivity and specificity of subacute computerized neurocognitive testing and symptom evaluation in predicting outcomes after sports-related concussion.

PubMed

Lau, Brian C; Collins, Michael W; Lovell, Mark R

2011-06-01

Concussions affect an estimated 136 000 high school athletes yearly. Computerized neurocognitive testing has been shown to be appropriately sensitive and specific in diagnosing concussions, but no studies have assessed its utility to predict length of recovery. Determining prognosis during subacute recovery after sports concussion will help clinicians more confidently address return-to-play and academic decisions. To quantify the prognostic ability of computerized neurocognitive testing in combination with symptoms during the subacute recovery phase from sports-related concussion. Cohort study (prognosis); Level of evidence, 2. In sum, 108 male high school football athletes completed a computer-based neurocognitive test battery within 2.23 days of injury and were followed until returned to play as set by international guidelines. Athletes were grouped into protracted recovery (>14 days; n = 50) or short-recovery (≤14 days; n = 58). Separate discriminant function analyses were performed using total symptom score on Post-Concussion Symptom Scale, symptom clusters (migraine, cognitive, sleep, neuropsychiatric), and Immediate Postconcussion Assessment and Cognitive Testing neurocognitive scores (verbal memory, visual memory, reaction time, processing speed). Multiple discriminant function analyses revealed that the combination of 4 symptom clusters and 4 neurocognitive composite scores had the highest sensitivity (65.22%), specificity (80.36%), positive predictive value (73.17%), and negative predictive value (73.80%) in predicting protracted recovery. Discriminant function analyses of total symptoms on the Post-Concussion Symptom Scale alone had a sensitivity of 40.81%; specificity, 79.31%; positive predictive value, 62.50%; and negative predictive value, 61.33%. The 4 symptom clusters alone discriminant function analyses had a sensitivity of 46.94%; specificity, 77.20%; positive predictive value, 63.90%; and negative predictive value, 62.86%. Discriminant function

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach.

PubMed

Ellis, Michael J; Leddy, John; Willer, Barry

2016-01-01

Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review, we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further evaluate this evolving pathophysiological approach.

Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach

PubMed Central

Ellis, Michael J.; Leddy, John; Willer, Barry

2016-01-01

Historically, patients with sports-related concussion (SRC) have been managed in a uniform fashion consisting mostly of prescribed physical and cognitive rest with the expectation that all symptoms will spontaneously resolve with time. Although this approach will result in successful return to school and sports activities in the majority of athletes, an important proportion will develop persistent concussion symptoms characteristic of post-concussion syndrome (PCS). Recent advances in exercise science, neuroimaging, and clinical research suggest that the clinical manifestations of PCS are mediated by unique pathophysiological processes that can be identified by features of the clinical history and physical examination as well as the use of graded aerobic treadmill testing. Athletes who develop PCS represent a unique population whose care must be individualized and must incorporate a rehabilitative strategy that promotes enhanced recovery of concussion-related symptoms while preventing physical deconditioning. In this review, we present our evolving evidence-based approach to evaluation and management of athletes with PCS that aims to identify the pathophysiological mechanisms mediating persistent concussion symptoms and guides the initiation of individually tailored rehabilitation programs that target these processes. In addition, we outline the important qualified roles that multi-disciplinary healthcare professionals can play in the management of this patient population, and discuss where future research efforts must be focused to further evaluate this evolving pathophysiological approach. PMID:27605923

Investigating Effects of Sex Differences and Prior Concussions on Symptom Reporting and Cognition Among Adolescent Soccer Players.

PubMed

Brooks, Brian L; Silverberg, Noah; Maxwell, Bruce; Mannix, Rebekah; Zafonte, Ross; Berkner, Paul D; Iverson, Grant L

2018-03-01

There has been increasing concern regarding the possible effect of multiple concussions on the developing brain, especially for adolescent females. Hypothesis/Purpose: The objectives were to determine if there are differences in cognitive functioning, symptom reporting, and/or sex effects from prior concussions. In a very large sample of youth soccer players, it was hypothesized that (1) there would be no differences in cognitive test performance between those with and without prior concussions, (2) baseline preseason symptoms would be better predicted by noninjury factors than concussion history, and (3) males and females with prior concussions would not have differences in cognition or symptoms. Cross-sectional study; Level of evidence, 3. Participants included 9314 youth soccer players (mean = 14.8 years, SD = 1.2) who completed preseason baseline cognitive testing, symptom reporting, and a health/injury history questionnaire from the ImPACT battery (Immediate Post-concussion Assessment and Cognitive Testing). On the basis of injury history, athletes were grouped by number of prior concussions: 0 (boys, n = 4012; girls, n = 3963), 1 (boys, n = 527; girls, n = 457), 2 (boys, n = 130; girls, n = 97), or ≥3 (boys, n = 73; girls, n = 55). The primary measures were the 4 primary cognitive scores and the total symptom ratings from ImPACT. Primary outcomes were assessed across injury groups, controlling for age, sex, learning disability, attention-deficit/hyperactivity disorder (ADHD), treatment for headaches/migraines, substance abuse, and mental health problems. Cognitive test performance was not associated with concussion history but was associated with sex, age, learning disability, ADHD, and prior mental health problems. Greater symptom reporting was more strongly associated with psychiatric problems, older age, learning disability, substance abuse, headaches, being female, and ADHD than with a history of multiple concussions. Boys and girls did not differ on

A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?

PubMed

Subbian, Vignesh; Ratcliff, Jonathan J; Korfhagen, Joseph J; Hart, Kimberly W; Meunier, Jason M; Shaw, George J; Lindsell, Christopher J; Beyette, Fred R

2016-04-01

Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of <100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with

A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma.

PubMed

Oeur, R Anna; Karton, Clara; Post, Andrew; Rousseau, Philippe; Hoshizaki, T Blaine; Marshall, Shawn; Brien, Susan E; Smith, Aynsley; Cusimano, Michael D; Gilchrist, Michael D

2015-08-01

Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p < 0.05. A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec(2), respectively) than the concussion group (149 g and 8111 rad/sec(2), respectively; p < 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for

[Alterations of brain network efficiency in patients with post-concussion syndrome].

PubMed

Peng, Nan; Qian, Ruobing; Fu, Xianming; Li, Shunli; Kang, Zhiqiang; Lin, Bin; Ji, Xuebing; Wei, Xiangpin; Niu, Chaoshi; Wang, Yehan

2015-07-07

To discuss the alterations of brain network efficiency in patients with post-concussion syndrome. A total of 23 patients from Anhui Provincial Hospital in the period from 2013/6 to 2014/3 who have had the concussion for 3 months were enrolled and 23 volunteers paired in sex, age and education were also enrolled as healthy controls. Comparisons of selective attention of both groups were conducted using Stroop Word-Color Test. The data of resting-state functional magnetic resonance imaging (fMRI) in both groups were collected and the data were dealt with Network Construction which is a part of GRETNA software to obtain the Matrix of brain network. Network analysis was used to obtain Global and Nodal efficiency, then independent t-test was used for statistical analyses of the value of Global and Nodal efficiency. The difference in Global efficiency of two groups in every threshold value had no statistical significance. Compared with healthy controls, the Nodal efficiencies in patients with post-concussion syndrome were significantly different in the brain regions as below: left orbital middle frontal gyrus, left posterior cingulate, left lingual, left thalamus, left superior temporal gyrus, right anterior cingulate, right posterior cingulate, right supramarginalgyrus. Compared with healthy controls, there is no significant changes of Globe efficiency in patients with post-concussion syndrome, and the brain function deficits in these patients may be caused by changes of Nodal efficiency in their brain network.

Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury.

PubMed

de Guise, Elaine; Bélanger, Sara; Tinawi, Simon; Anderson, Kirsten; LeBlanc, Joanne; Lamoureux, Julie; Audrit, Hélène; Feyz, Mitra

2016-01-01

The aim of the study was to determine if the Rivermead Postconcussion Symptoms Questionnaire (RPQ) is a better tool for outcome prediction than an objective neuropsychological assessment following mild traumatic brain injury (mTBI). The study included 47 patients with mTBI referred to an outpatient rehabilitation clinic. The RPQ and a brief neuropsychological battery were performed in the first few days following the trauma. The outcome measure used was the Mayo-Portland Adaptability Inventory-4 (MPAI-4) which was completed within the first 3 months. The only variable associated with results on the MPAI-4 was the RPQ score (p < .001). The predictive outcome model including age, education, and the results of the Trail-Making Test-Parts A and B (TMT) had a pseudo-R(2) of .02. When the RPQ score was added, the pseudo-R(2) climbed to .19. This model indicates that the usefulness of the RPQ score and the TMT in predicting moderate-to-severe limitations, while controlling for confounders, is substantial as suggested by a significant increase in the model chi-square value, delta (1df) = 6.517, p < .001. The RPQ and the TMT provide clinicians with a brief and reliable tool for predicting outcome functioning and can help target the need for further intervention and rehabilitation following mTBI.

Sub-Symptomatic Aerobic Exercise for Patients with Post-Concussion Syndrome: A Critically Appraised Topic.

PubMed

Ritter, Katrina G; Hussey, Matthew J; Valovich McLeod, Tamara C

2017-09-27

Clinical Scenario: Patients who experience prolonged concussion symptoms can be diagnosed with Post-Concussion Syndrome (PCS) when those symptoms persist past 4 weeks. Aerobic exercise protocols have been shown to be effective in improving physical and mental aspects of health. Emerging research suggests that aerobic exercise maybe useful as a treatment for PCS, where exercise allows patients to feel less isolated and more active during the recovery process. Is aerobic exercise more beneficial in reducing symptoms than current standard care in patients with prolonged symptoms or PCS lasting longer than 4 weeks? Summary of Key Findings: After a thorough literature search, 4 studies were selected relevant to the clinical question. Of the 4 studies, 1 was a randomized control trial and 3 were case series. All 4 studies investigate aerobic exercise protocol as treatment for PCS. 1-4 Three articles demonstrated a greater rate of symptom improvement from baseline assessment to follow-up after a controlled sub-symptomatic aerobic exercise program. 2-4 One study showed a decrease in symptoms in the aerobic exercise group compared to the full body stretching group. 1 Clinical Bottom Line: There is moderate evidence to support sub-symptomatic aerobic exercise as a treatment of PCS, therefore it should be considered as a clinical option for reducing PCS and prolonged concussion symptoms. A previously validated protocol, such as the Buffalo Concussion Treadmill Test, Balke Protocol, or Rating of Perceived Exertion (RPE) as mentioned in this critically appraised topic should be used to measure baseline values and treatment progression. Strength of Recommendation: Level C evidence exists that aerobic exercise protocol is more effective than the current standard of care in treating PCS.

Relationship Between Short Sleep Duration and Preseason Concussion Testing.

PubMed

Silverberg, Noah D; Berkner, Paul D; Atkins, Joseph E; Zafonte, Ross; Iverson, Grant L

2016-05-01

Baseline, preseason assessment of cognition, symptoms, and balance has been recommended as part of a comprehensive sport concussion management program. We examined the relationship between sleep and baseline test results. We hypothesized that adolescents who slept fewer hours the night before would report more symptoms and perform more poorly on cognitive testing than students who had a full night sleep. Cross-sectional observation study. Preseason concussion testing for high school athletes. A large sample (n = 2928) of student athletes from Maine, USA, between the ages of 13 and 18 years completed preseason testing. Participants with developmental problems, a history of treatment for neurological or psychiatric problems, recent concussion, or 3 or more prior concussions were excluded. Athletes were divided into 4 groups based on their sleep duration the night before testing. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT Applications, Inc, Pittsburgh, PA) cognitive composite scores and the embedded Post-Concussion Symptom Scale. Sleep was not related to any ImPACT cognitive composite score, after covarying for age and controlling for multiple comparisons. In contrast, there were sleep duration, sex, and sleep duration by sex effects on the Post-Concussion Symptom Scale. The effect of sleep duration on symptom reporting was more pronounced in girls. Supplementary analyses suggested that sleep insufficiency was associated with a diverse array of postconcussion-like symptoms. Poor sleep the night before baseline or postinjury testing may be an important confound when assessing postconcussion symptoms. Girls may be more vulnerable to experiencing and reporting symptoms following insufficient sleep. Clinicians should routinely ask how the athlete slept the night before preseason baseline testing and consider deferring the symptom assessment or later retesting athletes who slept poorly.

Influence of the severity and location of bodily injuries on post-concussive and combat stress symptom reporting after military-related concurrent mild traumatic brain injuries and polytrauma.

PubMed

French, Louis M; Lange, Rael T; Marshall, Kathryn; Prokhorenko, Olga; Brickell, Tracey A; Bailie, Jason M; Asmussen, Sarah B; Ivins, Brian; Cooper, Douglas B; Kennedy, Jan E

2014-10-01

Traumatic brain injuries (TBI) sustained in combat frequently co-occur with significant bodily injuries. Intuitively, more extensive bodily injuries might be associated with increased symptom reporting. In 2012, however, French et al. demonstrated an inverse relation between bodily injury severity and symptom reporting. This study expands on that work by examining the influence of location and severity of bodily injuries on symptom reporting after mild TBI. Participants were 579 US military service members who sustained an uncomplicated mild TBI with concurrent bodily injuries and who were evaluated at two military medical centers. Bodily injury severity was quantified using a modified Injury Severity Score (ISSmod). Participants completed the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist (PCL-C), on average, 2.5 months post-injury. There was a significant negative association between ISSmod scores and NSI (r=-0.267, p<0.001) and PCL-C (r=-0.273, p<0.001) total scores. Using linear regression to examine the relation between symptom reporting and injury severity across the six ISS body regions, three body regions were significant predictors of the NSI total score (face; p<0.001; abdomen; p=0.003; extremities; p<0.001) and accounted for 9.3% of the variance (p<0.001). For the PCL-C, two body regions were significant predictors of the PCL-C total score (face; p<0.001; extremities; p<0.001) and accounted for 10.5% of the variance. There was an inverse relation between bodily injury severity and symptom reporting in this sample. Hypothesized explanations include underreporting of symptoms, increased peer support, disruption of fear conditioning because of acute morphine use, or delayed expression of symptoms.

Trends in Post-Concussive Symptom Reporting Following Mild Traumatic Brain Injury in Operation Iraqi Freedom

DTIC Science & Technology

2011-04-01

complaints on the PDHA were examined and included pain (headache, back, joint, muscle), memory problems, sleep problems, and tinnitus . The PDHA also... aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for...PCS). 6-8 Common PCS symptoms include headache, tinnitus , sleep problems, chronic pain and cognitive deficits. 8 In 2004, the World Health

Persistent post-traumatic headache, postconcussion syndrome, and whiplash injuries: the evidence for a non-traumatic basis with an historical review.

PubMed

Evans, Randolph W

2010-04-01

There has been intense controversy about postconcussion syndrome since Erichsen's publication in 1866 on railway brain and railway spine. The fascinating history of this debate will be reviewed and then the non-organic explanations for postconcussion syndrome, headaches after head injury, and chronic whiplash injuries and headaches will be explored including the following: psychogenic, psychosocial, sociocultural, base rate misattribution, chronic pain, compensation and litigation, and malingering.

Mood symptoms correlate with kynurenine pathway metabolites following sports-related concussion.

PubMed

Singh, Rashmi; Savitz, Jonathan; Teague, T Kent; Polanski, David W; Mayer, Andrew R; Bellgowan, Patrick S F; Meier, Timothy B

2016-06-01

An imbalance of neuroactive kynurenine pathway metabolites has been proposed as one mechanism behind the neuropsychiatric sequelae of certain neurological disorders. We hypothesized that concussed football players would have elevated plasma levels of neurotoxic kynurenine metabolites and reduced levels of neuroprotective metabolites relative to healthy football players and that altered kynurenine levels would correlate with post-concussion mood symptoms. Mood scales and plasma concentrations of kynurenine metabolites were assessed in concussed (N=18; 1.61 days post-injury) and healthy football players (N=18). A subset of football players returned at 1-week (N=14; 9.29 days) and 1-month post-concussion (N=14, 30.93 days). Concussed athletes had significantly elevated levels of quinolinic acid (QUIN) and significantly lower ratios of kynurenic acid (KYNA) to QUIN at all time points compared with healthy athletes (p's<0.05), with no longitudinal evidence of normalization of KYNA or KYNA/QUIN. At 1-day post-injury, concussed athletes with lower levels of the putatively neuroprotective KYNA/QUIN ratio reported significantly worse depressive symptoms (p=0.04), and a trend toward worse anxiety symptoms (p=0.06), while at 1-month higher QUIN levels were associated with worse mood symptoms (p's<0.01). Finally, concussed athletes with worse concussion outcome, defined as number of days until return-to-play, had higher QUIN and lower KYNA/QUIN at 1-month post-injury (p's<0.05). These results converge with existing kynurenine literature on psychiatric patients and provide the first evidence of altered peripheral levels of kynurenine metabolites following sports-related concussion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Prevalence of neurocognitive and balance deficits in collegiate aged football players without clinically diagnosed concussion.

PubMed

Mulligan, Ivan; Boland, Mark; Payette, Justin

2012-07-01

Prospective cohort. To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition. Neurocognitive testing, balance assessments, and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected. Previous literature suggests many concussions go unreported. Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider. Forty-five Division IA collegiate football players participated in this study. Preseason baseline scores using the Balance Error Scoring System, the Immediate Post-Concussion Assessment and Cognitive Testing, and the Postconcussion Symptom Scale were compared to posttest results obtained 48 hours following a game. Prevalence of symptoms was analyzed and reported. Thirty-two (71%) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale, Balance Error Scoring System, or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing. Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function. In a cohort of football players tested 48 hours following their last game of the season, who did not seek medical attention related to a concussion, a significant number demonstrated limitations in neurocognitive and balance performance, suggesting that further research may need to be performed to improve recognition of an athlete's deficits and to improve the ability to assess concussion. Differential diagnosis/symptom prevalence, level 3b.

ASB clinical biomechanics award winner 2016: Assessment of gaze stability within 24-48hours post-concussion.

PubMed

Murray, Nicholas G; D'Amico, Nathan R; Powell, Douglas; Mormile, Megan E; Grimes, Katelyn E; Munkasy, Barry A; Gore, Russell K; Reed-Jones, Rebecca J

2017-05-01

Approximately 90% of athletes with concussion experience a certain degree of visual system dysfunction immediately post-concussion. Of these abnormalities, gaze stability deficits are denoted as among the most common. Little research quantitatively explores these variables post-concussion. As such, the purpose of this study was to investigate and compare gaze stability between a control group of healthy non-injured athletes and a group of athletes with concussions 24-48hours post-injury. Ten collegiate NCAA Division I athletes with concussions and ten healthy control collegiate athletes completed two trials of a sport-like antisaccade postural control task, the Wii Fit Soccer Heading Game. During play all participants were instructed to minimize gaze deviations away from a central fixed area. Athletes with concussions were assessed within 24-48 post-concussion while healthy control data were collected during pre-season athletic screening. Raw ocular point of gaze coordinates were tracked with a monocular eye tracking device (240Hz) and motion capture during the postural task to determine the instantaneous gaze coordinates. This data was exported and analyzed using a custom algorithm. Independent t-tests analyzed gaze resultant distance, prosaccade errors, mean vertical velocity, and mean horizontal velocity. Athletes with concussions had significantly greater gaze resultant distance (p=0.006), prosaccade errors (p<0.001), and horizontal velocity (p=0.029) when compared to healthy controls. These data suggest that athletes with concussions had less control of gaze during play of the Wii Fit Soccer Heading Game. This could indicate a gaze stability deficit via potentially reduced cortical inhibition that is present within 24-48hours post-concussion. Copyright © 2017 Elsevier Ltd. All rights reserved.

Neuropsychological Performance and Subjective Symptom Reporting in Military Service Members With a History of Multiple Concussions: Comparison With a Single Concussion, Posttraumatic Stress Disorder, and Orthopedic Trauma.

PubMed

Cooper, Douglas B; Curtiss, Glenn; Armistead-Jehle, Patrick; Belanger, Heather G; Tate, David F; Reid, Matthew; Bowles, Amy O; Velez, Carmen S; Kennedy, Jan E; Vanderploeg, Rodney D

To examine differences in objective neurocognitive performance and subjective cognitive symptoms in individuals with a history of a single concussion, multiple concussions, orthopedic injuries, and posttraumatic stress disorder (PTSD). Participants included 116 military service members who sustained a mild traumatic brain injury (mTBI) during combat deployment. Subjects were subdivided into groups based on concussion frequency: a single concussion (n = 42), 2 concussions (n = 21), and 3 or more concussions (n = 53). Eighty-one subjects sustained an orthopedic injury (n = 60) during deployment or were diagnosed with PTSD (n = 21), but had no history of mTBI. Subjects completed a battery of neuropsychological tests and self-report measures of postconcussive symptoms, PTSD symptoms, and psychopathology. No differences were found among the concussion groups on a composite neuropsychological measure. The PTSD group had the highest number of symptom complaints, with the 2-concussion and 3-plus-concussion groups being most similar to the PTSD group. The concussion groups showed a nonsignificant pattern of increasing distress with increasing number of concussions. The current findings are consistent with meta-analytic results showing no differential effect on neuropsychological functioning due to multiple concussions. Results also support the burden of adversity hypothesis suggesting increasing symptom levels with increasing psychological or physically traumatic exposures.

Which symptom assessments and approaches are uniquely appropriate for paediatric concussion?

PubMed

Gioia, G A; Schneider, J C; Vaughan, C G; Isquith, P K

2009-05-01

To (a) identify post-concussion symptom scales appropriate for children and adolescents in sports; (b) review evidence for reliability and validity; and (c) recommend future directions for scale development. Quantitative and qualitative literature review of symptom rating scales appropriate for children and adolescents aged 5 to 22 years. Literature identified via search of Medline, Ovid-Medline and PsycInfo databases; review of reference lists in identified articles; querying sports concussion specialists. 29 articles met study inclusion criteria. 5 symptom scales examined in 11 studies for ages 5-12 years and in 25 studies for ages 13-22. 10 of 11 studies for 5-12-year-olds presented validity evidence for three scales; 7 studies provided reliability evidence for two scales; 7 studies used serial administrations but no reliable change metrics. Two scales included parent-reports and one included a teacher report. 24 of 25 studies for 13-22 year-olds presented validity evidence for five measures; seven studies provided reliability evidence for four measures with 18 studies including serial administrations and two examining Reliable Change. Psychometric evidence for symptom scales is stronger for adolescents than for younger children. Most scales provide evidence of concurrent validity, discriminating concussed and non-concussed groups. Few report reliability and evidence for validity is narrow. Two measures include parent/teacher reports. Few scales examine reliable change statistics, limiting interpretability of temporal changes. Future studies are needed to fully define symptom scale psychometric properties with the greatest need in younger student-athletes.

[Formula: see text]Interpreting change on the neurobehavioral symptom inventory and the PTSD checklist in military personnel.

PubMed

Belanger, Heather G; Lange, Rael T; Bailie, Jason; Iverson, Grant L; Arrieux, Jacques P; Ivins, Brian J; Cole, Wesley R

2016-10-01

The purpose of this study was to examine the prevalence and stability of symptom reporting in a healthy military sample and to develop reliable change indices for two commonly used self-report measures in the military health care system. Participants were 215 U.S. active duty service members recruited from Fort Bragg, NC as normal controls as part of a larger study. Participants completed the Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Checklist (PCL) twice, separated by approximately 30 days. Depending on the endorsement level used (i.e. ratings of 'mild' or greater vs. ratings of 'moderate' or greater), approximately 2-15% of this sample met DSM-IV symptom criteria for Postconcussional Disorder across time points, while 1-6% met DSM-IV symptom criteria for Posttraumatic Stress Disorder. Effect sizes for change from Time 1 to Time 2 on individual symptoms were small (Cohen's d = .01 to .13). The test-retest reliability for the NSI total score was r = .78 and the PCL score was r = .70. An eight-point change in symptom reporting represented reliable change on the NSI total score, with a seven-point change needed on the PCL. Postconcussion-like symptoms are not unique to mild TBI and are commonly reported in a healthy soldier sample. It is important for clinicians to use normative data when evaluating a service member or veteran and when evaluating the likelihood that a change in symptom reporting is reliable and clinically meaningful.

Cross-Phenotype Polygenic Risk Score Analysis of Persistent Post-Concussive Symptoms in U.S. Army Soldiers with Deployment-Acquired Traumatic Brain Injury

PubMed Central

Polimanti, Renato; Chen, Chia-Yen; Ursano, Robert J.; Heeringa, Steven G.; Jain, Sonia; Kessler, Ronald C.; Nock, Matthew K.; Smoller, Jordan W.; Sun, Xiaoying; Gelernter, Joel

2017-01-01

Abstract Traumatic brain injury (TBI) contributes to the increased rates of suicide and post-traumatic stress disorder in military personnel and veterans, and it is also associated with the risk for neurodegenerative and psychiatric disorders. A cross-phenotype high-resolution polygenic risk score (PRS) analysis of persistent post-concussive symptoms (PCS) was conducted in 845 U.S. Army soldiers who sustained TBI during their deployment. We used a prospective longitudinal survey of three brigade combat teams to assess deployment-acquired TBI and persistent physical, cognitive, and emotional PCS. PRS was derived from summary statistics of large genome-wide association studies of Alzheimer's disease, Parkinson's disease, schizophrenia, bipolar disorder, and major depressive disorder (MDD); and for years of schooling, college completion, childhood intelligence, infant head circumference (IHC), and adult intracranial volume. Although our study had more than 95% of statistical power to detect moderate-to-large effect sizes, no association was observed with neurodegenerative and psychiatric disorders, suggesting that persistent PCS does not share genetic components with these traits to a moderate-to-large degree. We observed a significant finding: subjects with high IHC PRS recovered better from cognitive/emotional persistent PCS than the other individuals (R2 = 1.11%; p = 3.37 × 10−3). Enrichment analysis identified two significant Gene Ontology (GO) terms related to this result: GO:0050839∼Cell adhesion molecule binding (p = 8.9 × 10−6) and GO:0050905∼Neuromuscular process (p = 9.8 × 10−5). In summary, our study indicated that the genetic predisposition to persistent PCS after TBI does not have substantial overlap with neurodegenerative and psychiatric diseases, but mechanisms related to early brain growth may be involved. PMID:27439997

High symptom reporters are less interoceptively accurate in a symptom-related context.

PubMed

Bogaerts, Katleen; Millen, An; Li, Wan; De Peuter, Steven; Van Diest, Ilse; Vlemincx, Elke; Fannes, Stien; Van den Bergh, Omer

2008-11-01

We investigated the role of a symptom interpretation frame on the accuracy of interoception and on retrospective symptom reporting in nonclinical high and low reporters of medically unexplained symptoms. All participants (N=74) went through two subsequent trials of the Rebreathing Test, inducing altered respiration and other physical sensations as a result of a gradually increasing pCO(2) level in the blood. Each trial consisted of a baseline (60 s), a rebreathing phase (150 s), and a recovery phase (150 s). In one trial, the sensations were framed in a neutral way ("the gas mixture might alter breathing behavior and induce respiratory sensations"). In the other trial, a symptom frame was induced ("the gas mixture might alter breathing behavior and induce respiratory symptoms"). Breathing behavior was continuously monitored, subjective sensations were rated every 10 s, and after each trial, participants filled out a symptom checklist. Within-subject correlations between the subjective rating and its physiological referent were calculated for the rebreathing phase and recovery phase of each trial separately. High symptom reporters had more (retrospective) complaints than low symptom reporters, especially in the symptom trial. Only in the symptom frame were high symptom reporters less accurate than low symptom reporters. The reduction in interoceptive accuracy (IA) in high symptom reporters was most striking in the recovery phase of the symptom frame trial. A contextual cue, such as a reference to symptoms, reduced IA in high symptom reporters and this was more so during recovery from the symptom induction.

The Minnesota Multiphasic Personality Inventory-2-RF in Treatment-Seeking Veterans with History of Mild Traumatic Brain Injury.

PubMed

Jurick, S M; Crocker, L D; Keller, A V; Hoffman, S N; Bomyea, J; Jacobson, M W; Jak, A J

2018-05-30

This study examined the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form (MMPI-2-RF) to better understand symptom presentation in a sample of treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with self-reported history of mild traumatic brain injury (mTBI). Participants underwent a comprehensive clinical neuropsychological battery including performance and symptom validity measures and self-report measures of depressive, posttraumatic, and post-concussive symptomatology. Those with possible symptom exaggeration (SE+) on the MMPI-2-RF were compared with those without (SE-) with regard to injury, psychiatric, validity, and cognitive variables. Between 50% and 87% of participants demonstrated possible symptom exaggeration on one or more MMPI-2-RF validity scales, and a large majority were elevated on content scales related to cognitive, somatic, and emotional complaints. The SE+ group reported higher depressive, posttraumatic, and post-concussive symptomatology, had higher scores on symptom validity measures, and performed more poorly on neuropsychological measures compared with the SE- group. There were no group differences with regard to injury variables or performance validity measures. Participants were more likely to exhibit possible symptom exaggeration on cognitive/somatic compared with traditional psychopathological validity scales. A sizable portion of treatment-seeking OEF/OIF Veterans demonstrated possible symptom exaggeration on MMPI-2-RF validity scales, which was associated with elevated scores on self-report measures and poorer cognitive performance, but not higher rates of performance validity failure, suggesting symptom and performance validity are distinct concepts. These findings have implications for the interpretation of clinical data in the context of possible symptom exaggeration and treatment in Veterans with persistent post-concussive symptoms.

Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder

PubMed Central

Harch, Paul G.; Andrews, Susan R.; Fogarty, Edward F.; Lucarini, Juliette; Van Meter, Keith W.

2017-01-01

Mild traumatic brain injury (TBI) persistent post-concussion syndrome (PPCS) and post-traumatic stress disorder (PTSD) are epidemic in United States Iraq and Afghanistan War veterans. Treatment of the combined diagnoses is limited. The aim of this study is to assess safety, feasibility, and effectiveness of hyperbaric oxygen treatments (HBOT) for mild TBI PPCS and PTSD. Thirty military subjects aged 18–65 with PPCS with or without PTSD and from one or more blast-induced mild-moderate traumatic brain injuries that were a minimum of 1 year old and occurred after 9/11/2001 were studied. The measures included symptom lists, physical exam, neuropsychological and psychological testing on 29 subjects (1 dropout) and SPECT brain imaging pre and post HBOT. Comparison was made using SPECT imaging on 29 matched Controls. Side effects (30 subjects) experienced due to the HBOT: reversible middle ear barotrauma (n = 6), transient deterioration in symptoms (n = 7), reversible bronchospasm (n = 1), and increased anxiety (n = 2; not related to confinement); unrelated to HBOT: ureterolithiasis (n = 1), chest pain (n = 2). Significant improvement (29 subjects) was seen in neurological exam, symptoms, intelligence quotient, memory, measures of attention, dominant hand motor speed and dexterity, quality of life, general anxiety, PTSD, depression (including reduction in suicidal ideation), and reduced psychoactive medication usage. At 6-month follow-up subjects reported further symptomatic improvement. Compared to Controls the subjects' SPECT was significantly abnormal, significantly improved after 1 and 40 treatments, and became statistically indistinguishable from Controls in 75% of abnormal areas. HBOT was found to be safe and significantly effective for veterans with mild to moderate TBI PPCS with PTSD in all four outcome domains: clinical medicine, neuropsychology, psychology, and SPECT imaging. Veterans also experienced a significant reduction in suicidal ideation and reduction

Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder.

PubMed

Harch, Paul G; Andrews, Susan R; Fogarty, Edward F; Lucarini, Juliette; Van Meter, Keith W

2017-01-01

Mild traumatic brain injury (TBI) persistent post-concussion syndrome (PPCS) and post-traumatic stress disorder (PTSD) are epidemic in United States Iraq and Afghanistan War veterans. Treatment of the combined diagnoses is limited. The aim of this study is to assess safety, feasibility, and effectiveness of hyperbaric oxygen treatments (HBOT) for mild TBI PPCS and PTSD. Thirty military subjects aged 18-65 with PPCS with or without PTSD and from one or more blast-induced mild-moderate traumatic brain injuries that were a minimum of 1 year old and occurred after 9/11/2001 were studied. The measures included symptom lists, physical exam, neuropsychological and psychological testing on 29 subjects (1 dropout) and SPECT brain imaging pre and post HBOT. Comparison was made using SPECT imaging on 29 matched Controls. Side effects (30 subjects) experienced due to the HBOT: reversible middle ear barotrauma ( n = 6), transient deterioration in symptoms ( n = 7), reversible bronchospasm ( n = 1), and increased anxiety ( n = 2; not related to confinement); unrelated to HBOT: ureterolithiasis ( n = 1), chest pain ( n = 2). Significant improvement (29 subjects) was seen in neurological exam, symptoms, intelligence quotient, memory, measures of attention, dominant hand motor speed and dexterity, quality of life, general anxiety, PTSD, depression (including reduction in suicidal ideation), and reduced psychoactive medication usage. At 6-month follow-up subjects reported further symptomatic improvement. Compared to Controls the subjects' SPECT was significantly abnormal, significantly improved after 1 and 40 treatments, and became statistically indistinguishable from Controls in 75% of abnormal areas. HBOT was found to be safe and significantly effective for veterans with mild to moderate TBI PPCS with PTSD in all four outcome domains: clinical medicine, neuropsychology, psychology, and SPECT imaging. Veterans also experienced a significant reduction in suicidal ideation and

Effects of Sleep Loss on Subjective Complaints and Objective Neurocognitive Performance as Measured by the Immediate Post-Concussion Assessment and Cognitive Testing.

PubMed

Stocker, Ryan P J; Khan, Hassen; Henry, Luke; Germain, Anne

2017-05-01

This study examined the effects of total and partial sleep deprivation on subjective symptoms and objective neurocognitive performance, as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in a sample of healthy adults. One-hundred and two, right-handed, healthy participants (between ages 18 and 30 years old) completed three consecutive nights in the sleep laboratory with concurrent continuous polysomnography monitoring. Night 1 served as a baseline night. Prior to Night 2, they were randomly assigned to one of three sleep conditions: undisrupted normal sleep (N = 34), sleep restriction (50% of habitual sleep, N = 37), or total sleep deprivation (N = 31). Participants slept undisturbed on Night 3. ImPACT was administered on three separate occasions. Sleep loss was associated with increased severity of subjectively reported affective, cognitive, physical, and sleep symptoms. Although objective neurocognitive task scores derived from the ImPACT battery did not corroborate subjective complaints, sleep loss was associated with significant differences on tasks of visual memory, reaction time, and visual motor speed over time. While self-report measures suggested marked impairments following sleep loss, deficits in neurocognitive performance were observed only on three domains measured with ImPACT. ImPACT may capture subtle changes in neurocognitive performance following sleep loss; however, independent and larger validation studies are needed to determine its sensitivity to acute sleep loss and recovery sleep. Neurocognitive screening batteries may be useful for detecting the effects of more severe or chronic sleep loss under high-stress conditions that mimic high-risk occupations. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Adversity and Resilience Are Associated with Outcome after Mild Traumatic Brain Injury in Military Service Members.

PubMed

Reid, Matthew W; Cooper, Douglas B; Lu, Lisa H; Iverson, Grant L; Kennedy, Jan E

2018-05-15

The objective of this study was to assess the associations between resilience, adversity, post-concussion symptoms, and post-traumatic stress symptom reporting after mild traumatic brain injury (mTBI). We hypothesized that resilience would be associated with less symptom reporting, and adversity would be associated with greater symptom reporting. This was a cross-sectional study of retrospective data collected for an ongoing TBI repository. United States military service members who screened positive for mTBI during a primary care visit completed the Trauma History Screen (THS), Connor-Davidson Resilience Scale (CD-RISC), Neurobehavioral Symptom Inventory (NSI), and post-traumatic stress disorder (PTSD) Checklist-Civilian Version (PCL-C). Data collected from February 2015 to August 2016 were used for the present study. Only participants with complete data for the above measures were included, yielding a sample size of 165 participants. Adversity (THS) and resilience (CD-RISC) scores were each correlated significantly with post-concussion (NSI) and traumatic stress (PCL-C) total and subscale scores in the hypothesized direction. Interactions between adversity and resilience were absent for all measures except the NSI sensory subscale. Four traumatic event types were significantly associated positively with most NSI and PCL-C total and subscale scores, but the age at which traumatic events were first experienced showed few and mixed significant associations. In conclusion, resilience and adversity were significantly associated with symptom endorsement after mTBI. Screening for cumulative adversity may identify individuals at greater risk of developing persistent post-concussion symptoms and/or PTSD, and interventions that increase resilience may reduce symptom severity.

Multimodal imaging of mild traumatic brain injury and persistent postconcussion syndrome.

PubMed

Dean, Philip Ja; Sato, Joao R; Vieira, Gilson; McNamara, Adam; Sterr, Annette

2015-01-01

Persistent postconcussion syndrome (PCS) occurs in around 5-10% of individuals after mild traumatic brain injury (mTBI), but research into the underlying biology of these ongoing symptoms is limited and inconsistent. One reason for this could be the heterogeneity inherent to mTBI, with individualized injury mechanisms and psychological factors. A multimodal imaging study may be able to characterize the injury better. To look at the relationship between functional (fMRI), structural (diffusion tensor imaging), and metabolic (magnetic resonance spectroscopy) data in the same participants in the long term (>1 year) after injury. It was hypothesized that only those mTBI participants with persistent PCS would show functional changes, and that these changes would be related to reduced structural integrity and altered metabolite concentrations. Functional changes associated with persistent PCS after mTBI (>1 year postinjury) were investigated in participants with and without PCS (both n = 8) and non-head injured participants (n = 9) during performance of working memory and attention/processing speed tasks. Correlation analyses were performed to look at the relationship between the functional data and structural and metabolic alterations in the same participants. There were no behavioral differences between the groups, but participants with greater PCS symptoms exhibited greater activation in attention-related areas (anterior cingulate), along with reduced activation in temporal, default mode network, and working memory areas (left prefrontal) as cognitive load was increased from the easiest to the most difficult task. Functional changes in these areas correlated with reduced structural integrity in corpus callosum and anterior white matter, and reduced creatine concentration in right dorsolateral prefrontal cortex. These data suggest that the top-down attentional regulation and deactivation of task-irrelevant areas may be compensating for the reduction in working

Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is "Typical"?

PubMed

Hunt, Anne Williams; Paniccia, Melissa; Reed, Nick; Keightley, Michelle

2016-10-01

After a concussion, guidelines emphasize that an athlete should be asymptomatic before starting a return-to-play protocol. However, many concussion symptoms are nonspecific and may be present in individuals without concussion. Limited evidence exists regarding the presence of "typical" or preinjury (baseline) symptoms in child and youth athletes. To describe the frequency of symptoms reported at baseline by child and youth athletes and identify how age, sex, history of concussion, and learning factors influence the presence of baseline symptoms. Cross-sectional cohort study. Baseline testing was conducted at a hospital research laboratory or in a sport or school setting (eg, gym or arena). A total of 888 child (9-12 years old, n = 333) and youth (13-17 years old, n = 555) athletes participated (46.4% boys and 53.6% girls, average age = 13.09 ± 1.83 years). Demographic and symptom data were collected as part of a baseline protocol. Age-appropriate versions of the Post-Concussion Symptom Inventory (a self-report concussion-symptoms measure with strong psychometric properties for pediatric populations) were administered. Demographic data (age, sex, concussion history, learning factors) were also collected. Common baseline symptoms for children were feeling sleepier than usual (30% boys, 24% girls) and feeling nervous or worried (17% boys, 25% girls). Fatigue was reported by more than half of the youth group (50% boys, 67% girls). Nervousness was reported by 32% of youth girls. Headaches, drowsiness, and difficulty concentrating were each reported by 25% of youth boys and girls. For youths, a higher total symptom score was associated with increasing age and number of previous concussions, although these effects were small (age r s = 0.143, number of concussions r s = .084). No significant relationships were found in the child group. Children and youths commonly experienced symptoms at baseline, including fatigue and nervousness. Whether clinicians should expect

Quantitative EEG Neurometric Analysis-Guided Neurofeedback Treatment in Postconcussion Syndrome (PCS): Forty Cases. How Is Neurometric Analysis Important for the Treatment of PCS and as a Biomarker?

PubMed

Surmeli, Tanju; Eralp, Emin; Mustafazade, Ilham; Kos, Ismet Hadi; Özer, Gül Elif; Surmeli, Orkun H

2017-05-01

Postconcussion syndrome (PCS) has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on magnetic resonance imaging and computed tomography scans. In this clinical case series, the efficacy of quantitative EEG-guided neurofeedback in 40 subjects diagnosed with PCS was investigated. Overall improvement was seen in all the primary (Symptom Assessment-45 Questionnaire, Clinical Global Impressions Scale, Hamilton Depression Scale) and secondary measures (Minnesota Multiphasic Personality Inventory, Test of Variables for Attention). The Neuroguide Traumatic Brain Index for the group also showed a decrease. Thirty-nine subjects were followed up long term with an average follow-up length of 3.1 years (CI = 2.7-3.3). All but 2 subjects were stable and were off medication. Overall neurofeedback treatment was shown to be effective in this group of subjects studied.

The role of the cervical spine in post-concussion syndrome.

PubMed

Marshall, Cameron M; Vernon, Howard; Leddy, John J; Baldwin, Bradley A

2015-07-01

While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.

Physical Activity Level and Symptom Duration Are Not Associated After Concussion.

PubMed

Howell, David R; Mannix, Rebekah C; Quinn, Bridget; Taylor, J Andrew; Tan, Can Ozan; Meehan, William P

2016-04-01

Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. Cohort study; Level of evidence, 2. This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms. © 2016 The Author(s).

Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is “Typical”?

PubMed Central

Hunt, Anne Williams; Paniccia, Melissa; Reed, Nick; Keightley, Michelle

2016-01-01

Context: After a concussion, guidelines emphasize that an athlete should be asymptomatic before starting a return-to-play protocol. However, many concussion symptoms are nonspecific and may be present in individuals without concussion. Limited evidence exists regarding the presence of “typical” or preinjury (baseline) symptoms in child and youth athletes. Objective: To describe the frequency of symptoms reported at baseline by child and youth athletes and identify how age, sex, history of concussion, and learning factors influence the presence of baseline symptoms. Design: Cross-sectional cohort study. Setting: Baseline testing was conducted at a hospital research laboratory or in a sport or school setting (eg, gym or arena). Patients or Other Participants: A total of 888 child (9−12 years old, n = 333) and youth (13−17 years old, n = 555) athletes participated (46.4% boys and 53.6% girls, average age = 13.09 ± 1.83 years). Main Outcome Measure(s): Demographic and symptom data were collected as part of a baseline protocol. Age-appropriate versions of the Post-Concussion Symptom Inventory (a self-report concussion-symptoms measure with strong psychometric properties for pediatric populations) were administered. Demographic data (age, sex, concussion history, learning factors) were also collected. Results: Common baseline symptoms for children were feeling sleepier than usual (30% boys, 24% girls) and feeling nervous or worried (17% boys, 25% girls). Fatigue was reported by more than half of the youth group (50% boys, 67% girls). Nervousness was reported by 32% of youth girls. Headaches, drowsiness, and difficulty concentrating were each reported by 25% of youth boys and girls. For youths, a higher total symptom score was associated with increasing age and number of previous concussions, although these effects were small (age rs = 0.143, number of concussions rs = .084). No significant relationships were found in the child group. Conclusions: Children and

Sex Differences and Self-Reported Attention Problems During Baseline Concussion Testing.

PubMed

Brooks, Brian L; Iverson, Grant L; Atkins, Joseph E; Zafonte, Ross; Berkner, Paul D

2016-01-01

Amateur athletic programs often use computerized cognitive testing as part of their concussion management programs. There is evidence that athletes with preexisting attention problems will have worse cognitive performance and more symptoms at baseline testing. The purpose of this study was to examine whether attention problems affect assessments differently for male and female athletes. Participants were drawn from a database that included 6,840 adolescents from Maine who completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) at baseline (primary outcome measure). The final sample included 249 boys and 100 girls with self-reported attention problems. Each participant was individually matched for sex, age, number of past concussions, and sport to a control participant (249 boys, 100 girls). Boys with attention problems had worse reaction time than boys without attention problems. Girls with attention problems had worse visual-motor speed than girls without attention problems. Boys with attention problems reported more total symptoms, including more cognitive-sensory and sleep-arousal symptoms, compared with boys without attention problems. Girls with attention problems reported more cognitive-sensory, sleep-arousal, and affective symptoms than girls without attention problems. When considering the assessment, management, and outcome from concussions in adolescent athletes, it is important to consider both sex and preinjury attention problems regarding cognitive test results and symptom reporting.

Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment

PubMed Central

Arciniegas, David B; Anderson, C Alan; Topkoff, Jeannie; McAllister, Thomas W

2005-01-01

Traumatic brain injury (TBI) is a common occurrence in the United States, with an estimated incidence exceeding 1 million injuries per year. Cognitive, emotional, behavioral, and physical impairments are common sequelae of TBI and may, in a significant minority of patients, persist well into the late period following injury. The etiology of these symptoms in individuals with mild TBI is controversial, with hypotheses of postconcussive symptom formation variously ascribing greater or lesser weight to neural damage, pre- and/or post-injury psychological or psychiatric factors, somatization, malingering, or some combination of these. Some of these hypotheses reflect biases common to medicolegal or compensation-related contexts, whereas others are derived from recent neuroimaging and electrophysiology studies. Studies of the latter sort suggest that many of the typical postconcussive symptoms are associated with neurobiological dysfunction in one or more areas of the central nervous system. Whether these symptoms constitute a postconcussive syndrome per se is debatable. Instead, it may be more accurate to describe them as commonly co-occurring symptoms rather than as a syndromal sequela of TBI. The present review addresses these issues including the epidemiology and course of recovery from mild TBI and the validity of the postconcussive syndrome. Suggestions regarding the assessment and treatment of individuals with post-concussive symptoms are offered. PMID:18568112

The Utility of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in US Military Veterans With a History of Mild Traumatic Brain Injury.

PubMed

OʼRourke, Justin; Critchfield, Edan; Soble, Jason; Bain, Kathleen; Fullen, Chrystal; Eapen, Blessen

2018-05-31

To examine the utility of the Mayo-Portland Adaptability Inventory-4th Edition Participation Index (M2PI) as a self-report measure of functional outcome following mild traumatic brain injury (mTBI) in US Military veterans. Department of Veterans Affairs Polytrauma Rehabilitation Center specialty hospital. On hundred thirty-nine veterans with a history of self-reported mTBI. Retrospective cross-sectional examination of data collected from regular clinical visits. M2PI, Neurobehavioral Symptoms Inventory with embedded validity measures, Posttraumatic Stress Disorder Checklist-Military Version. Forty-one percent of the sample provided symptom reports that exceeded established cut scores on embedded symptom validity tests. Invalid responders had higher levels of unemployment and endorsed significantly greater functional impairment, posttraumatic stress symptoms, and postconcussive complaints. For valid responders, regression analyses revealed that self-reported functioning was primarily related to posttraumatic stress complaints, followed by postconcussive cognitive complaints. For invalid responders, posttraumatic stress complaints also predicted self-reported functioning. Caution is recommended when utilizing the M2PI to measure functional outcome following mTBI in military veterans, particularly in the absence of symptom validity tests.

Predictors of postconcussion syndrome after sports-related concussion in young athletes: a matched case-control study.

PubMed

Morgan, Clinton D; Zuckerman, Scott L; Lee, Young M; King, Lauren; Beaird, Susan; Sills, Allen K; Solomon, Gary S

2015-06-01

OBJECT Sport-related concussion (SRC) is a major public health problem. Approximately 90% of SRCs in high school athletes are transient; symptoms recover to baseline within 1 week. However, a small percentage of patients remain symptomatic several months after injury, with a condition known as postconcussion syndrome (PCS). The authors aimed to identify risk factors for PCS development in a cohort of exclusively young athletes (9-18 years of age) who sustained SRCs while playing a sport. METHODS The authors conducted a retrospective case-control study by using the Vanderbilt Sports Concussion Clinic database. They identified 40 patients with PCS and matched them by age at injury and sex to SRC control patients (1 PCS to 2 control). PCS patients were those experiencing persistent symptoms at 3 months after an SRC. Control patients were those with documented resolution of symptoms within 3 weeks of an SRC. Data were collected in 4 categories: 1) demographic variables; 2) key medical, psychiatric, and family history; 3) acute-phase postinjury symptoms (at 0-24 hours); and 4) subacute-phase postinjury features (at 0-3 weeks). The chi-square Fisher exact test was used to assess categorical variables, and the Mann-Whitney U-test was used to evaluate continuous variables. Forward stepwise regression models (Pin = 0.05, Pout = 0.10) were used to identify variables associated with PCS. RESULTS PCS patients were more likely than control patients to have a concussion history (p = 0.010), premorbid mood disorders (p = 0.002), other psychiatric illness (p = 0.039), or significant life stressors (p = 0.036). Other factors that increased the likelihood of PCS development were a family history of mood disorders, other psychiatric illness, and migraine. Development of PCS was not predicted by race, insurance status, body mass index, sport, helmet use, medication use, and type of symptom endorsement. A final logistic regression analysis of candidate variables showed PCS to be

Sensitivity and specificity of the online version of ImPACT in high school and collegiate athletes.

PubMed

Schatz, Philip; Sandel, Natalie

2013-02-01

The utility of postconcussion neurocognitive testing versus symptom data has been debated. The sensitivity of the desktop version of the Immediate Post-concussion assessment and cognitive testing (ImPACT) tool has been documented, but psychometric properties of the recently released online version of ImPACT have yet to be fully established. To document the sensitivity of the online ImPACT version in samples of (1) symptomatic concussed (high school and collegiate) athletes, and (2) asymptomatic concussed (high school and collegiate) athletes suspected of hiding their concussions. Cohort study; level of evidence, 3. A total of 81 athletes observed to sustain a concussion by a certified athletic trainer or team physician, a finding that was confirmed with reported postconcussion symptoms, completed the ImPACT test within 3 days of injury. Data were compared with an independent sample of 81 athletes who completed preseason baseline cognitive assessments using ImPACT and who were matched (with concussed athletes) on the basis of sex, age, sport, concussion history, and absence of attention deficit hyperactivity disorder and learning disability. An independent group of 37 athletes who were also observed to sustain a concussion completed ImPACT within 3 days of injury. These athletes reported no postconcussion symptoms but were noted for suspected invalid response patterns on ImPACT (impulse control index >30 and verbal memory index <69%). The subscale data from the assessments (excluding those contributing to the aforementioned indices) were compared with a matched sample of 37 athletes who completed preseason baseline cognitive assessments in ImPACT (using the same criteria described above). Data from the ImPACT online version yielded 91.4% sensitivity and 69.1% specificity. For asymptomatic athletes suspected of hiding their concussion, data from ImPACT yielded 94.6% sensitivity and 97.3% specificity. The online version of the ImPACT tool is a valid measure of

The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk.

PubMed

Legarreta, Andrew D; Brett, Benjamin L; Solomon, Gary S; Zuckerman, Scott L

2018-06-01

OBJECTIVE Sport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named postconcussion syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS. METHODS A retrospective cohort study of 154 high school athletes with complete documentation of postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate regression analyses examined specific FPH pathologies and PCS. RESULTS Athletes with FPH/PPH compared with controls had an increased risk of PCS (χ 2 = 8.90, p = 0.018; OR 5.06, 95% CI 1.71-14.99). Athletes with FPH only compared with controls also had an increased risk of PCS (χ 2 = 6.04, p = 0.03; OR 2.52, 95% CI 1.20-5.30). Comparing athletes with FPH/PPH to athletes with FPH only, no added PCS risk was noted (χ 2 = 1.64, p = 0.247; OR 2.01, 95% CI 0.68-5.94). Among various FPH diagnoses, anxiety (χ 2 = 7.48, p = 0.021; OR 2.99, 95% CI 1.36-6.49) and bipolar disorder (χ 2 = 5.13, p = 0.036; OR 2.74, 95% CI 1.14-6.67) were significantly associated with the presence of PCS. CONCLUSIONS Concussed high school athletes with FPH/PPH were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased

Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance.

PubMed

Park, Kyoungyoun; Ksiazek, Thomas; Olson, Bernadette

2018-05-04

Adolescents who suffer sport concussion typically respond to a prescription of cognitive and physical rest in the acute phases of healing; however, some adolescents do not respond to rest alone. Dizziness, unsteadiness, and imbalance are impairments, which may linger longer than 30 days, leading to a diagnosis of postconcussion syndrome (PCS). Vestibular assessment and therapy may benefit adolescents suffering from these persistent symptoms. Does vestibular rehabilitation therapy (VRT) rather than continued prescription of rest (cognitive and physical) reduce recovery time and persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents (12-18 y) who suffer PCS following a sports-related concussion? Summary of Key Findings: All 4 studies selected included adolescents suffering from PCS, specifically continued dizziness, unsteadiness, and imbalance. VRT was an effective intervention for this population. Adolescents presenting with this cluster of symptoms may also demonstrate verbal and visual memory loss linked to changes in the vestibular system postconcussion. Improved screening tools can help better understand vestibular system changes, identify adolescents who may benefit from VRT sooner, and decrease long-term impairments. Clinical Bottom Line: Moderate evidence supports that adolescents who suffer from persistent symptoms of dizziness, unsteadiness, and imbalance following sport concussion should be evaluated more specifically and earlier for vestibular dysfunction and can benefit from participation in individualized VRT. Early evaluation and treatment may result in a reduction of time lost from sport as well as a return to their premorbid condition. For these adolescents, VRT may be more beneficial than continued physical and cognitive rest when an adolescent's symptoms last longer than 30 days. Strength of Recommendation: Grade B evidence exists to support that VRT is more effective than continued cognitive and physical rest in reducing

The Effectiveness of Early Educational Interventions in the Emergency Department to Reduce Incidence or Severity of Postconcussion Syndrome Following a Concussion: A Systematic Review.

PubMed

Eliyahu, Leeor; Kirkland, Scott; Campbell, Sandy; Rowe, Brian H

2016-05-01

Concussions or mild traumatic brain injury are a major public health concern accounting for 85% of all brain injuries. Postconcussion syndrome (PCS) has been found to affect between 15 and 25% of patients with concussion 1 year after the initial injury. The goal of this review is to assess the effectiveness of early educational information or interventions provided in the emergency department on the onset and/or severity of PCS. A comprehensive literature search strategy involving seven electronic databases was developed. A grey literature search of Google Scholar, recent conference proceedings in emergency medicine, bibliographies of included studies, and clinical trial registries was also performed. The citation list was reviewed independently by two reviewers; no restrictions on publication status or language of publication were applied. The Cochrane risk-of-bias tool and the Newcastle-Ottawa scale were used to assess quality. From 1,325 citations retrieved, four RCTs and one controlled clinical trial met inclusion criteria. Interventions identified in these studies included: educational information sheets, with or without telephone or in-person follow-up, and one study on bed rest. While rarely requested, one study offered referrals and additional treatment, if needed. None of the studies were deemed to be high quality. Heterogeneity among outcome reporting, follow-up dates and interventions used precluded a pooled analysis. Overall, only two of the five included studies involving adult patients receiving early educational interventions reported a significant improvement in PCS symptoms. No reduction in PCS symptoms was found in the study on bed rest interventions. Limited evidence exists regarding the effectiveness of early educational interventions following concussion. Standardization of the interventions, outcome measures, and follow-up periods would make quantitative comparisons more valid. Moreover, higher-quality research in the field of early

Symptom attribution after a plane crash: comparison between self-reported symptoms and GP records.

PubMed Central

Donker, G A; Yzermans, C J; Spreeuwenberg, P; van der Zee, J

2002-01-01

BACKGROUND: On 4 October 1992, an El Al Boeing 747-F cargo aeroplane crashed on two apartment buildings in Amsterdam. Thirty-nine residents on the ground and the four crew members of the plane died. In the years after, a gradually increasing number of people attributed physical signs and symptoms to their presence at the disaster scene. AIM: To investigate the consistency between patients' symptoms attributed to the crash and GPs' diagnoses and perception of the association with the crash. DESIGN OF STUDY: Comparison between self-reported symptoms to a call centre and GPs' medical records on onset and type of symptoms, diagnoses, and GPs' perception of association with the disaster, assessed by questionnaire. SETTING: Consenting patients (n = 621) contacting the call centre and their GPs. METHOD: Patients were interviewed by the call centre staff and interview data were recorded on a database. Questionnaires were sent to the consenting patients' GPs, requesting their opinions on whether or not their patients' symptoms were attributable to the effects of disaster. Baseline differences and differences in reported symptoms between interviewed patients and their GP records were tested using the chi2 test. RESULTS: The 553 responders reported on average 4.3 symptoms to the call centre. The majority of these symptoms (74%) were reported to the GP. Of the ten most commonly reported symptoms, fatigue, skin complaints, feeling anxious or nervous, dyspnoea, and backache featured in 80% of symptoms reported to the GP. One out of four symptoms was either reported to the GP before the disaster took place, or six or more years after (1998/1999, during a period of much media attention). Depression (7%), post-traumatic stress disorder (PTSD) (5%) and eczema (5%) were most frequently diagnosed by GPs. They related 6% of all reported symptoms to the disaster. CONCLUSIONS: Most of the symptoms attributed to a disaster by patients have been reported to their GP, who related only a

Symptom attribution after a plane crash: comparison between self-reported symptoms and GP records.

PubMed

Donker, G A; Yzermans, C J; Spreeuwenberg, P; van der Zee, J

2002-11-01

On 4 October 1992, an El Al Boeing 747-F cargo aeroplane crashed on two apartment buildings in Amsterdam. Thirty-nine residents on the ground and the four crew members of the plane died. In the years after, a gradually increasing number of people attributed physical signs and symptoms to their presence at the disaster scene. To investigate the consistency between patients' symptoms attributed to the crash and GPs' diagnoses and perception of the association with the crash. Comparison between self-reported symptoms to a call centre and GPs' medical records on onset and type of symptoms, diagnoses, and GPs' perception of association with the disaster, assessed by questionnaire. Consenting patients (n = 621) contacting the call centre and their GPs. Patients were interviewed by the call centre staff and interview data were recorded on a database. Questionnaires were sent to the consenting patients' GPs, requesting their opinions on whether or not their patients' symptoms were attributable to the effects of disaster. Baseline differences and differences in reported symptoms between interviewed patients and their GP records were tested using the chi2 test. The 553 responders reported on average 4.3 symptoms to the call centre. The majority of these symptoms (74%) were reported to the GP. Of the ten most commonly reported symptoms, fatigue, skin complaints, feeling anxious or nervous, dyspnoea, and backache featured in 80% of symptoms reported to the GP. One out of four symptoms was either reported to the GP before the disaster took place, or six or more years after (1998/1999, during a period of much media attention). Depression (7%), post-traumatic stress disorder (PTSD) (5%) and eczema (5%) were most frequently diagnosed by GPs. They related 6% of all reported symptoms to the disaster. Most of the symptoms attributed to a disaster by patients have been reported to their GP, who related only a small proportion of these to the disaster.

Symptoms, disabilities, and life satisfaction five years after whiplash injuries.

PubMed

Styrke, Johan; Sojka, Peter; Björnstig, Ulf; Stålnacke, Britt-Marie

2017-12-29

Background Chronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area. Methods The study was carried out at a public hospital in northern Sweden and was a cross-sectional survey of patients five years after the injury event in a cohort of whiplash-injured patients. Five years after the emergency department visit, 186 persons aged 18-64 answered questionnaires on symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire, RHFUQ), and life satisfaction (LiSat-11). The answers were compared to those of a comparison cohort. Results The most common symptoms five years after whiplash injury were fatigue (41%), poor memory (39%), and headache (37%). Inability to sustain previous workload (44%) and fatigue at work (43%) were frequently reported disabilities. Only 39% were satisfied with their somatic health and 60% with their

Improving Work Outcomes for Veterans with Traumatic Brain Injury

DTIC Science & Technology

2011-09-01

12-month study. Results thus far indicate that CogSMART has robust effects on postconcussive symptoms, as well as some aspects of neuropsychological ... neuropsychological evaluations (required for entrance into the study if not already completed). None of these issues were problematic in Year 2 or Year 3...between neuropsychological performance, psychiatric symptom severity, and post-concussive symptom severity among the first 28 participants with

A Cross-Cultural Comparison of Symptom Reporting and Symptom Clusters in Heart Failure.

PubMed

Park, Jumin; Johantgen, Mary E

2017-07-01

An understanding of symptoms in heart failure (HF) among different cultural groups has become increasingly important. The purpose of this study was to compare symptom reporting and symptom clusters in HF patients between a Western (the United States) and an Eastern Asian sample (China and Taiwan). A secondary analysis of a cross-sectional observational study was conducted. The data were obtained from a matched HF patient sample from the United States and China/Taiwan ( N = 240 in each). Eight selective items related to HF symptoms from the Minnesota Living with Heart Failure Questionnaire were analyzed. Compared with the U.S. sample, HF patients from China/Taiwan reported a lower level of symptom distress. Analysis of two different regional groups did not result in the same number of clusters using latent class approach: the United States (four classes) and China/Taiwan (three classes). The study demonstrated that symptom reporting and identification of symptom clusters might be influenced by cultural factors.

The association between self-reported anxiety symptoms and suicidality.

PubMed

Diefenbach, Gretchen J; Woolley, Stephen B; Goethe, John W

2009-02-01

This cross-sectional study assessed the association between self-reported anxiety symptoms and self-reported suicidality among a mixed diagnostic sample of psychiatric outpatients. Data were obtained from chart review of 2,778 outpatients who completed a routine diagnostic clinical interview and a standardized self-report of psychiatric symptoms on admission. Bivariate analyses indicated that those with >or= moderate anxiety symptoms were over three times as likely to report >or= moderate difficulty with suicidality. Self-reported anxiety symptoms were associated with a 2-fold increased likelihood of reporting suicidality after controlling for confounding (demographics, depressive symptoms, and diagnoses). These data are consistent with a growing literature demonstrating an association between anxiety symptoms and suicidality, and suggest that this association is not accounted for by coexisting mood symptoms or diagnoses. A single item, self-report may be a useful screening tool for symptoms that are pertinent to assessment of suicide risk.

Prevalence of self-reported depressive symptoms in young adolescents.

PubMed Central

Schoenbach, V J; Kaplan, B H; Wagner, E H; Grimson, R C; Miller, F T

1983-01-01

To investigate the significance and measurement of depressive symptoms in young adolescents, 624 junior high school students were asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) during home interviews. In 384 usable symptom scales, item-scale correlations (most were above .50), inter-item correlations, coefficient alpha (.85), and patterns of reported symptoms were reasonable. Persistent symptoms were reported more often by Blacks, especially Black males. Prevalence of persistent symptoms in Whites was quite close to reported figures for adults, ranging from 1 per cent to 15 per cent in adolescent males and 2 per cent to 13 per cent in adolescent females. Adolescents reported persistent vegetative symptoms less often and psychosocial symptoms more often. Reports of symptoms without regard to duration were much more frequent in the adolescents, ranging from 18 per cent to 76 per cent in White males, 34 per cent to 76 per cent in White and Black females, and 41 per cent to 85 per cent in Black males. The results support the feasibility of using a self-report symptom scale to measure depressive symptoms in young adolescents. Transient symptoms reported by adolescents probably reflect their stage of development, but persistent symptoms are likely to have social psychiatric importance. PMID:6625033

Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment.

PubMed

Olivera, Anlys; Lejbman, Natasha; Jeromin, Andreas; French, Louis M; Kim, Hyung-Suk; Cashion, Ann; Mysliwiec, Vincent; Diaz-Arrastia, Ramon; Gill, Jessica

2015-10-01

Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated. To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations. Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included. Concentration of total tau in peripheral blood. Concentrations of plasma tau were significantly elevated in the 70 participants with self-reported

On counterbalancing of symptom-reporting in trauma surveys.

PubMed

Reddy, Madhavi K; Polusny, Melissa A; Murdoch, Maureen

2009-12-01

Some traumatic stress research surveys are potentially subject to context effects, such as priming, because they include questions about traumatic experiences and trauma-related symptoms within the same survey. In this study, asking about traumatic experiences before or after asking about PTSD influenced symptom reporting was investigated in a sample of 424 National Guard soldiers. Results indicate ordering of symptom measures immediately before or after reports of combat experiences did not influence reports of PTSD symptoms. Implications of results are discussed.

A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program

PubMed Central

Benson, Brian W.; Meeuwisse, Willem H.; Rizos, John; Kang, Jian; Burke, Charles J.

2011-01-01

Background In 1997, the National Hockey League (NHL) and NHL Players’ Association (NHLPA) launched a concussion program to improve the understanding of this injury. We explored initial postconcussion signs, symptoms, physical examination findings and time loss (i.e., time between the injury and medical clearance by the physician to return to competitive play), experienced by male professional ice-hockey players, and assessed the utility of initial postconcussion clinical manifestations in predicting time loss among hockey players. Methods We conducted a prospective case series of concussions over seven NHL regular seasons (1997–2004) using an inclusive cohort of players. The primary outcome was concussion and the secondary outcome was time loss. NHL team physicians documented post-concussion clinical manifestations and recorded the date when a player was medically cleared to return to play. Results Team physicians reported 559 concussions during regular season games. The estimated incidence was 1.8 concussions per 1000 player-hours. The most common postconcussion symptom was headache (71%). On average, time loss (in days) increased 2.25 times (95% confidence interval [CI] 1.41–3.62) for every subsequent (i.e., recurrent) concussion sustained during the study period. Controlling for age and position, significant predictors of time loss were postconcussion headache (p < 0.001), low energy or fatigue (p = 0.01), amnesia (p = 0.02) and abnormal neurologic examination (p = 0.01). Using a previously suggested time loss cut-point of 10 days, headache (odds ratio [OR] 2.17, 95% CI 1.33–3.54) and low energy or fatigue (OR 1.72, 95% CI 1.04–2.85) were significant predictors of time loss of more than 10 days. Interpretation Postconcussion headache, low energy or fatigue, amnesia and abnormal neurologic examination were significant predictors of time loss among professional hockey players. PMID:21502355

A prospective study of concussions among National Hockey League players during regular season games: the NHL-NHLPA Concussion Program.

PubMed

Benson, Brian W; Meeuwisse, Willem H; Rizos, John; Kang, Jian; Burke, Charles J

2011-05-17

In 1997, the National Hockey League (NHL) and NHL Players' Association (NHLPA) launched a concussion program to improve the understanding of this injury. We explored initial postconcussion signs, symptoms, physical examination findings and time loss (i.e., time between the injury and medical clearance by the physician to return to competitive play), experienced by male professional ice-hockey players, and assessed the utility of initial postconcussion clinical manifestations in predicting time loss among hockey players. We conducted a prospective case series of concussions over seven NHL regular seasons (1997-2004) using an inclusive cohort of players. The primary outcome was concussion and the secondary outcome was time loss. NHL team physicians documented post-concussion clinical manifestations and recorded the date when a player was medically cleared to return to play. Team physicians reported 559 concussions during regular season games. The estimated incidence was 1.8 concussions per 1000 player-hours. The most common postconcussion symptom was headache (71%). On average, time loss (in days) increased 2.25 times (95% confidence interval [CI] 1.41-3.62) for every subsequent (i.e., recurrent) concussion sustained during the study period. Controlling for age and position, significant predictors of time loss were postconcussion headache (p < 0.001), low energy or fatigue (p = 0.01), amnesia (p = 0.02) and abnormal neurologic examination (p = 0.01). Using a previously suggested time loss cut-point of 10 days, headache (odds ratio [OR] 2.17, 95% CI 1.33-3.54) and low energy or fatigue (OR 1.72, 95% CI 1.04-2.85) were significant predictors of time loss of more than 10 days. Postconcussion headache, low energy or fatigue, amnesia and abnormal neurologic examination were significant predictors of time loss among professional hockey players.

Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance.

PubMed

Cottle, Jordan E; Hall, Eric E; Patel, Kirtida; Barnes, Kenneth P; Ketcham, Caroline J

2017-02-01

Neurocognitive test scores are often considered an important aspect of concussion management. To best use these data, clinicians must understand potential factors that may influence baseline performance on these tests. To determine preexisting factors that may influence performance on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Cross-sectional study. Research laboratory. A total of 486 National Collegiate Athletic Association Division I collegiate student-athletes. To determine neurocognitive functioning and total symptom score at baseline, ImPACT was administered. Outcomes were verbal memory, visual memory, visual motor speed, reaction time, and total symptom score. A self-report demographic section at the beginning of ImPACT was used to gather information concerning previous treatment for headaches, migraines, and psychiatric conditions; diagnosis of attention-deficit/hyperactivity disorder; and exposure to previous strenuous exercise. We conducted multivariate analyses of variance to determine if the ImPACT composite and total symptom scores differed according to preexisting factors (P < .0083). Sex showed an effect on verbal memory (P = .001), visual motor speed (P < .001), and reaction time (P = .006), with women performing better than men. A previous diagnosis of attention-deficit/hyperactivity disorder affected visual motor speed (P = .008). Previous treatment for headaches (P < .001), migraines (P = .001), a psychiatric condition (P < .001), or a diagnosis of attention-deficit/hyperactivity disorder (P < .001) all showed effects on the total symptom score. Strenuous exercise did not affect neurocogntive performance or total symptom score. Based on our findings and the previous literature, we suggest that many preexisting factors influence baseline neurocognitive data. Baseline testing is an important aspect of concussion management. Sports medicine professionals should be cognizant of these factors when developing concussion

Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance

PubMed Central

Cottle, Jordan E.; Hall, Eric E.; Patel, Kirtida; Barnes, Kenneth P.; Ketcham, Caroline J.

2017-01-01

Context: Neurocognitive test scores are often considered an important aspect of concussion management. To best use these data, clinicians must understand potential factors that may influence baseline performance on these tests. Objective: To determine preexisting factors that may influence performance on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 486 National Collegiate Athletic Association Division I collegiate student-athletes. Main Outcome Measure(s): To determine neurocognitive functioning and total symptom score at baseline, ImPACT was administered. Outcomes were verbal memory, visual memory, visual motor speed, reaction time, and total symptom score. A self-report demographic section at the beginning of ImPACT was used to gather information concerning previous treatment for headaches, migraines, and psychiatric conditions; diagnosis of attention-deficit/hyperactivity disorder; and exposure to previous strenuous exercise. We conducted multivariate analyses of variance to determine if the ImPACT composite and total symptom scores differed according to preexisting factors (P < .0083). Results: Sex showed an effect on verbal memory (P = .001), visual motor speed (P < .001), and reaction time (P = .006), with women performing better than men. A previous diagnosis of attention-deficit/hyperactivity disorder affected visual motor speed (P = .008). Previous treatment for headaches (P < .001), migraines (P = .001), a psychiatric condition (P < .001), or a diagnosis of attention-deficit/hyperactivity disorder (P < .001) all showed effects on the total symptom score. Strenuous exercise did not affect neurocogntive performance or total symptom score. Conclusions: Based on our findings and the previous literature, we suggest that many preexisting factors influence baseline neurocognitive data. Baseline testing is an important aspect of

Neurocognitive performance and symptom profiles of Spanish-speaking Hispanic athletes on the ImPACT test.

PubMed

Ott, Summer; Schatz, Philip; Solomon, Gary; Ryan, Joseph J

2014-03-01

This study documented baseline neurocognitive performance of 23,815 athletes on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test. Specifically, 9,733 Hispanic, Spanish-speaking athletes who completed the ImPACT test in English and 2,087 Hispanic, Spanish-speaking athletes who completed the test in Spanish were compared with 11,955 English-speaking athletes who completed the test in English. Athletes were assigned to age groups (13-15, 16-18). Results revealed a significant effect of language group (p < .001; partial η(2) = 0.06) and age (p < .001; partial η(2) = 0.01) on test performance. Younger athletes performed more poorly than older athletes, and Spanish-speaking athletes completing the test in Spanish scored more poorly than Spanish-speaking and English-speaking athletes completing the test in English, on all Composite scores and Total Symptom scores. Spanish-speaking athletes completing the test in English also performed more poorly than English-speaking athletes completing the test in English on three Composite scores. These differences in performance and reported symptoms highlight the need for caution in interpreting ImPACT test data for Hispanic Americans.

The influence of sleep duration and sleep-related symptoms on baseline neurocognitive performance among male and female high school athletes.

PubMed

Sufrinko, Alicia; Johnson, Eric W; Henry, Luke C

2016-05-01

Typically, the effects of sleep duration on cognition are examined in isolation. This study examined the effects of restricted sleep and related symptoms on neurocognitive performance. Baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and postconcussion symptom scale (PCSS) were administered to athletes (N = 7,150) ages 14-17 (M = 15.26, SD = 1.09) prior to sport participation. Three groups of athletes were derived from total sleep duration: sleep restriction (≤5 hours), typical sleep (5.5-8.5 hours), and optimal sleep (≥9 hours). A MANCOVA (age and sex as covariates) was conducted to examine differences across ImPACT/PCSS. Follow-up MANOVA compared ImPACT/PCSS performance among symptomatic (e.g., trouble falling asleep, sleeping less than usual) adolescents from the sleep restriction group (n = 78) with asymptomatic optimal sleepers (n = 99). A dose-response effect of sleep duration on ImPACT performance and PCSS was replicated (Wilk's λ = .98, F2,7145 = 17.25, p < .001, η2 = .01). The symptomatic sleep restricted adolescents (n = 78) had poorer neurocognitive performance: verbal memory, F = 11.60, p = .001, visual memory, F = 6.57, p = .01, visual motor speed, F = 6.19, p = .01, and reaction time (RT), F = 5.21, p = .02, compared to demographically matched controls (n = 99). Girls in the sleep problem group performed worse on RT (p = .024). Examining the combination of sleep-related symptoms and reduced sleep duration effectively identified adolescents at risk for poor neurocognitive performance than sleep duration alone. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Heart Rate Variability in Healthy Non-Concussed Youth Athletes: Exploring the Effect of Age, Sex, and Concussion-Like Symptoms.

PubMed

Paniccia, Melissa; Verweel, Lee; Thomas, Scott; Taha, Tim; Keightley, Michelle; Wilson, Katherine E; Reed, Nick

2017-01-01

Heart rate variability (HRV) is a non-invasive neurophysiological measure of autonomic nervous system regulation emerging in concussion research. To date, most concussion studies have focused on the university-aged athlete with no research examining healthy active youths. Corroborating changes in HRV alongside traditional subjective self-report measures (concussion symptoms) in the non-concussed state provides a foundation for interpreting change following concussion. The objectives were to (1) explore the influence of age and sex on HRV and (2) examine the relationship between HRV and baseline/pre-injury concussion symptom domains (physical, cognitive, emotional, and fatigue) in healthy youth athletes. Healthy, youth athletes 13-18 years of age [ N  = 294, female = 166 (56.5%), male = 128 (43.5%)] participated in this cross-sectional study. Age, sex, and concussion-like symptoms were collected as part of a baseline/pre-injury assessment. The Post-Concussion Symptom Inventory-SR13 (PCSI-SR13) was used to collect domain scores for physical, cognitive, emotional, and fatigue symptoms. HRV was collected for 24 h. HRV measures included time (SDNN, RMSSD, and pNN50) and frequency (HF, HFnu, LF, LFnu, and total power) domain HRV measures. Variables were logarithmically transformed to increase robustness of linear regression models. Older youth participants displayed significantly higher HRV compared to younger participants ( p  < 0.05). Females displayed significantly lower HRV compared to males ( p  < 0.05). A significant interaction effect between concussion-like symptoms and HRV indicated differential patterns as a function of sex ( p  < 0.05). Youth athletes who reported more cognitive symptoms had lower HRV ( p  < 0.05). HRV was found to have a significant relationship with a traditional clinical measure (subjective self-report of concussion-like symptoms) utilized in concussion assessment and management. Baseline

Factors Contributing to Disparities in Baseline Neurocognitive Performance and Concussion Symptom Scores Between Black and White Collegiate Athletes.

PubMed

Wallace, Jessica; Covassin, Tracey; Moran, Ryan; Deitrick, Jamie McAllister

2017-11-02

National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athletes must have a concussion baseline test prior to commencing their competitive season. To date, little research has examined potential racial differences on baseline neurocognitive performance among NCAA athletes. The purpose of this study was to investigate differences between Black and White collegiate athletes on baseline neurocognitive performance and self-reported symptoms. A total of 597 collegiate athletes (400 White, 197 Black) participated in this study. Athletes self-reported their race on the demographic section of their pre-participation physical examination and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) neurocognitive battery in a supervised, quiet room. Controlling for sex, data were analyzed using separate one-way analyses of covariance (ANCOVAs) on symptom score, verbal and visual memory, visual motor processing speed, and reaction time composite scores. Results revealed significant differences between White and Black athletes on baseline symptom score (F (1,542)  = 5.82, p = .01), visual motor processing speed (F (1,542)  = 14.89, p < .001), and reaction time (F (1,542)  = 11.50, p < .01). White athletes performed better than Black athletes on baseline visual motor processing speed and reaction time. Black athletes reported higher baseline symptom scores compared to Whites. There was no statistical difference between race on verbal memory (p = .08) and that on visual memory (p = .06). Black athletes demonstrated disparities on some neurocognitive measures at baseline. These results suggest capturing an individual baseline on each athlete, as normative data comparisons may be inappropriate for athletes of a racial minority.

Self-Reported versus Informant-Reported Depressive Symptoms in Adults with Mild Intellectual Disability

ERIC Educational Resources Information Center

Mileviciute, I.; Hartley, S. L.

2015-01-01

Background: Virtually nothing is known about potential differences in the types of depression symptoms reported by adults with mild intellectual disability (ID) on self-reported questionnaires as compared with the types of symptoms reported by caregivers on informant questionnaires. Moreover, little is known about how the presentation of…

Self-Report of Depressive Symptoms in Low Back Pain Patients.

ERIC Educational Resources Information Center

Crisson, James; And Others

1986-01-01

Presents two studies designed to examine the self-report of depressive symptoms in low back pain patients (N=134). Both studies found that patients were more likely to report somatic than cognitive symptoms of depression. Patients with multiple physical findings were not more likely to report somatic symptoms than patients with few physical…

Hyperbaric oxygen ameliorates worsening signs and symptoms of post-traumatic stress disorder

PubMed Central

Eovaldi, Benjamin; Zanetti, Claude

2010-01-01

Hyperbaric oxygen therapy at 2.4 atmospheric pressure absolutes for 90 minutes per day ameliorated the signs and symptoms of agitation, confusion, and emotional distress in a 27-year-old male seven days following a traumatic accident. Hyperbaric oxygen was used to treat the patient’s crush injury and underlying nondisplaced pelvic fractures which were sustained in a bicycle versus automobile traffic accident. Its effect on the patient’s neuropsychiatric symptoms was surprising and obvious immediately following the initial hyperbaric oxygen treatment. Complete cognitive and psychiatric recovery was achieved by the seventh and final hyperbaric oxygen treatment. We propose that hyperbaric oxygen was effective in improving the patient’s neuropsychiatric symptoms by reducing cerebral oxidative stress, inflammation, vasogenic edema, and hippocampal neuronal apoptosis. Further investigation into the use of hyperbaric oxygen as a novel therapy for the secondary prevention of post-traumatic stress disorder that often accompanies post-concussive syndrome may be warranted. We acknowledge that hyperbaric oxygen therapy has been shown to have a strong placebo effect on neurologic and psychiatric diseases. PMID:21212826

Early symptom burden predicts recovery after sport-related concussion

PubMed Central

Mannix, Rebekah; Monuteaux, Michael C.; Stein, Cynthia J.; Bachur, Richard G.

2014-01-01

Objective: To identify independent predictors of and use recursive partitioning to develop a multivariate regression tree predicting symptom duration greater than 28 days after a sport-related concussion. Methods: We conducted a prospective cohort study of patients in a sports concussion clinic. Participants completed questionnaires that included the Post-Concussion Symptom Scale (PCSS). Participants were asked to record the date on which they last experienced symptoms. Potential predictor variables included age, sex, score on symptom inventories, history of prior concussions, performance on computerized neurocognitive assessments, loss of consciousness and amnesia at the time of injury, history of prior medical treatment for headaches, history of migraines, and family history of concussion. We used recursive partitioning analysis to develop a multivariate prediction model for identifying athletes at risk for a prolonged recovery from concussion. Results: A total of 531 patients ranged in age from 7 to 26 years (mean 14.6 ± 2.9 years). The mean PCSS score at the initial visit was 26 ± 26; mean time to presentation was 12 ± 5 days. Only total score on symptom inventory was independently associated with symptoms lasting longer than 28 days (adjusted odds ratio 1.044; 95% confidence interval [CI] 1.034, 1.054 for PCSS). No other potential predictor variables were independently associated with symptom duration or useful in developing the optimal regression decision tree. Most participants (86%; 95% CI 80%, 90%) with an initial PCSS score of <13 had resolution of their symptoms within 28 days of injury. Conclusions: The only independent predictor of prolonged symptoms after sport-related concussion is overall symptom burden. PMID:25381296

Early symptom burden predicts recovery after sport-related concussion.

PubMed

Meehan, William P; Mannix, Rebekah; Monuteaux, Michael C; Stein, Cynthia J; Bachur, Richard G

2014-12-09

To identify independent predictors of and use recursive partitioning to develop a multivariate regression tree predicting symptom duration greater than 28 days after a sport-related concussion. We conducted a prospective cohort study of patients in a sports concussion clinic. Participants completed questionnaires that included the Post-Concussion Symptom Scale (PCSS). Participants were asked to record the date on which they last experienced symptoms. Potential predictor variables included age, sex, score on symptom inventories, history of prior concussions, performance on computerized neurocognitive assessments, loss of consciousness and amnesia at the time of injury, history of prior medical treatment for headaches, history of migraines, and family history of concussion. We used recursive partitioning analysis to develop a multivariate prediction model for identifying athletes at risk for a prolonged recovery from concussion. A total of 531 patients ranged in age from 7 to 26 years (mean 14.6 ± 2.9 years). The mean PCSS score at the initial visit was 26 ± 26; mean time to presentation was 12 ± 5 days. Only total score on symptom inventory was independently associated with symptoms lasting longer than 28 days (adjusted odds ratio 1.044; 95% confidence interval [CI] 1.034, 1.054 for PCSS). No other potential predictor variables were independently associated with symptom duration or useful in developing the optimal regression decision tree. Most participants (86%; 95% CI 80%, 90%) with an initial PCSS score of <13 had resolution of their symptoms within 28 days of injury. The only independent predictor of prolonged symptoms after sport-related concussion is overall symptom burden. © 2014 American Academy of Neurology.

A parental report of children's anxiety symptoms in Japan.

PubMed

Ishikawa, Shin-ichi; Shimotsu, Saki; Ono, Tetsuya; Sasagawa, Satoko; Kondo-Ikemura, Kiyomi; Sakano, Yuji; Spence, Susan H

2014-06-01

Using parental reports, the current study investigated anxiety symptoms among Japanese children as part of the process of developing the Japanese version of the Spence Children's Anxiety Scale for Parents (SCAS-P). The participants were 677 parents and children aged 9-12 years. Confirmatory factor analysis on 568 parents and children supported that the SCAS-P had a 6-factor structure. The scale showed satisfactory internal consistency and good convergent validity. A MANOVA indicated no significant gender or age differences except for the obsessive-compulsive disorder subscale. Among Japanese children, the most prevalent symptoms within the parental report were items related to fear of the dark and of insects/spiders. Finally, we observed very low correlations between parental and child reports of anxiety symptoms; the relationships between child and parental reports were rather poor among Japanese children. We briefly discuss the utility of the SCAS-P as a screening instrument assessing parental reports of anxiety symptoms.

Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review.

PubMed

Makdissi, Michael; Schneider, Kathryn J; Feddermann-Demont, Nina; Guskiewicz, Kevin M; Hinds, Sidney; Leddy, John J; McCrea, Michael; Turner, Michael; Johnston, Karen M

2017-06-01

To conduct a systematic review of the literature regarding assessment and treatment modalities in patients with persistent symptoms following sport-related concussion (SRC). We searched Medline, Embase, SPORTSDiscus, PsycINFO, CINAHL, Cochrane library and ProQuest Dissertation & Theses Global electronic databases. Studies were included if they were original research, reported on SRC as the primary source of injury, included patients with persistent postconcussive symptoms (>10 days) and investigated the role of assessment or treatment modalities. Of 3225 articles identified in the preliminary search, 25 articles met the inclusion criteria. 11 articles were concerned with assessment and 14 articles with treatment of persistent symptoms following SRC. There were three randomised control trials and one quasi-experimental study. The remainder consisting of cross-sectional studies, historical cohorts and case series. 'Persistent symptoms' following SRC can be defined as clinical recovery that falls outside expected time frames (ie, >10-14 days in adults and >4 weeks in children). It does not reflect a single pathophysiological entity, but describes a constellation of non-specific post-traumatic symptoms that may be linked to coexisting and/or confounding pathologies. A detailed multimodal clinical assessment is required to identify specific primary and secondary processes, and treatment should target specific pathologies identified. There is preliminary evidence supporting the use of symptom-limited aerobic exercise, targeted physical therapy and a collaborative approach that includes cognitive behavioural therapy. Management of patients with persistent symptoms is challenging and should occur in a multidisciplinary collaborative setting, with healthcare providers with experience in SRC. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

Longitudinal assessment of local and global functional connectivity following sports-related concussion.

PubMed

Meier, Timothy B; Bellgowan, Patrick S F; Mayer, Andrew R

2017-02-01

Growing evidence suggests that sports-related concussions (SRC) may lead to acute changes in intrinsic functional connectivity, although most studies to date have been cross-sectional in nature with relatively modest sample sizes. We longitudinally assessed changes in local and global resting state functional connectivity using metrics that do not require a priori seed or network selection (regional homogeneity; ReHo and global brain connectivity; GBC, respectively). A large sample of collegiate athletes (N = 43) was assessed approximately one day (1.74 days post-injury, N = 34), one week (8.44 days, N = 34), and one month post-concussion (32.47 days, N = 30). Healthy contact sport-athletes served as controls (N = 51). Concussed athletes showed improvement in mood symptoms at each time point (p's < 0.05), but had significantly higher mood scores than healthy athletes at every time point (p's < 0.05). In contrast, self-reported symptoms and cognitive deficits improved over time following concussion (p's < 0.001), returning to healthy levels by one week post-concussion. ReHo in sensorimotor, visual, and temporal cortices increased over time post-concussion, and was greatest at one month post-injury. Conversely, ReHo in the frontal cortex decreased over time following SRC, with the greatest decrease evident at one month post-concussion. Differences in ReHo relative to healthy athletes were primarily observed at one month post-concussion rather than the more acute time points. Contrary to our hypothesis, no significant cross-sectional or longitudinal differences in GBC were observed. These results are suggestive of a delayed onset of local connectivity changes following SRC.

Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.

PubMed

Fagundes, Christopher P; Shi, Qiuling; Vaporciyan, Ara A; Rice, David C; Popat, Keyuri U; Cleeland, Charles S; Wang, Xin Shelley

2015-09-01

Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer. Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery. The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

The impact of pediatric neuropsychological consultation in mild traumatic brain injury: a model for providing feedback after invalid performance.

PubMed

Connery, Amy K; Peterson, Robin L; Baker, David A; Kirkwood, Michael W

2016-05-01

In recent years, pediatric practitioners have increasingly recognized the importance of objectively measuring performance validity during clinical assessments. Yet, no studies have examined the impact of neuropsychological consultation when invalid performance has been identified in pediatric populations and little published guidance exists for clinical management. Here we provide a conceptual model for providing feedback after noncredible performance has been detected. In a pilot study, we examine caregiver satisfaction and postconcussive symptoms following provision of this feedback for patients seen through our concussion program. Participants (N = 70) were 8-17-year-olds with a history of mild traumatic brain injury who underwent an abbreviated neuropsychological evaluation between 2 and 12 months post-injury. We examined postconcussive symptom reduction and caregiver satisfaction after neuropsychological evaluation between groups of patients who were determined to have provided noncredible effort (n = 9) and those for whom no validity concerns were present (n = 61). We found similarly high levels of caregiver satisfaction between groups and greater reduction in self-reported symptoms after feedback was provided using the model with children with noncredible presentations compared to those with credible presentations. The current study lends preliminary support to the idea that the identification and communication of invalid performance can be a beneficial clinical intervention that promotes high levels of caregiver satisfaction and a reduction in self-reported and caregiver-reported symptoms.

Daily Life Experience and Somatic Symptoms: A Preliminary Report.

DTIC Science & Technology

1981-03-01

AAO7 9 859 STATE UNIV OF NEW YORK AT STONY BROOK FG 5/10 DAILY LIFE EXPERIENCE AND SOMATIC SYMPTOMS: A PRELIMINARY REPOR--ETC(U) MAR 8I A A STONE. J...Experience and Somatic Symptoms: A Preliminary Report Arthur A. Stone Long Island Research Institute and Department of Psychiatry arnd Behavioral...TITLE (and S..,til.) s. ALF - , rlA9OQ COVERED Daily Life Experience and Somatic Symptoms: A Technical p " Preliminary Report, EL..... S. PERFORMING

The impact of personality on the reporting of unfounded symptoms and illness.

PubMed

Feldman, P J; Cohen, S; Doyle, W J; Skoner, D P; Gwaltney, J M

1999-08-01

This study examined the role of personality in the reporting of symptoms and illness not supported by underlying pathology. After assessment of the Big Five personality factors, 276 healthy volunteers were inoculated with a common cold virus. On each of the following 5 days, objective indicators of pathology, self-reported symptoms, and self-reported illness onset were assessed. Neuroticism was directly associated with reports of unfounded (without a physiological basis) symptoms in individuals at baseline and postinoculation in those with and without colds. Neuroticism was also indirectly associated with reports of unfounded illness through reports of more symptoms. Openness to Experience was associated with reporting unfounded symptoms in those with verifiable colds, whereas Conscientiousness was associated with reporting unfounded illness in those who were not ill.

Multiple Past Concussions in High School Football Players

PubMed Central

Brooks, Brian L.; Mannix, Rebekah; Maxwell, Bruce; Zafonte, Ross; Berkner, Paul D.; Iverson, Grant L.

2017-01-01

Background There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. Purpose To determine if there are measureable differences in cognitive functioning or symptom reporting in high school football players with a history of multiple concussions. Study Design Cross-sectional study; Level of evidence, 3. Methods Participants included 5232 male adolescent football players (mean [±SD] age, 15.5 ± 1.2 years) who completed baseline testing between 2009 and 2014. On the basis of injury history, athletes were grouped into 0 (n = 4183), 1 (n = 733), 2 (n = 216), 3 (n = 67), or ≥4 (n = 33) prior concussions. Cognitive functioning was measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery, and symptom ratings were obtained from the Post-Concussion Symptom Scale. Results There were no statistically significant differences between groups (based on the number of reported concussions) regarding cognitive functioning. Athletes with ≥3 prior concussions reported more symptoms than did athletes with 0 or 1 prior injury. In multivariate analyses, concussion history was independently related to symptom reporting but less so than developmental problems (eg, attention or learning problems) or other health problems (eg, past treatment for psychiatric problems, headaches, or migraines). Conclusion In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting. PMID:27474382

Patient-reported symptoms during radiotherapy : Clinically relevant symptom burden in patients treated with palliative and curative intent.

PubMed

Körner, Philipp; Ehrmann, Katja; Hartmannsgruber, Johann; Metz, Michaela; Steigerwald, Sabrina; Flentje, Michael; van Oorschot, Birgitt

2017-07-01

The benefits of patient-reported symptom assessment combined with integrated palliative care are well documented. This study assessed the symptom burden of palliative and curative-intent radiation oncology patients. Prior to first consultation and at the end of RT, all adult cancer patients planned to receive fractionated percutaneous radiotherapy (RT) were asked to answer the Edmonton Symptom Assessment Scale (ESAS; nine symptoms from 0 = no symptoms to 10 = worst possible symptoms). Mean values were used for curative vs. palliative and pre-post comparisons, and the clinical relevance was evaluated (symptom values ≥ 4). Of 163 participating patients, 151 patients (90.9%) completed both surveys (116 curative and 35 palliative patients). Before beginning RT, 88.6% of palliative and 72.3% of curative patients showed at least one clinically relevant symptom. Curative patients most frequently named decreased general wellbeing (38.6%), followed by tiredness (35.0%), anxiety (32.4%), depression (30.0%), pain (26.3%), lack of appetite (23.5%), dyspnea (17.8%), drowsiness (8.0%) and nausea (6.1%). Palliative patients most frequently named decreased general wellbeing (62.8%), followed by pain (62.8%), tiredness (60.0%), lack of appetite (40.0%), anxiety (38.0%), depression (33.3%), dyspnea (28.5%), drowsiness (25.7%) and nausea (14.2%). At the end of RT, the proportion of curative and palliative patients with a clinically relevant symptom had increased significantly to 79.8 and 91.4%, respectively; whereas the proportion of patients reporting clinically relevant pain had decreased significantly (42.8 vs. 62.8%, respectively). Palliative patients had significantly increased tiredness. Curative patients reported significant increases in pain, tiredness, nausea, drowsiness, lack of appetite and restrictions in general wellbeing. Assessment of patient-reported symptoms was successfully realized in radiation oncology routine. Overall, both groups showed a high symptom

Factors Associated With Concussion-like Symptom Reporting in High School Athletes

PubMed Central

Iverson, Grant L.; Silverberg, Noah D.; Mannix, Rebekah; Maxwell, Bruce A.; Atkins, Joseph E.; Zafonte, Ross; Berkner, Paul D.

2017-01-01

Importance Every state in the United States has passed legislation for sport-related concussion, making this health issue important for physicians and other health care professionals. Safely returning athletes to sport after concussion relies on accurately determining when their symptoms resolve. Objective To evaluate baseline concussion-like symptom reporting in uninjured adolescent student athletes. Design, Setting, and Participants In this cross-sectional, observational study, we studied 31 958 high school athletes from Maine with no concussion in the past 6 months who completed a preseason baseline testing program between 2009 and 2013. Results Symptom reporting was more common in girls than boys. Most students with preexisting conditions reported one or more symptoms (60%-82% of boys and 73%-97% of girls). Nineteen percent of boys and 28% of girls reported having a symptom burden resembling an International Classification of Diseases, 10th Revision (ICD-10) diagnosis of postconcussional syndrome (PCS). Students with preexisting conditions were even more likely to endorse a symptom burden that resembled PCS (21%-47% for boys and 33%-72% for girls). Prior treatment of a psychiatric condition was the strongest independent predictor for symptom reporting in boys, followed by a history of migraines. For girls, the strongest independent predictors were prior treatment of a psychiatric condition or substance abuse and attention-deficit/hyperactivity disorder. The weakest independent predictor of symptoms for both sexes was history of prior concussions. Conclusions and Relevance In the absence of a recent concussion, symptom reporting is related to sex and preexisting conditions. Consideration of sex and preexisting health conditions can help prevent misinterpretation of symptoms in student athletes who sustain a concussion. PMID:26457403

Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology.

PubMed

Giza, Christopher C; Kutcher, Jeffrey S; Ashwal, Stephen; Barth, Jeffrey; Getchius, Thomas S D; Gioia, Gerard A; Gronseth, Gary S; Guskiewicz, Kevin; Mandel, Steven; Manley, Geoffrey; McKeag, Douglas B; Thurman, David J; Zafonte, Ross

2013-06-11

To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article. We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations. Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.

Parent-Reported Penicillin Allergy Symptoms in the Pediatric Emergency Department.

PubMed

Vyles, David; Chiu, Asriani; Simpson, Pippa; Nimmer, Mark; Adams, Juan; Brousseau, David C

2017-04-01

Children often present to the pediatric emergency department (ED) with a reported penicillin allergy. The true incidence of pediatric penicillin allergy is low, and patients may be inappropriately denied first-line antibiotics. We hypothesized that more than 70% of reported penicillin allergies in the pediatric ED are low risk for true allergy. Parents of children presenting to the pediatric ED with parent-reported penicillin allergy completed an allergy questionnaire. The questionnaire included age at allergy diagnosis, symptoms of allergy, and time to allergic reaction from first dose. The allergy symptoms were dichotomized into high and low risk in consultation with a pediatric allergist before questionnaire implementation. A total of 605 parents were approached; 500 (82.6%) completed the survey. The median (interquartile range) age of the children at diagnosis was 1 year (7 months, 2 years); 75% were diagnosed before their third birthday. Overall, 380 (76%) (95% confidence interval 72.3, 79.7) children had exclusively low-risk symptoms. The most commonly reported symptoms were rash (466, 92.8%) and itching (203, 40.6%). Of the 120 children with one or more high-risk symptom, facial swelling (50, 10%) was the most common. Overall, 354 children (71%) were diagnosed after their first exposure to penicillin. Symptom onset within 24 hours of medication administration occurred in 274 children (54.8%). Seventy-six percent of patients with parent-reported penicillin allergy have symptoms unlikely to be consistent with true allergy. Determination of true penicillin allergy in patients with low-risk symptoms may permit the increased use of first-line penicillin antibiotics. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Patient-reported symptom distress, and most bothersome issues, before and during cancer treatment

PubMed Central

Hong, Fangxin; Blonquist, Traci M; Halpenny, Barbara; Berry, Donna L

2016-01-01

Introduction Frequently reported symptoms and treatment side effects may not be the most bothersome issues to patients with cancer. The purpose of this study was to investigate patient-reported symptom distress and bothersome issues among participants with cancer. Methods Participants completed the Symptom Distress Scale-15 before treatment (T1) and during cancer treatment (T2) and reported up to two most bothersome issues among symptoms rated with moderate-to-severe distress. We compared symptom ratings and perceived bother and explored two approaches predicting patients’ most bothersome issues: worst absolute symptom score or worst change from pretreatment. Results Significantly, (P≤0.0002) more patients reported moderate-to-severe distress at T2 for eight of 13 symptoms. At T1, 81% of patients reported one and 56% reported multiple symptoms with moderate-to-severe distress, while at T2, 89% reported one and 69% reported multiple symptoms with moderate-to-severe distress. Impact on sexual activity/interest, pain, fatigue, and insomnia were the most prevalent symptoms with moderate-to-severe distress. Fatigue, pain, and insomnia were perceived most often as bothersome. When one symptom was rated moderate-to-severe, predictive accuracy of the absolute score was 46% and 48% (T1 & T2) and 38% with the change score (T2–T1). When two or more symptoms were rated moderate-to-severe, predictive accuracy of the absolute score was 76% and 79% (T1 & T2) and 70% with the change score (T2–T1). Conclusion More patients experienced moderate-to-severe symptom distress after treatment initiation. Patient identification of bothersome issues could not be assumed based on prevalence of symptoms reported with moderate-to-severe distress. The absolute symptom distress scores identified patients’ most bothersome issues with good accuracy, outperforming change scores. PMID:27672346

Racial and socioeconomic disparities in the symptom reporting of persons living with HIV.

PubMed

Schnall, Rebecca; Siegel, Karolynn; Jia, Haomiao; Olender, Susan; Hirshfield, Sabina

2018-06-01

Persons living with HIV (PLWH) today can survive decades with the disease, making the symptom experience much more relevant to their lifestyle and health outcomes. The goal of the research reported here was to assess the symptom reporting of PLWH in the Unites States (US) in the combined antiretroviral therapy (cART) age of the epidemic. We conducted an anonymous online survey of symptomatic PLWH in the US and asked participants to report the frequency and intensity of 28 frequently occurring symptoms in the past 30 days. The relationship between symptom reporting and demographic factors was investigated using the adaptive least absolute shrinkage and selection operator (LASSO) method. Fatigue was the most frequently reported symptom in our study population. Those with the lowest income were more likely to report more burdensome symptoms. In comparison to other racial and ethnic groups, Black non-Hispanic participants were significantly more likely to report a lower symptom burden score for fatigue, depression, muscle aches, anxiety, difficulties with memory and concentration. There were no racial/ ethnic differences in the burden of the symptoms related to sleep or neuropathy. Findings from this study present new evidence on the symptom reporting of PLWH in the US. Neuropathy continues to be a pervasive neurological symptom with no difference noted between racial/ ethnic groups.

Loneliness Predicts Self-reported Cold Symptoms after a Viral Challenge

PubMed Central

LeRoy, Angie S.; Murdock, Kyle W.; Jaremka, Lisa M.; Loya, Asad; Fagundes, Christopher P.

2017-01-01

Objective Loneliness is a well-established risk factor for poor physical health. Much less is known about how loneliness affects patient-reported outcomes (PROs), such as somatic symptoms, which are increasingly important for guiding symptom management and assessing quality of patient care. The current study investigates whether (a) loneliness and social isolation predict cold symptoms independent of each other, and (b) whether loneliness is a more robust risk factor than objective social isolation for experiencing cold symptoms. Methods As part of a larger parent study, 213 healthy participants completed the Short Loneliness Scale (LON) and the Social Network Index (SNI) at baseline. They were given nasal drops containing rhinovirus 39 (RV39; i.e., a common cold virus), then quarantined for 5 days during which they reported on subjective cold symptoms in addition to being monitored for objective indicators of infection. Data from 160 of the participants (who were infected with the virus) were used in the present analyses. Results A hierarchical multiple regression revealed that baseline loneliness predicted self-reported cold symptoms over time (assessed via area under the curve), over and above demographic variables, season of participation, and depressive affect. Interestingly, social network size and diversity did not predict cold symptoms. Conclusions These findings suggest that the perception of loneliness is more closely linked to self-reported illness symptoms than objectively measured social isolation. Assessing psychosocial factors such as loneliness when treating and evaluating the common cold could contribute to health care practitioners’ understanding of their patients’ experiences with acute illness. PMID:28358524

Lumbar disc herniation presenting with contralateral symptoms: a case report.

PubMed

Koh, Zhi Sheng Darren; Lin, Shuxun; Hey, Hwee Weng Dennis

2017-03-01

Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy.

Ways of encoding somatic information and their effects on retrospective symptom reporting.

PubMed

Walentynowicz, Marta; Van Diest, Ilse; Raes, Filip; Van den Bergh, Omer

2017-05-01

Retrospective symptom reports tend to overestimate actual symptom intensity. This study explored how focusing on sensory-perceptual or on affective-motivational aspects of a somatic experience influenced retrospective symptom reports in high and low habitual symptom reporters (HSR). We hypothesized that a focus on affective-motivational aspects of somatic episodes contributes to retrospective overestimation compared to a focus on sensory-perceptual aspects. Dyspnoea (rebreathing) and pain (cold pain) were induced during two experimental sessions in healthy women: 21 high and 24 low HSR, selected using cut-off scores on a symptom checklist. Within-subject manipulation of sensory and affective processing focus (PF) took place at the encoding phase before symptom induction. Dyspnoea and pain ratings were collected immediately after the symptom inductions and after 2 weeks. Breathing behaviour was recorded during dyspnoea trials, while affective state and symptom measures were collected after each trial. Compared to pain, dyspnoea induction was perceived as more unpleasant, arousing, and threatening (ps < .001). Affective PF led to higher arousal (p < .01) and threat ratings (p = .01) than sensory PF. Affective PF also led to an increase in retrospective dyspnoea ratings over the course of 2 weeks (p = .039), which was not observed for pain, nor for dyspnoea after sensory PF. The effects of PF on symptom ratings were independent of the HSR levels. The PF during symptom encoding may explain previously observed bias in retrospective symptom reporting. The results are relevant to understand the mechanisms underlying symptom overreporting. Statement of contribution What is already known on this subject? Retrospective symptom ratings are often biased when compared to the momentary assessments. Attending to either sensory or affective aspects of the somatic experience is one of the factors affecting self-reported symptoms. What does this study add? Focusing on

Lumbar disc herniation presenting with contralateral symptoms: a case report

PubMed Central

Koh, Zhi Sheng Darren; Lin, Shuxun

2017-01-01

Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy. PMID:28435926

Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies.

PubMed

Niesten, Isabella J M; Müller, Wenke; Merckelbach, Harald; Dandachi-FitzGerald, Brechje; Jelicic, Marko

2017-01-01

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints ( n  = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls ( n  = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n  = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls ( n  = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population ( N  = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.

Beyond symptom self-report: use of a computer "avatar" to assess post-traumatic stress disorder (PTSD) symptoms.

PubMed

Myers, Catherine E; Radell, Milen L; Shind, Christine; Ebanks-Williams, Yasheca; Beck, Kevin D; Gilbertson, Mark W

2016-11-01

Post-traumatic stress disorder (PTSD) can occur in the wake of exposure to a traumatic event. Currently, PTSD symptoms are assessed mainly through self-report in the form of questionnaire or clinical interview. Self-report has inherent limitations, particularly in psychiatric populations who may have limited awareness of deficit, reduced attention span, or poor vocabulary and/or literacy skills. Diagnosis and evaluation of treatment efficacy would be aided by behavioral measures. A viable alternative may be virtual environments, in which the participant guides an on-screen "avatar" through a series of onscreen events meant to simulate real-world situations. Here, a sample of 82 veterans, self-assessed for PTSD symptoms was administered such a task, in which the avatar was confronted with situations that might evoke avoidant behavior, a core feature of PTSD. Results showed a strong correlation between PTSD symptom burden and task performance; in fact, the ability to predict PTSD symptom burden based on simple demographic variables (age, sex, combat exposure) was significantly improved by adding task score as a predictor variable. The results therefore suggest that virtual environments may provide a new way to assess PTSD symptoms, while avoiding at least some of the limitations associated with symptom self-report, and thus might be a useful complement to questionnaire or clinical interview, potentially facilitating both diagnosis and evaluation of treatment efficacy.

Immediate versus delayed self-reporting of symptoms and side effects during chemotherapy: does timing matter?

PubMed

Coolbrandt, Annemarie; Van den Heede, Koen; Vanhove, Ellen; De Bom, Ann; Milisen, Koen; Wildiers, Hans

2011-04-01

The aim of this study was to examine how patients recall symptoms at a delayed self-report. Accurate insight into toxicity symptoms during chemotherapy is essential so that nurses and doctors can assess therapeutic tolerance and adjust supportive care accordingly. A non-experimental, longitudinal design was employed. Using the Therapy-Related Symptoms Checklist (TRSC), respondents (n = 142) reported their initial symptoms during the first 7 days of the chemotherapy cycle at two different times: (1) each day of the first seven days after the chemotherapy administration (immediate self-report), and (2) at their next hospital visit for chemotherapy (delayed self-report). We compared the number and severity of symptoms and side effects reported in the immediate and delayed self-reports. Respondents reported significantly fewer symptoms and fewer severe symptoms in the delayed self-report. For 22 out of 25 symptoms the delayed-reported grade was significantly lower than the immediate-reported maximum grade. Compared to the immediate-reported median grade, significant differences occurred in only 10 out of the 25 symptoms. In all cases, except fatigue, the delayed-reported grade was significantly higher than the immediate-reported median grade. This study indicates that delayed self-report of chemotherapy side effects is not an appropriate measure of actual symptoms and side effects experienced by patients. Delayed self-report gives a weaker insight into actual symptom burden. Fatigue is at particular risk to be minimized at the delayed self-report. Therefore it is recommended to assess chemotherapy-related symptoms and side effects by means of immediate self-report. Copyright © 2010 Elsevier Ltd. All rights reserved.

Yale Study: African-American Women Report More Menopause Symptoms than White Women

ERIC Educational Resources Information Center

Black Issues in Higher Education, 2005

2005-01-01

A study of African-American women in menopause shows that while they experience many of the same symptoms as White women, they report more vasomotor symptoms such as dizziness and bloating, according to a study by a Yale School of Nursing researcher. The women reported symptoms common among White women in menopause--hot flashes, irregular…

Adolescent Coping Profiles Differentiate Reports of Depression and Anxiety Symptoms

PubMed Central

Herres, Joanna; Ohannessian, Christine McCauley

2015-01-01

The purpose of the study was to identify groups of adolescents based on their reported use of different coping strategies and compare levels of depression and anxiety symptoms across the groups. Tenth and eleventh grade public school students (N = 982; 51% girls; 66% Caucasian; M age =16.04, SD = .73) completed a battery of self-report measures that assessed their use of different coping strategies, depressive symptoms, and anxiety symptoms. Latent profile analysis (LPA) classified the participants into four distinct groups based on their responses on subscales of the COPE inventory (Carver, Scheier, & Weintraub, 1989). Groups differed in amount of coping with participants in each group showing relative preference for engaging in certain strategies over others. Disengaged copers reported the lowest amounts of coping with a preference for avoidance strategies. Independent copers reported moderate levels of coping with relatively less use of support-seeking. Social support-seeking copers and active copers reported the highest levels of coping with a particular preference for support-seeking strategies. The independent copers reported the lowest levels of depressive symptoms compared to the three other groups. The Social Support Seeking and Active Coping Groups reported the highest levels of anxiety. Although distinct coping profiles were observed, findings showed that adolescents between the ages of 14 and 16 engage in multiple coping strategies and are more likely to vary in their amount of coping than in their use of specific strategies. PMID:26275359

Quantitative assessment of post-concussion syndrome following mild traumatic brain injury using robotic technology.

PubMed

Subbian, Vignesh; Meunier, Jason M; Korfhagen, Joseph J; Ratcliff, Jonathan J; Shaw, George J; Beyette, Fred R

2014-01-01

Post-Concussion Syndrome (PCS) is a common sequelae of mild Traumatic Brain Injury (mTBI). Currently, there is no reliable test to determine which patients will develop PCS following an mTBI. As a result, clinicians are challenged to identify patients at high risk for subsequent PCS. Hence, there is a need to develop an objective test that can guide clinical risk stratification and predict the likelihood of PCS at the initial point of care in an Emergency Department (ED). This paper presents the results of robotic-assisted neurologic testing completed on mTBI patients in the ED and its ability to predict PCS at 3 weeks post-injury. Preliminary results show that abnormal proprioception, as measured using robotic testing is associated with higher risk of developing PCS following mTBI. In this pilot study, proprioceptive measures obtained through robotic testing had a 77% specificity (95CI: 46%-94%) and a 64% sensitivity (95CI: 41%-82%).

Impact of Cabin Ozone Concentrations on Passenger Reported Symptoms in Commercial Aircraft

PubMed Central

Bekö, Gabriel; Allen, Joseph G.; Weschler, Charles J.; Vallarino, Jose; Spengler, John D.

2015-01-01

Due to elevated ozone concentrations at high altitudes, the adverse effect of ozone on air quality, human perception and health may be more pronounced in aircraft cabins. The association between ozone and passenger-reported symptoms has not been investigated under real conditions since smoking was banned on aircraft and ozone converters became more common. Indoor environmental parameters were measured at cruising altitude on 83 US domestic and international flights. Passengers completed a questionnaire about symptoms and satisfaction with the indoor air quality. Average ozone concentrations were relatively low (median: 9.5 ppb). On thirteen flights (16%) ozone levels exceeded 60 ppb, while the highest peak level reached 256 ppb for a single flight. The most commonly reported symptoms were dry mouth or lips (26%), dry eyes (22.1%) and nasal stuffiness (18.9%). 46% of passengers reported at least one symptom related to the eyes or mouth. A third of the passengers reported at least one upper respiratory symptom. Using multivariate logistic (individual symptoms) and linear (aggregated continuous symptom variables) regression, ozone was consistently associated with symptoms related to the eyes and certain upper respiratory endpoints. A concentration-response relationship was observed for nasal stuffiness and eye and upper respiratory symptom indicators. Average ozone levels, as opposed to peak concentrations, exhibited slightly weaker associations. Medium and long duration flights were significantly associated with more symptoms compared to short flights. The relationship between ultrafine particles and ozone on flights without meal service was indicative of ozone-initiated chemistry. PMID:26011001

Sex Differences in Vestibular/Ocular and Neurocognitive Outcomes After Sport-Related Concussion.

PubMed

Sufrinko, Alicia M; Mucha, Anne; Covassin, Tracey; Marchetti, Greg; Elbin, R J; Collins, Michael W; Kontos, Anthony P

2017-03-01

To examine sex differences in vestibular and oculomotor symptoms and impairment in athletes with sport-related concussion (SRC). The secondary purpose was to replicate previously reported sex differences in total concussion symptoms, and performance on neurocognitive and balance testing. Prospective cross-sectional study of consecutively enrolled clinic patients within 21 days of a SRC. Specialty Concussion Clinic. Included male (n = 36) and female (n = 28) athletes ages 9 to 18 years. Vestibular symptoms and impairment was measured with the Vestibular/Ocular Motor Screening (VOMS). Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT), Post-concussion Symptom Scale (PCSS), and Balance Error Scoring System (BESS). Sex differences on clinical measures. Females had higher PCSS scores (P = 0.01) and greater VOMS vestibular ocular reflex (VOR) score (P = 0.01) compared with males. There were no sex differences on BESS or ImPACT. Total PCSS scores together with female sex accounted for 45% of the variance in VOR scores. Findings suggest higher VOR scores after SRC in female compared with male athletes. Findings did not extend to other components of the VOMS tool suggesting that sex differences may be specific to certain types of vestibular impairment after SRC. Additional research on the clinical significance of the current findings is needed.

Baseline neurocognitive testing in sports-related concussions: the importance of a prior night's sleep.

PubMed

McClure, D Jake; Zuckerman, Scott L; Kutscher, Scott J; Gregory, Andrew J; Solomon, Gary S

2014-02-01

The management of sports-related concussions (SRCs) utilizes serial neurocognitive assessments and self-reported symptom inventories to assess recovery and safety for return to play (RTP). Because postconcussive RTP goals include symptom resolution and a return to neurocognitive baseline levels, clinical decisions rest in part on understanding modifiers of this baseline. Several studies have reported age and sex to influence baseline neurocognitive performance, but few have assessed the potential effect of sleep. We chose to investigate the effect of reported sleep duration on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance and the number of patient-reported symptoms. We hypothesized that athletes receiving less sleep before baseline testing would perform worse on neurocognitive metrics and report more symptoms. Cross-sectional study; Level of evidence, 3. We retrospectively reviewed 3686 nonconcussed athletes (2371 male, 1315 female; 3305 high school, 381 college) with baseline symptom and ImPACT neurocognitive scores. Patients were stratified into 3 groups based on self-reported sleep duration the night before testing: (1) short, <7 hours; (2) intermediate, 7-9 hours; and (3) long, ≥9 hours. A multivariate analysis of covariance (MANCOVA) with an α level of .05 was used to assess the influence of sleep duration on baseline ImPACT performance. A univariate ANCOVA was performed to investigate the influence of sleep on total self-reported symptoms. When controlling for age and sex as covariates, the MANCOVA revealed significant group differences on ImPACT reaction time, verbal memory, and visual memory scores but not visual-motor (processing) speed scores. An ANCOVA also revealed significant group differences in total reported symptoms. For baseline symptoms and ImPACT scores, subsequent pairwise comparisons revealed these associations to be most significant when comparing the short and intermediate sleep groups. Our

Low basal salivary cortisol is associated with teacher-reported symptoms of conduct disorder.

PubMed

Oosterlaan, Jaap; Geurts, Hilde M; Knol, Dirk L; Sergeant, Joseph A

2005-03-30

Cortisol has been implicated in psychobiological explanations of antisocial behavior. This study measured basal salivary cortisol in a sample of 25 children (age range 6 to 12 years) selected to vary in levels of antisocial behavior. Regression analyses were used to predict cortisol concentrations from parent- and teacher-reported symptoms. Parent-reported symptoms did not predict basal cortisol. Teacher-reported conduct disorder (CD) symptoms explained 38% of the variance in the cortisol concentrations, with high symptom severity associated with low cortisol. When a distinction was made between aggressive and non-aggressive CD symptoms, aggressive CD symptoms were more clearly related to low cortisol than non-aggressive CD symptoms. In contrast to previous research, no evidence was found for a mediating role of anxiety symptoms in the relationship between CD and cortisol. The results support biologically based models of antisocial behavior in children that involve reduced autonomic activity.

Posttraumatic Symptom Reporting and Reported Cigarette Smoking During Pregnancy.

PubMed

Kornfield, Sara L; Moseley, Marian; Appleby, Dina; McMickens, Courtney L; Sammel, Mary D; Epperson, C Neill

2017-06-01

Increased prevalence of nicotine dependence among individuals suffering from posttraumatic stress disorder (PTSD) is well established. However, there are limited studies on the prevalence of smoking during pregnancy in relation to prepregnancy history of trauma exposures and active PTSD symptoms during pregnancy. Prenatal smoking has been implicated in a host of negative outcomes for mother and baby. Given maternal and fetal risk, it is critical to define predictors of continued cigarette smoking during pregnancy. Pregnant women from an urban perinatal clinic completed an anonymous survey of trauma history using a modified Traumatic Life Events Questionnaire (TLEQ), PTSD symptoms using the PTSD Symptom Checklist-Civilian Version (PCL-C) and current and past smoking behavior. Those who smoked any number of cigarettes per day after pregnancy confirmation were considered to be "pregnant smokers." Of 218 women who completed the survey, 34 (15.6%) reported smoking cigarettes after confirmation of pregnancy. In unadjusted models, trauma exposure that resulted in fear, helplessness, or horror (FHH), as well as current PTSD symptom severity and probable PTSD diagnosis showed statistical significance as predictors of smoking during pregnancy. After adjusting for age only, PTSD symptoms retained their significant association with smoking during pregnancy. When history of smoking at least five cigarettes per day was added to our models, none of the associations remained significant. These findings emphasize the importance of the behavioral response to past traumatic exposures in influencing cigarette smoking behavior before pregnancy. Given such behaviors enhance risk for continued tobacco use during pregnancy, a trauma-informed approach to smoking cessation in preconception care may ultimately reduce the likelihood of smoking during pregnancy and requires further study.

Self-reported symptoms of gynecological morbidity and their treatment in south India.

PubMed

Bhatia, J C; Cleland, J

1995-01-01

This article presents an analysis of self-reported symptoms of gynecological problems among 3,600 recent mothers in Karnataka State, India. Approximately one-third of all women reported at least one current symptom; the most common were a feeling of weakness and tiredness (suggestive of anemia); menstrual disorders; white or colored vaginal discharge (suggestive of lower reproductive tract infection); and lower abdominal pain and discharge with fever (suggestive of acute pelvic inflammatory disease). Obstetric morbidity, associated with the last live birth, was strongly predictive of current gynecological symptoms. Women who delivered their last child in a private institution were significantly less likely to report symptoms than were those who delivered at home or in a government hospital. Nonusers or users of reversible contraceptive methods were also less likely to report symptoms of morbid conditions than were sterilized women. These associations persisted in analyses controlling for potentially confounding economic and demographic characteristics, and have far-reaching policy implications.

The Body Dysmorphic Disorder Symptom Scale: Development and preliminary validation of a self-report scale of symptom specific dysfunction.

PubMed

Wilhelm, Sabine; Greenberg, Jennifer L; Rosenfield, Elizabeth; Kasarskis, Irina; Blashill, Aaron J

2016-06-01

The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is a new self-report measure used to examine the severity of a wide variety of symptoms associated with body dysmorphic disorder (BDD). The BDD-SS was designed to differentiate, for each group of symptoms, the number of symptoms endorsed and their severity. This report evaluates and compares the psychometric characteristics of the BDD-SS in relation to other measures of BDD, body image, and depression in 99 adult participants diagnosed with BDD. Total scores of the BDD-SS showed good reliability and convergent validity and moderate discriminant validity. Analyses of the individual BDD-SS symptom groups confirmed the reliability of the checking, grooming, weight/shape, and cognition groups. The current findings indicate that the BDD-SS can be quickly administered and used to examine the severity of heterogeneous BDD symptoms for research and clinical purposes. Copyright © 2016. Published by Elsevier Ltd.

Assessment of patient-reported symptoms of anxiety

PubMed Central

Rose, Matthias; Devine, Janine

2014-01-01

Patient self-reported symptoms are of crucial importance to identify anxiety disorders, as well as to monitor their treatment in clinical practice and research. Thus, for evidence-based medicine, a precise, reliable, and valid (ie, “objective”) assessment of the patient's reported “subjective” symptoms is warranted. There is a plethora of instruments available, which can provide psychometrically sound assessments of anxiety, but there are several limitations of current tools that need to be carefully considered for their successful use. Nevertheless, the empirical assessment of mental health status is not as accepted in medicine as is the assessment of biomarkers. One reason for this may be that different instruments assessing the same psychological construct use different scales. In this paper we present some new developments that promise to provide one common metric for the assessment of anxiety, to facilitate the general acceptance of mental health assessments in the future. PMID:25152658

Predictors of Self-Reported Physical Symptoms in Low-Income, Inner-City African American Women: The Role of Optimism, Depressive Symptoms, and Chronic Illness

ERIC Educational Resources Information Center

Jones, Deborah J.; O'Connell, Cara; Gound, Mary; Heller, Laurie; Forehand, Rex

2004-01-01

In this study we examined the association of optimism and depressive symptoms with self-reported physical symptoms in 241 low-income, inner-city African American women with or without a chronic illness (HIV). Although optimism was not a unique predictor of self-reported physical symptoms over and above depressive symptoms, optimism interacted with…

Assessing the accuracy of blood RNA profiles to identify patients with post-concussion syndrome: A pilot study in a military patient population.

PubMed

Hardy, Jimmaline J; Mooney, Scott R; Pearson, Andrea N; McGuire, Dawn; Correa, Daniel J; Simon, Roger P; Meller, Robert

2017-01-01

Mild traumatic brain injury (mTBI) is a complex, neurophysiological condition that can have detrimental outcomes. Yet, to date, no objective method of diagnosis exists. Physical damage to the blood-brain-barrier and normal waste clearance via the lymphatic system may enable the detection of biomarkers of mTBI in peripheral circulation. Here we evaluate the accuracy of whole transcriptome analysis of blood to predict the clinical diagnosis of post-concussion syndrome (PCS) in a military cohort. Sixty patients with clinically diagnosed chronic concussion and controls (no history of concussion) were recruited (retrospective study design). Male patients (46) were split into a training set comprised of 20 long-term concussed (> 6 months and symptomatic) and 12 controls (no documented history of concussion). Models were validated in a testing set (control = 9, concussed = 5). RNA_Seq libraries were prepared from whole blood samples for sequencing using a SOLiD5500XL sequencer and aligned to hg19 reference genome. Patterns of differential exon expression were used for diagnostic modeling using support vector machine classification, and then validated in a second patient cohort. The accuracy of RNA profiles to predict the clinical diagnosis of post-concussion syndrome patients from controls was 86% (sensitivity 80%; specificity 89%). In addition, RNA profiles reveal duration of concussion. This pilot study shows the potential utility of whole transcriptome analysis to establish the clinical diagnosis of chronic concussion syndrome.

A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome.

PubMed

Azulay, Joanne; Smart, Colette M; Mott, Tasha; Cicerone, Keith D

2013-01-01

To evaluate the effectiveness of the mindfulness-based stress reduction (MBSR) program tailored to individuals with mild traumatic brain injury (mTBI). A convenience sample recruited from clinical referrals over a 2-year period completed outcome measures pre- and posttreatment intervention. Post-acute brain injury rehabilitation center within a suburban medical facility. Twenty-two individuals with mTBI and a time postinjury more than 7 months. Eleven participants were men and 11 were women, ranging in age from 18 to 62 years. A 10-week group (with weekly 2-hour sessions) modeled after the MBSR program of Kabat-Zinn, but with modifications designed to facilitate implementation in a population of individuals with brain injury. (The treatment involved enhancement of attentional skills, in addition to increased awareness of internal and external experiences associated with the perspective change of acceptance and nonjudgmental attitude regarding those experiences). Perceived Quality of Life Scale, Perceived Self-Efficacy Scale, and the Neurobehavioral Symptom Inventory. Secondary measures included neuropsychological tests, a self-report problem-solving inventory, and a self-report measure of mindfulness. Clinically meaningful improvements were noted on measures of quality of life (Cohen d = 0.43) and perceived self-efficacy (Cohen d = 0.50) with smaller but still significant effects on measures of central executive aspects of working memory and regulation of attention. The MBSR program can be adapted for participants with mTBI. Improved performance on measures associated with improved quality of life and self-efficacy may be related to treatment directed at improving awareness and acceptance, thereby minimizing the catastrophic assessment of symptoms associated with mTBI and chronic disability. Additional research on the comparative effectiveness of the MBSR program for people with mTBI is warranted.

Self-Reported Symptoms of Parkinson's Disease by Sex and Disease Duration.

PubMed

Shin, Ju Young; Pohlig, Ryan T; Habermann, Barbara

2017-11-01

Parkinson's disease (PD) is a neurodegenerative disease with a wide range of symptom presentations. The purpose of this research was to compare self-reported motor and non-motor symptoms of PD by sex and disease duration. This study was a cross-sectional descriptive survey in community-dwelling people with PD. A total of 141 participants (64.6% response rate; 59.6% men; M age = 69.7 years) were included. Males reported more rigidity, speech problems, sexual dysfunction, memory problems, and socializing problems than females. The number of motor symptoms in three groups divided by increments of 5 years was significantly increased. Postural instability, freezing, off periods, dyskinesia, speech problems, and hallucinations/psychosis were significantly increased as the disease duration increased. Thorough assessment of motor and non-motor symptoms could decrease the risk of inadequate symptom management. Provision of information regarding PD symptoms at each stage may help people with PD and their caregivers in planning their future care and life.

Self-reported Discrimination and Depressive Symptoms Among Older Chinese Adults in Chicago.

PubMed

Li, Lydia W; Dong, XinQi

2017-07-01

Discrimination is part of life for many Americans, especially ethnic minorities. Focusing on older Chinese Americans, this study examines the association between self-reported discrimination and depressive symptoms and identifies subgroups that are more likely to report experiencing discrimination. We conducted cross-sectional analysis of data collected from adults (age 60+ years) of Chinese origin residing in the Greater Chicago area (N = 3,004). Self-reported discrimination was assessed by the Experiences of Discrimination instrument and was dichotomized (yes vs no). Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). Logistic regression of self-reported discrimination and negative binominal regression of depressive symptoms were conducted. About 21.5% of the sample reported having experienced discrimination. The odds of reporting discrimination are higher for those who are younger, have higher education and income, are more acculturated, have been in the United States longer, live outside Chinatown, and have higher levels of neuroticism and conscientiousness. Self-reported discrimination is significantly and positively associated with depressive symptoms, independent of sociodemographic characteristics, migration-related variables, and personality factors. Findings suggest a robust relationship between self-reported discrimination and depressive symptoms in older Chinese Americans. They further suggest that the relatively advantaged groups-younger, higher socioeconomic status, more acculturated, and living outside Chinatown-are more likely to report experiencing discrimination. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Discordance between self-reported arthritis and musculoskeletal signs and symptoms in older women.

PubMed

Lo, Tkt; Parkinson, Lynne; Cunich, Michelle; Byles, Julie

2016-12-01

Arthritis is a gendered disease where women have a higher prevalence and more disability than men with arthritis of the same age. Health survey data is a major source of information for monitoring of the burden of arthritis. The validity of self-reported arthritis and the determinants of its accuracy among women have not been thoroughly studied. The objectives of this study were to: 1) examine the agreement between self-report diagnosed arthritis and musculoskeletal signs and symptoms in community-living older women; 2) estimate the sensitivity, specificity, and predictive values of self-reported arthritis; and 3) assess the factors associated with the disagreement. A cross-sectional survey of women was undertaken in 2012-13. The health survey asked women about diagnosed arthritis and musculoskeletal signs and symptoms. Agreement between self-reported arthritis and musculoskeletal signs symptoms was measured by Cohen's kappa. Sensitivity, specificity, and predictive values of self-reported arthritis were estimated using musculoskeletal signs and symptoms as the reference standard. Factors associated with disagreement between self-reported arthritis and the reference standard were examined using multiple logistic regression. There were 223 participants self-reported arthritis and 347 did not. A greater number of participants who self-reported arthritis were obese compared to those who did not report arthritis. Those who reported arthritis had worse health, physical functioning, and arthritis symptom measures. Among the 570 participants, 198 had musculoskeletal signs and symptoms suggesting arthritis (the reference standard). Agreement between self-reported arthritis and the reference standard was moderate (kappa = 0.41). Sensitivity, specificity, and positive and negative predictive values of self-reported arthritis in older women were 66.7, 75.5, 59.2, and 81.0% respectively. Regression analysis results indicated that false-positive is associated with better

Self-Reported Bruxism and Symptoms of Temporomandibular Disorders in Finnish University Students.

PubMed

Huhtela, Outi S; Näpänkangas, Ritva; Joensuu, Tiina; Raustia, Aune; Kunttu, Kristina; Sipilä, Kirsi

2016-01-01

To evaluate the prevalence of self-reported bruxism and symptoms of temporomandibular disorders (TMD) and to investigate their association in academic and applied science university students in Finland. The data were gathered from 4,403 Finnish students included in the Finnish Student Health Survey 2012. The comprehensive questionnaire included five questions concerning bruxism and TMD symptoms. Bivariate associations between self-reported bruxism and TMD symptoms were evaluated using chi-square tests, and logistic regression model was used with age and gender as factors. Sleep bruxism was reported by 21.0% of women and by 12.5% of men, awake bruxism by 2.0% of women and by 2.8% of men, and both sleep and awake bruxism by 7.2% of women and by 3.2% of men. TMD pain was reported by 25.9% of women and by 11.4% of men and temporomandibular joint (TMJ) pain on jaw movement by 9.6% of women and by 4.2% of men. Report of sleep bruxism increased the risk for all TMD symptoms in both genders. Among women, report of awake bruxism increased the risk for TMD pain and TMJ pain on jaw movement. Reporting stress as a perpetuating factor for TMD pain increased the risk for both sleep and awake bruxism in both genders. The logistic regression analysis (including age and gender) showed that report of sleep bruxism and/or awake bruxism was associated with TMD pain (Odds Ratio [OR] = 5.71; 95% confidence interval [CI] = 4.86-6.70), TMJ pain on jaw movement (OR = 4.49; 95% CI = 3.54-5.69), and TMJ locking (OR = 2.98; 95% CI = 2.17-4.10). Bruxism and TMD symptoms are frequent in Finnish university students. Self-reported bruxism is associated with TMD symptoms, confirming earlier findings.

Occupational needs and intervention strategies for military personnel with mild traumatic brain injury and persistent post-concussion symptoms: a review.

PubMed

Cogan, Alison M

2014-01-01

Mild traumatic brain injury (mTBI), also known as concussion, has been labeled the "signature injury" of the wars in Iraq and Afghanistan. A subset of military personnel with mTBI experience ongoing symptoms well beyond the normal recovery window. While much research has been dedicated to understanding the etiology and severity of the symptoms, very little has assessed how long-term symptoms impact participation in daily life. A scoping study of the occupational science and occupational therapy literature was conducted to ascertain the current state of research on the impact of mTBI on participation in daily life activities, as well as occupational therapy interventions for mTBI. Although the emphasis in this article is on military personnel with mTBI, studies on civilians with mTBI were included in the review as research with military populations is extremely limited. Based on the literature reviewed, the author suggests a role for occupational science research and occupational therapy practice in meeting the occupational needs of military service members with persistent symptoms after mTBI. Copyright 2014, SLACK Incorporated.

Health complaints and wind turbines: The efficacy of explaining the nocebo response to reduce symptom reporting.

PubMed

Crichton, Fiona; Petrie, Keith J

2015-07-01

A number of people are reporting an environmental sensitivity to sub-audible windfarm sound (infrasound), characterised by the experience of recurrent non-specific symptoms. A causal link between exposure and symptoms is not indicated by empirical evidence. Research indicates symptoms may be explained by the nocebo response, whereby health concerns and negative expectations, created from social discourse and media reports, trigger symptom reporting. The experimental aim was to test whether providing a nocebo explanation for symptoms, to individuals reporting symptomatic experiences during infrasound exposure, would ameliorate symptoms during further exposure. Sixty-six volunteers were randomly assigned to nocebo explanation or biological explanation groups. Participants were concurrently exposed to infrasound and audible windfarm sound, while reporting on current symptoms and mood, during two exposure sessions. Preceding session one, participants watched a presentation integrating media warnings about purported health risks posed by windfarm infrasound. Before session two, nocebo explanation participants viewed material outlining how nocebo responding could explain symptom reporting. Instead biological explanation participants watched material presenting pathophysiological theories for symptoms. During session one, participants reported increased symptoms and mood deterioration from baseline assessment. During session two symptom reporting and mood deterioration was maintained by biological explanation participants, while mood and symptoms reported by nocebo explanation participants returned to baseline levels. Results indicate that providing an explanation of the nocebo response, followed by exposure to infrasound, has the potential to operate as an intervention to reduce symptomatic experiences in people reporting symptoms attributed to windfarm generated infrasound. Copyright © 2015 Elsevier Inc. All rights reserved.

Acute post-traumatic stress symptoms and age predict outcome in military blast concussion.

PubMed

Mac Donald, Christine L; Adam, Octavian R; Johnson, Ann M; Nelson, Elliot C; Werner, Nicole J; Rivet, Dennis J; Brody, David L

2015-05-01

High rates of adverse outcomes have been reported following blast-related concussive traumatic brain injury in US military personnel, but the extent to which such adverse outcomes can be predicted acutely after injury is unknown. We performed a prospective, observational study of US military personnel with blast-related concussive traumatic brain injury (n = 38) and controls (n = 34) enrolled between March and September 2012. Importantly all subjects returned to duty and did not require evacuation. Subjects were evaluated acutely 0-7 days after injury at two sites in Afghanistan and again 6-12 months later in the United States. Acute assessments revealed heightened post-concussive, post-traumatic stress, and depressive symptoms along with worse cognitive performance in subjects with traumatic brain injury. At 6-12 months follow-up, 63% of subjects with traumatic brain injury and 20% of controls had moderate overall disability. Subjects with traumatic brain injury showed more severe neurobehavioural, post-traumatic stress and depression symptoms along with more frequent cognitive performance deficits and more substantial headache impairment than control subjects. Logistic regression modelling using only acute measures identified that a diagnosis of traumatic brain injury, older age, and more severe post-traumatic stress symptoms provided a good prediction of later adverse global outcomes (area under the receiver-operating characteristic curve = 0.84). Thus, US military personnel with concussive blast-related traumatic brain injury in Afghanistan who returned to duty still fared quite poorly on many clinical outcome measures 6-12 months after injury. Poor global outcome seems to be largely driven by psychological health measures, age, and traumatic brain injury status. The effects of early interventions and longer term implications of these findings are unknown. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All

Vegans report less bothersome vasomotor and physical menopausal symptoms than omnivores.

PubMed

Beezhold, Bonnie; Radnitz, Cynthia; McGrath, Robert E; Feldman, Arielle

2018-06-01

Lifestyle modifications that may reduce menopausal symptoms have generated much interest. The vegetarian diet has been associated with a lower risk of chronic disease as well as a more healthy hormonal milieu. Our objective in this cross-sectional study was to survey peri- and postmenopausal women to investigate menopausal symptoms and dietary pattern. Survey distribution in 2015-2016 was aimed at female vegans, vegetarians, and omnivores between the ages of 45 and 80 years, who were active on senior and vegetarian social networking websites and at vegan restaurants and events. We investigated vasomotor and physical symptoms as measured by the Menopause-specific Quality of Life Questionnaire (MENQOL) and dietary pattern classified by animal protein intakes reported in response to food frequency questions. Out of 754 participants who completed the survey, 604 reported they were perimenopausal (n = 121) or postmenopausal (n = 483), of whom 539 also completed the food frequency questions. We compared vasomotor and physical symptoms in omnivores (n = 304, consumed meat and/or poultry at least monthly) and vegans (n = 125, abstained from all animal proteins) using general linear models; covariates included age, exercise, hormone replacement therapy, presence of reproductive organs, and age at menopause. Among perimenopausal women, vegans reported less bothersome vasomotor (p < 0.01) and physical symptoms (p < 0.01) than omnivores. For both symptom types, more vegetables and less flesh food were associated with less bothersome symptoms (p values < 0.05). Eating a plant-based diet may be helpful for women in menopausal transition who prefer a natural means to manage their symptoms. Copyright © 2018 Elsevier B.V. All rights reserved.

A diary-based modification of symptom attributions in pathological health anxiety: effects on symptom report and cognitive biases.

PubMed

Kerstner, Tobias; Witthöft, Michael; Mier, Daniela; Diener, Carsten; Rist, Fred; Bailer, Josef

2015-06-01

To examine whether a 2-week attribution modification training (AMT) changes symptom severity, emotional evaluation of health-threatening stimuli, and cognitive biases in pathological health anxiety. We randomized 85 patients with pathological health anxiety into an electronic diary-based AMT group (AMTG; n = 42) and a control group without AMT (CG; n = 43). Self-report symptom measures, emotional evaluation, attentional bias, and memory bias toward symptom and illness words were assessed with an emotional Stroop task, a recognition task, and an emotional rating task for valence and arousal. After the 2-week period, the AMTG compared with the CG reported lower symptoms of pathological health anxiety, F(1, 82) = 10.94, p < .01, η2p = .12, rated symptom, F(1, 82) = 5.56, p = .02, η2p = .06, and illness words, F(1, 82) = 4.13, p = .045, η2p = .05, as less arousing, and revealed a smaller memory response bias toward symptom words in the recognition task F(1, 82) = 12.32, p < .01, η2p = .13. However, no specific AMT effect was observed for the attentional bias. The results support the efficacy of a comparatively short cognitive intervention in pathological health anxiety as a possible add-on intervention to existing treatment approaches to reduce symptom severity, as well as abnormalities in health-related emotional evaluation and memory processes. (c) 2015 APA, all rights reserved).

Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis.

PubMed

Wall, Pamela L Herbig

2012-01-01

The use of unconventional weaponry combined with decreased mortality rates and servicemembers being exposed to intense ground combat during multiple deployments has increased the risk of servicemembers living with the consequences of traumatic brain injuries (TBI) and combat operational stress. The purpose of this article is to perform a critical analysis of the literature to identify current rates of comorbid posttraumatic stress disorder (PTSD) and TBI in military and veteran populations who have served in Iraq or Afghanistan and their combined effects on persistent postconcussive symptoms. A search of the literature with military and veteran populations published after 2001 in Pubmed, OVID/Medline, Cochran Database, Embase, Scopus, CINAHL, and PsychInfo was conducted using keywords. Twenty studies met inclusion criteria. The literature search yielded mixed results for rates of PTSD, TBI, and comorbid conditions. There is some evidence that comorbid PTSD and TBI result in greater reports of postconcussive symptomology than either condition alone. Limitations include lack of consistency of measurements, sampling biases, and lack of experimental design, and these warrant further exploration. Future research is needed to decrease variability in study findings and elucidate relationships between these disorders and their effects on persistent postconcussive symptomology.

Recovery from sports-related concussion: Days to return to neurocognitive baseline in adolescents versus young adults.

PubMed

Zuckerman, Scott L; Lee, Young M; Odom, Mitchell J; Solomon, Gary S; Forbes, Jonathan A; Sills, Allen K

2012-01-01

Sports-related concussions (SRC) among high school and collegiate athletes represent a significant public health concern. The Concussion in Sport Group (CIS) recommended greater caution regarding return to play with children and adolescents. We hypothesized that younger athletes would take longer to return to neurocognitive baseline than older athletes after a SRC. Two hundred adolescent and young adult athletes who suffered a SRC were included in our clinical research cohort. Of the total participants, 100 were assigned to the 13-16 year age group and 100 to the 18-22 year age group and were matched on the number of prior concussions. Each participant completed baseline and postconcussion neurocognitive testing using the Immediate Post-Concussion assessment and Cognitive Testing (ImPACT) test battery. Return to baseline was defined operationally as post-concussion neurocognitive and symptom scores being equivalent to baseline using reliable change index (RCI) criteria. For each group, the average number of days to return to cognitive and symptom baseline were calculated. Independent sample t-tests were used to compare the mean number of days to return to baseline. Significant differences were found for days to return to baseline between 13-16 year olds and 18-22 year olds in three out of four neurocognitive measures and on the total symptom score. The average number of days to return to baseline was greater for 13-16 year olds than for 18-22 year olds on the following variables: Verbal memory (7.2 vs. 4.7, P = 0.001), visual memory (7.1 vs. 4.7, P = 0.002), reaction time (7.2 vs. 5.1 P = 0.01), and postconcussion symptom scale (8.1 vs. 6.1, P = 0.026). In both groups, greater than 90% of athletes returned to neurocognitive and symptom baseline within 1 month. Our results in this clinical research study show that in SRC, athletes 13-16 years old take longer to return to their neurocognitive and symptom baselines than athletes 18-22 years old.

Self-report pain and symptom measures for primary dysmenorrhoea: a critical review.

PubMed

Chen, C X; Kwekkeboom, K L; Ward, S E

2015-03-01

Primary dysmenorrhoea (PD) is highly prevalent among women of reproductive age and it can have significant short- and long-term consequences for both women and society as a whole. Validated symptom measures are fundamental for researchers to understand women's symptom experience of PD and to test symptom interventions. The objective of this paper was to critically review the content and psychometric properties of self-report tools to measure symptoms of PD. Databases including PubMed, PsychoINFO, Cumulative Index of Nursing and Allied Health Literature, and Health and Psychosocial Instruments were searched for self-report symptom measures that had been used among women with either PD or perimenstrual symptoms. A total of 15 measures met inclusion criteria and were included in the final analysis. The measures were categorized into generic pain measures, dysmenorrhoea-specific measures, and tools designed to measure perimenstrual symptoms. These measures had varying degrees of comprehensiveness of symptoms being measured, relevance to PD, multidimensionality and psychometric soundness. No single measure was found to be optimal for use, but some dysmenorrhoea-specific measures could be recommended if revised and further tested. Key issues in symptom measurement for PD are discussed. Future research needs to strengthen dysmenorrhoea-specific symptom measures by including a comprehensive list of symptoms based on the pathogenesis of PD, exploring relevant symptom dimensions beyond symptom severity (e.g., frequency, duration, symptom distress), and testing psychometric properties of the adapted tools using sound methodology and diverse samples. © 2014 European Pain Federation - EFIC®

The reporting of specific physical symptoms for mental distress in general practice.

PubMed

de Waal, Margot W M; Arnold, Ingrid A; Spinhoven, Philip; Eekhof, Just A H; van Hemert, Albert M

2005-08-01

Do patients report specific physical symptoms in the presence of mental distress, taking into account the presence of somatic disease? Cross-sectional data were collected from 1458 participants in eight general practices in The Netherlands. Electronic patient records provided information on somatic disease. Questionnaires included the Hospital Anxiety and Depression Scale (HADS) to measure mental distress and the Physical Symptom Checklist (PSC). Patients reporting mental distress reported all types of physical symptoms more often than did patients without mental distress. Multivariate analyses in women, corrected for the presence of somatic disease, did not substantially change the univariate pattern. Odds ratios were particularly high (>6) for feeling tired or having low energy, fatigue without exertion and forgetfulness. It is the level of mental distress rather than gender or somatic disease that accounts for the reporting of any physical symptom. Fatigue might be an exception, but here, the classification as "physical" rather then "mental" is somewhat ambiguous.

Connecting the Dots: Could Microbial Translocation Explain Commonly Reported Symptoms in HIV Disease?

PubMed Central

Wilson, Natalie L.; Vance, David E.; Moneyham, Linda D.; Raper, James L.; Mugavero, Michael J.; Heath, Sonya L.; Kempf, Mirjam-Colette

2017-01-01

Microbial translocation within the context of HIV disease has been described as one of the contributing causes of inflammation and disease progression in HIV infection. HIV-associated symptoms have been related to inflammatory markers and sCD14, a surrogate marker for microbial translocation, suggesting a plausible link between microbial translocation and symptom burden in HIV disease. Similar pathophysiological responses and symptoms have been reported in inflammatory bowel disease. We provide a comprehensive review of microbial translocation, HIV-associated symptoms, and symptoms connected with inflammation. We identify studies showing a relationship among inflammatory markers, sCD14, and symptoms reported in HIV disease. A conceptual framework and rationale to investigate the link between microbial translocation and symptoms is presented. The impact of inflammation on symptoms supports recommendations to reduce inflammation as part of HIV symptom management. Research in reducing microbial translocation-induced inflammation is limited, but needed, to further promote positive health outcomes among HIV-infected patients. PMID:25305025

Connecting the dots: could microbial translocation explain commonly reported symptoms in HIV disease?

PubMed

Wilson, Natalie L; Vance, David E; Moneyham, Linda D; Raper, James L; Mugavero, Michael J; Heath, Sonya L; Kempf, Mirjam-Colette

2014-01-01

Microbial translocation within the context of HIV disease has been described as one of the contributing causes of inflammation and disease progression in HIV infection. HIV-associated symptoms have been related to inflammatory markers and sCD14, a surrogate marker for microbial translocation, suggesting a plausible link between microbial translocation and symptom burden in HIV disease. Similar pathophysiological responses and symptoms have been reported in inflammatory bowel disease. We provide a comprehensive review of microbial translocation, HIV-associated symptoms, and symptoms connected with inflammation. We identify studies showing a relationship among inflammatory markers, sCD14, and symptoms reported in HIV disease. A conceptual framework and rationale to investigate the link between microbial translocation and symptoms is presented. The impact of inflammation on symptoms supports recommendations to reduce inflammation as part of HIV symptom management. Research in reducing microbial translocation-induced inflammation is limited, but needed, to further promote positive health outcomes among HIV-infected patients. Published by Elsevier Inc.

Self-reported wrist and finger symptoms associated with other physical/mental symptoms and use of computers/mobile phones.

PubMed

Korpinen, Leena; Pääkkönen, Rauno; Gobba, Fabriziomaria

2018-03-01

Recently, computer, mobile phone and Internet use has increased. This study aimed to determine the possible relation between self-reported wrist and finger symptoms (aches, pain or numbness) and using computers/mobile phones, and to analyze how the symptoms are specifically associated with utilizing desktop computers, portable computers or mini-computers and mobile phones. A questionnaire was sent to 15,000 working-age Finns (age 18-65). Via a questionnaire, 723 persons reported wrist and finger symptoms often or more with use. Over 80% use mobile phones daily and less than 30% use desktop computers or the Internet daily at leisure, e.g., over 89.8% quite often or often experienced pain, numbness or aches in the neck, and 61.3% had aches in the hips and the lower back. Only 33.7% connected their symptoms to computer use. In the future, the development of new devices and Internet services should incorporate the ergonomics of the hands and wrists.

A Cross-Cultural Study of Self-Report Depressive Symptoms among College Students.

ERIC Educational Resources Information Center

Crittenden, Kathleen S.; And Others

1992-01-01

A study of self-report depressive symptoms measured by the Zung Self-Rating Depression Scale was conducted in Korea, the Philippines, Taiwan, and the United States with 953 college students. There are marked differences among countries in symptoms reported. Research designs and measurement strategies for cross-cultural research are discussed. (SLD)

Spontaneously Reported Symptoms by Informants Are Associated with Clinical Severity in Dementia Help-Seekers.

PubMed

Xu, Jia-Qi; Choy, Jacky C P; Tang, Jennifer Y M; Liu, Tian-Yin; Luo, Hao; Lou, Vivian W Q; Lum, Terry Y S; Wong, Gloria H Y

2017-09-01

To investigate the predictive value of symptoms of dementia that the person or an informant noticed spontaneously in determining the clinical severity of dementia. Cross-sectional. Community-based open-referral dementia assessment service in Hong Kong between 2005 and 2013. Help-seekers for dementia assessment service and their informants (N = 965 dyads). Participants underwent a clinical dementia interview based on the Clinical Dementia Rating. Spontaneous complaints that the person and the informant made that had prompted their help-seeking of groups with interview results suggestive of no impairment, mild cognitive impairment, and dementia were compared. Logistic regression was used to evaluate the predictive value of spontaneous complaints for clinical severity. Independent raters blinded to clinical results coded spontaneously reported symptoms into theoretical themes: memory, executive function, language, time and place orientation, neuropsychiatric, mood, and avolition. Memory problems were the most frequently reported complaints for participants (87.7%) and their informants (95.5%), followed by self-reported language (33.0%) and informant-reported orientation (33.0%) difficulties. Informant-reported but not self-reported symptoms predicted clinical severity. Compared with the persons themselves, informants reported more pervasive symptoms corresponding to clinical severity. Persons with dementia self-reported fewer types of symptoms than their healthy or mildly impaired counterparts. Spontaneously reported language and orientation symptoms by the informant distinguished persons with mild or worse dementia (P < .001, Nagelkerke coefficient of determination = 29.7%, percentage correct 85.6%). The type and pervasiveness of symptoms spontaneously that informants reported predicted clinical severity. This may provide a quick reference for triage. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Ethnic Differences in Somatic Symptom Reporting in Children with Asthma and Their Parents

ERIC Educational Resources Information Center

Vasquez, Juan C.; Fritz, Gregory K.; Jopel, Sheryl J.; Seifer, Ronald; McQuaid, Elizabeth L.; Canino, Glorisa

2009-01-01

The relationship between child and parent somatic symptom reporting and pediatric asthma reporting in Latino and non-Latino white children in Rhode Island and Puerto Rico is examined. Findings supported studies that showed Latinos having higher symptom reporting than whites. Findings also provided new insight into the relationship between general…

Team versus individual sport participation as a modifying factor in the development of post-concussion syndrome after first concussion: A pilot study.

PubMed

Jeckell, Aaron S; Brett, Benjamin L; Totten, Douglas J; Solomon, Gary S

2018-01-19

Identification of modifying factors that influence the development of post-concussion syndrome (PCS) following sport-related concussion (SRC) has drawn considerable interest. In this pilot study, we investigate the effect of team vs. individual sport participation on the development of PCS in a sample of 136 high school and college student-athletes. Controlling for several confounding variables, we employed a binary logistic regression and chi-squared test. Results of this pilot study indicate that participation in team versus individual sport is not a significant factor in the development of PCS. The identification of other forms of protective mechanisms is discussed.

Increased Symptom Reporting in Young Athletes Based on History of Previous Concussions.

PubMed

Moser, Rosemarie Scolaro; Schatz, Philip

2017-01-01

Research documents increased symptoms in adolescents with a history of two or more concussions. This study examined baseline evaluations of 2,526 younger athletes, ages 10 to 14. Between-groups analyses examined Post Concussion Symptom Scale symptoms by concussion history group (None, One, Two+) and clusters of Physical, Cognitive, Emotional, and Sleep symptoms. Healthy younger athletes with a concussion history reported greater physical, emotional, and sleep-related symptoms than those with no history of concussion, with a greater endorsement in physical/sleep symptom clusters. Findings suggest younger athletes with a history of multiple concussions may experience residual symptoms.

Self-Reported Symptoms of Parkinson’s Disease by Sex and Disease Duration

PubMed Central

Shin, Ju Young; Pohlig, Ryan T.; Habermann, Barbara

2017-01-01

Parkinson’s disease (PD) is a neurodegenerative disease with a wide range of symptom presentations. The purpose of this research was to compare self-reported motor and non-motor symptoms of PD by sex and disease duration. This study was a cross-sectional descriptive survey in community-dwelling people with PD. A total of 141 participants (64.6% response rate; 59.6% men; Mage = 69.7 years) were included. Males reported more rigidity, speech problems, sexual dysfunction, memory problems, and socializing problems than females. The number of motor symptoms in three groups divided by increments of 5 years was significantly increased. Postural instability, freezing, off periods, dyskinesia, speech problems, and hallucinations/psychosis were significantly increased as the disease duration increased. Thorough assessment of motor and non-motor symptoms could decrease the risk of inadequate symptom management. Provision of information regarding PD symptoms at each stage may help people with PD and their caregivers in planning their future care and life. PMID:27664144

Dandy-Walker syndrome with psychotic symptoms: a case report.

PubMed

Buonaguro, Elisabetta F; Cimmarosa, Sara; de Bartolomeis, Andrea

2014-01-01

Here we report the case of a patient with psychotic symptoms apparently resistant to antipsychotic treatments. Since the last admission in a psychiatric division the patient was diagnosed with Bipolar Disorder type I and then referred to our Outpatients Unit of Treatment Resistant Psychosis, where she was subsequently re-diagnosed with Dandy-Walker Syndrome. The Dandy Walker Complex is a congenital brain malformation involving the fourth ventricle and the cerebellum. We investigated the cognitive impairment of the patient and found deficits prominently in executive functions. This report may add further evidence on the importance of a correct diagnosis prior to defining a patient as treatment resistant and highlights cerebellar dysfunctions that may contribute to neuropsychiatric symptoms and cognitive impairment.

Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion.

PubMed

Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W

2015-11-01

The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth.

Education and Reported Onset of Symptoms among Individuals with Alzheimer’s Disease

PubMed Central

Roe, Catherine M.; Xiong, Chengjie; Grant, Elizabeth; Miller, J. Phillip; Morris, John C.

2010-01-01

Objective To examine whether reported age at onset (AAO) of dementia symptoms among participants with Alzheimer’s disease (AD) is later for those with fewer years of education and, if so, to see if it is attributed to delayed detection of symptoms. Design Case series. Setting National Alzheimer’s Coordinating Center Minimum Data Set (N=21,880 participants) and Washington University Alzheimer’s Disease Research Center (N=1,449 participants). Results Reported AAO of dementia symptoms is slightly earlier for participants with more education. Participants with fewer years of education show greater clinical severity of AD at first assessment. Conclusion Symptoms of AD are recognized later among those with less education. PMID:18195147

Hypoxia symptoms reported during helicopter operations below 10,000 ft: a retrospective survey.

PubMed

Smith, Adrian

2005-08-01

During routine aviation medicine training, rotary-wing aircrew are instructed that the impact of hypoxia on them from flying in unpressurized cabins up to 10,000 ft (3048 m) above mean sea level (AMSL) is relatively small and has few implications for aviation safety. Such reassurance is based on data derived from experiments conducted on resting subjects and may not reflect the true impact of hypoxia in aircrew engaged in operational tasks. A survey listing common symptoms of hypoxia was distributed to Australian Army helicopter aircrew who had operated at altitudes up to 10,000 ft AMSL. There were 53 surveys that were returned (71% response), representing 25 loadmasters, 23 pilots, and 5 aircrewman technicians. All respondents were Australian Army aircrew. One or more symptoms consistent with hypoxia were reported by 86.6% of non-pilot aircrew and 60.9% of pilots. 60% of non-pilot aircrew reported four or more symptoms, compared with only 17% of pilots. The most commonly reported symptoms were difficulty with calculations (45%), feeling light-headed (38%), delayed reaction time (38%), and mental confusion (36%). Loadmasters reported more symptoms (mean 5.4) than pilots (mean 2.2) (p < 0.001). From the narratives provided (n = 21), aircrew experienced potentially operationally significant symptoms at a mean altitude of 8462 ft (2579 m). The helicopter aircrew surveyed reported symptoms consistent with hypoxia at altitudes within the so-called physiological zone; loadmasters reported more effects than pilots. It may be inappropriate to emphasize the benign nature of the physiological zone during aviation medicine training of a non-resting population such as helicopter aircrew.

Sex Differences in High School Athletes' Knowledge of Sport-Related Concussion Symptoms and Reporting Behaviors.

PubMed

Wallace, Jessica; Covassin, Tracey; Beidler, Erica

2017-07-01

  Recent researchers have reported that athletes' knowledge of sport-related concussion (SRC) has increased but that athletes still lack knowledge of all the signs and symptoms of SRC. Understanding the signs and symptoms of SRC and the dangers of playing while symptomatic are critical to reporting behaviors in high school athletes.   To examine sex differences in knowledge of SRC symptoms and reasons for not reporting a suspected SRC to an authoritative figure in high school athletes.   Cross-sectional study.   Survey.   A total of 288 athletes across 7 sports (198 males [68.8%] and 90 females [31.2%]).   A validated knowledge-of-SRC survey consisted of demographic questions, a list of 21 signs and symptoms of SRC, and reasons why athletes would not report their SRC. The independent variable was sex. Athlete knowledge of SRC symptoms was assessed by having participants identify the signs and symptoms of SRC from a list of 21 symptoms. Knowledge scores were calculated by summing the number of correct answers; scores ranged from 0 to 21, with a score closer to 21 representing greater knowledge. Reporting-behavior questions asked athletes to choose reasons why they decided not to report any possible SRC signs and symptoms to an authoritative figure.   A sex difference in total SRC symptom knowledge was found (F 286 = 4.97, P = .03, d = 0.26). Female high school athletes had more total SRC symptom knowledge (mean ± standard deviation = 15.06 ± 2.63; 95% confidence interval = 14.54, 15.57) than males (14.36 ± 2.76; 95% confidence interval = 13.97, 14.74). Chi-square tests identified significant relationships between sex and 8 different reasons for not reporting an SRC.   High school males and females had similar SRC symptom knowledge; however, female athletes were more likely to report their concussive symptoms to an authoritative figure.

Assertiveness in Women Reporting Symptoms of Bulimia.

ERIC Educational Resources Information Center

Ruhl, Berenice; McCanne, Thomas R.

It has been suggested that a lack of assertiveness may be an important component of the psychological make-up of bulimic women, and that bulimic women may experience particular difficulties in asserting themselves in interactions with men. In this study, 23 women reporting the symptoms of bulimia by high scores on the Bulimia Test (BULIT) and 21…

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India.

PubMed

Jaisoorya, T S; Beena, K V; Beena, M; Ellangovan, K; George, Sanju; Thennarasu, K; Srinath, Shoba

2016-09-02

To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive-impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD. © The Author(s) 2016.

Self-report of physical symptoms associated with using mobile phones and other electrical devices.

PubMed

Korpinen, Leena H; Pääkkönen, Rauno J

2009-09-01

The aim of our work was to study the working-age population's self-reported physical symptoms associated with using mobile phones and other electrical devices. A qualitative method was applied using an open-ended question in a questionnaire, which included questions about the possible influence of new technical equipment on health. We then created subgroups of respondents for different self-reported symptoms associated with mobile phones and other electrical devices. The research questions were: (1) how the respondents described physical symptoms associated with using mobile phones and other electrical devices and (2) how the answers can be classified into subgroups based on symptoms or devices. We identified the following categories: (1) respondents with different self-reported symptoms which they associated with using mobile phones (headache, earache, or warmth sensations), (2) respondents who had skin symptoms when they stayed in front of a computer screen, (3) respondents who mentioned physical symptoms associated with using mobile phones and other electrical devices. Total prevalence of self-reported physical symptoms associated with using mobile phones and other electrical devices (categories 1 and 2) was 0.7%. In the future it will be possible to obtain new knowledge of these topics by using qualitative methods.

Self-reported temporomandibular disorder symptoms and severity of malocclusion in prospective orthognathic-surgical patients.

PubMed

Svedström-Oristo, Anna-Liisa; Ekholm, Heidi; Tolvanen, Mimmi; Peltomäki, Timo

2016-08-01

The objective of this study is to analyze the association between self-reported symptoms of temporomandibular joint disorder (TMD) and the severity of malocclusion in prospective orthognathic-surgical patients. The subjects consisted of 50 consecutive patients (13 males and 37 females) referred to two university clinics for assessment of orthodontic-surgical treatment need. Data considering self-reported TMD symptoms were gathered using a semi-structured diary. At the first appointment, all patients rated the importance of treatment (on a scale of 1-10) and assessed self-perceived dental appearance using a VAS scale. The scale was anchored with photographs 1 and 10 from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Study models were assessed by an experienced orthodontic specialist using the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON). Association between the PAR and ICON scores and the number of reported symptoms was analyzed statistically. Seventy-one percent of patients reported experiencing TMD symptoms. The most prevalent symptoms were pain in the head and/or neck region and fatigue in the TMJ region. The number of symptoms was highest in the morning. Ninety percent of males and 86% of females rated the importance of treatment as high; males experiencing TMD symptoms tended to rate surgery as more important compared with males with no symptoms (p = 0.056). In this sample, the results cannot unambiguously confirm an association between self-reported symptoms of TMD and objectively defined severity of malocclusion.

Self-reported depression and anxiety symptoms in school-aged Singaporean children.

PubMed

Magiati, Iliana; Ponniah, Kathryn; Ooi, Yoon Phaik; Chan, Yiong Huak; Fung, Daniel; Woo, Bernardine

2015-03-01

Few studies have examined anxiety and depression experiences of primary (middle) school-aged children from ethnically diverse backgrounds, and most have relied on parents or others as informants. The present study aimed to investigate self-reported anxiety and depression symptoms in Singaporean primary school-aged children. Age, gender, and ethnic differences and interactions were explored as well as similarities and differences between Singaporean children and US norms. A large representative community sample of 1655 8- to 12-year-old Singaporean children (Chinese, Malay, and Indian) completed the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI) as part of a larger epidemiological study of mental health in Singaporean children. Rates of clinically elevated symptoms of anxiety and depression were 9.3% and 16.9% on the MASC and the CDI, respectively. Separation and social anxieties were most common. Evidence of a gender difference in levels of emotional symptoms was most evident in Indian children, with girls reporting more symptoms than boys. The relationship between age and internalizing problems was weak. A substantial minority of primary school-aged Singaporean children reported elevated anxious and depressive symptoms. Better understanding of the factors that contribute to the development and maintenance of these problems can help the development of culture-specific interventions and facilitate the planning of community-tailored services and initiatives. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

Depressive symptoms in mothers and daughters: Attachment style moderates reporter agreement

PubMed Central

Milan, Stephanie; Wortel, Sanne; Ramirez, Jenna; Oshin, Linda

2016-01-01

Parents and adolescents show only modest agreement when reporting on depressive symptoms. Drawing from attachment theory and previous research on informant discrepancies, we tested hypotheses about how adolescent attachment style may impact reporting agreement in a sample of 184 low-income mother-adolescent daughter dyads (adolescent mean age = 15.4 (SD = 1.05), maternal mean age = 41.4 (SD = 7.60); 58% Latina, 26% African-American/Black, 16% as non-Hispanic, White). Mothers and adolescents reported on their own and each others’ depressive symptoms and adolescents reported on attachment style. Using a moderated Actor Partner Interdependence Model (APIM) to calculate reporter bias and accuracy estimates, we tested whether attachment style moderated maternal and adolescent accuracy in theoretically consistent ways. Mothers and adolescents showed similar levels of accuracy and bias when reporting on each other. Consistent with hypotheses, we found that adolescents who reported high levels of preoccupation were less accurate when reporting on their mothers because they tended to observe symptoms that their mothers did not endorse. Conversely, mothers were the most accurate in these dyads, potentially because preoccupied adolescents tend to elevate displays of emotional distress. Reporting accuracy was not affected by a dismissive style. These results add to literature indicating that parent-child reporting discrepancies often reflect meaningful information about relationships, and highlight the need to consider different sources of reporting bias and accuracy in assessment and treatment. PMID:27130142

PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program.

PubMed

Greer, George R; Grob, Charles S; Halberstadt, Adam L

2014-01-01

New Mexico was the first state to list post-traumatic stress disorder (PTSD) as a condition for the use of medical cannabis. There are no published studies, other than case reports, of the effects of cannabis on PTSD symptoms. The purpose of the study was to report and statistically analyze psychometric data on PTSD symptoms collected during 80 psychiatric evaluations of patients applying to the New Mexico Medical Cannabis Program from 2009 to 2011. The Clinician Administered Posttraumatic Scale for DSM-IV (CAPS) was administered retrospectively and symptom scores were then collected and compared in a retrospective chart review of the first 80 patients evaluated. Greater than 75% reduction in CAPS symptom scores were reported when patients were using cannabis compared to when they were not. Cannabis is associated with reductions in PTSD symptoms in some patients, and prospective, placebo-controlled study is needed to determine efficacy of cannabis and its constituents in treating PTSD.

The Relationship between ADHD Symptoms, Mood Instability, and Self-Reported Offending

ERIC Educational Resources Information Center

Gudjonsson, Gisli H.; Sigurdsson, Jon Fridrik; Adalsteinsson, Tomas F.; Young, Susan

2013-01-01

Objective: To investigate the relative importance of ADHD symptoms, mood instability, and antisocial personality disorder traits in predicting self-reported offending. Method: A total of 295 Icelandic students completed two scales of offending behavior and measures of ADHD symptoms, mood instability, and antisocial personality traits. Results:…

Post-traumatic stress disorder vs traumatic brain injury

PubMed Central

Bryant, Richard

2011-01-01

Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) often coexist because brain injuries are often sustained in traumatic experiences. This review outlines the significant overlap between PTSD and TBI by commencing with a critical outline of the overlapping symptoms and problems of differential diagnosis. The impact of TBI on PTSD is then described, with increasing evidence suggesting that mild TBI can increase risk for PTSD. Several explanations are offered for this enhanced risk. Recent evidence suggests that impairment secondary to mild TBI is largely attributable to stress reactions after TBI, which challenges the long-held belief that postconcussive symptoms are a function of neurological insult This recent evidence is pointing to new directions for treatment of postconcussive symptoms that acknowledge that treating stress factors following TBI may be the optimal means to manage the effects of many TBIs, PMID:22034252

Patient and Parent-Reported Signs and Symptoms for Group A Streptococcal Pharyngitis.

PubMed

Lindgren, Christina; Neuman, Mark I; Monuteaux, Michael C; Mandl, Kenneth D; Fine, Andrew M

2016-07-01

Identifying symptomatic patients who are at low risk for group A streptococcal (GAS) pharyngitis could reduce unnecessary visits and antibiotic use. The accuracy with which patients and parents report signs and symptoms of GAS has not been studied. Our objectives were to measure agreement between patient or parent and physician-reported signs and symptoms of GAS and to evaluate the performance of a modified Centor score, based on patient or parent and physician reports, for identifying patients at low risk for GAS pharyngitis. Children 3 to 21 years old presenting to a single tertiary care emergency department between October 2013 and January 2015 were included if they complained of a sore throat and were tested for GAS. Patients or parents and physicians completed surveys assessing signs and symptoms to determine a modified age-adjusted Centor score for GAS. We evaluated the overall agreement and κ between patient or parent and physician-reported signs and symptoms and compared the performance of the scores based on assessments by patients or parents and physicians and the risk of GAS. Of 320 patients enrolled, 107 (33%) tested GAS positive. Agreement was higher for symptoms (fever [agreement = 82%, κ = 0.64] and cough [72%, 0.45]) than for signs (exudate [80%, 0.41] and tender cervical nodes [73%, 0.18]). Agreement was highest when no signs and symptoms contained in the Centor score were present (94%, κ = 0.61). The proportion of patients testing GAS positive rose as the modified Centor score increased. For identifying GAS pharyngitis, patients or parents and physicians showed moderate to substantial agreement for 3 of 4 key pharyngitis signs and symptoms. Copyright © 2016 by the American Academy of Pediatrics.

Inadequate vocal hygiene habits associated with the presence of self-reported voice symptoms in telemarketers.

PubMed

Fuentes-López, Eduardo; Fuente, Adrian; Contreras, Karem V

2017-12-18

The aim of this study is to determine possible associations between vocal hygiene habits and self-reported vocal symptoms in telemarketers. A cross-sectional study that included 79 operators from call centres in Chile was carried out. Their vocal hygiene habits and self-reported symptoms were investigated using a validated and reliable questionnaire created for the purposes of this study. Forty-five percent of telemarketers reported having one or more vocal symptoms. Among them, 16.46% reported that their voices tense up when talking and 10.13% needed to clear their throat to make their voices clearer. Five percent mentioned that they always talk without taking a break and 40.51% reported using their voices in noisy environments. The number of working hours per day and inadequate vocal hygiene habits were associated with the presence of self-reported symptoms. Additionally, an interaction between the use of the voice in noisy environments and not taking breaks during the day was observed. Finally, the frequency of inadequate vocal hygiene habits was associated with the number of symptoms reported. Using the voice in noisy environments and talking without taking breaks were both associated with the presence of specific vocal symptoms. This study provides some evidence about the interaction between these two inadequate vocal hygiene habits that potentiates vocal symptoms.

The relationship between ADHD symptoms, mood instability, and self-reported offending.

PubMed

Gudjonsson, Gisli H; Sigurdsson, Jon Fridrik; Adalsteinsson, Tomas F; Young, Susan

2013-05-01

To investigate the relative importance of ADHD symptoms, mood instability, and antisocial personality disorder traits in predicting self-reported offending. A total of 295 Icelandic students completed two scales of offending behavior and measures of ADHD symptoms, mood instability, and antisocial personality traits. Self-reported offending from the two independent scales correlated significantly with ADHD symptoms, mood instability, and antisocial personality traits with medium to large effect size. Multiple regressions showed that ADHD symptoms contributed to the two outcome measures beyond that of age and gender with a medium effect size. The ADHD effects were only partly mediated by mood instability and antisocial personality traits for general offending but were almost completely mediated by the more reactive measure of antisocial behavior. ADHD appears to be a potential risk factor for general offending in its own right irrespective of the presence of comorbidity, whereas mood instability is more important with regard to reactive behavior.

Challenge of assessing symptoms in seriously ill intensive care unit patients: can proxy reporters help?

PubMed

Puntillo, Kathleen A; Neuhaus, John; Arai, Shoshana; Paul, Steven M; Gropper, Michael A; Cohen, Neal H; Miaskowski, Christine

2012-10-01

Determine levels of agreement among intensive care unit patients and their family members, nurses, and physicians (proxies) regarding patients' symptoms and compare levels of mean intensity (i.e., the magnitude of a symptom sensation) and distress (i.e., the degree of emotionality that a symptom engenders) of symptoms among patients and proxy reporters. Prospective study of proxy reporters of symptoms in seriously ill patients. Two intensive care units in a tertiary medical center in the Western United States. Two hundred and forty-five intensive care unit patients, 243 family members, 103 nurses, and 92 physicians. None. On the basis of the magnitude of intraclass correlation coefficients, where coefficients from .35 to .78 are considered to be appropriately robust, correlation coefficients between patients' and family members' ratings met this criterion (≥.35) for intensity in six of ten symptoms. No intensity ratings between patients and nurses had intraclass correlation coefficients >.32. Three symptoms had intensity correlation coefficients of ≥.36 between patients' and physicians' ratings. Correlation coefficients between patients and family members were >.40 for five symptom-distress ratings. No symptoms had distress correlation coefficients of ≥.28 between patients' and nurses' ratings. Two symptoms had symptom-distress correlation coefficients between patients' and physicians' ratings at >.39. Family members, nurses, and physicians reported higher symptom-intensity scores than patients did for 80%, 60%, and 60% of the symptoms, respectively. Family members, nurses, and physicians reported higher symptom-distress scores than patients did for 90%, 70%, and 80% of the symptoms, respectively. Patient-family intraclass correlation coefficients were sufficiently close for us to consider using family members to help assess intensive care unit patients' symptoms. Relatively low intraclass correlation coefficients between intensive care unit clinicians' and

Self reported symptoms and inhibition of acetylcholinesterase activity among Kenyan agricultural workers.

PubMed

Ohayo-Mitoko, G J; Kromhout, H; Simwa, J M; Boleij, J S; Heederik, D

2000-03-01

This study was part of the East African pesticides project. The general objective was to assess health hazards posed by handling, storage, and use of pesticides, on agricultural estates and small farms with a view to developing strategies for prevention and control of pesticide poisoning. The aim of this paper is to describe the prevalence of symptoms in this population, to relate levels of inhibition to reported symptoms and evaluate at which levels of inhibition symptoms become increased. Complete data were available for 256 exposed subjects and 152 controls from four regions in Kenya. A structured questionnaire on symptoms experienced at the time of interview was given to all subjects and controls. Information was also obtained on sex, age, main occupation, and level of education. Symptoms reported during the high exposure period, were initially clustered in broader symptom categories from reference literature on health effects of pesticides that inhibit cholinesterase (organophosphate and carbamate). Prevalence ratios were estimated for symptoms with changes in cholinesterase activity in serum. Symptom prevalence in exposed subjects was higher during the high exposure period than the low exposure period, although these differences were not significant. Interestingly, a clear and significant change in symptoms prevalence was found in the controls with a higher prevalence in the low exposure period. Analysis of the relation between cholinesterase inhibition and symptoms showed that prevalence ratios were significantly > 1 for respiratory, eye, and central nervous system symptoms for workers with > 30% inhibition. Similar results were found for analyses with the actual level of acetylcholinesterase activity. The results suggest the presence of a relation between exposure and acetylcholinesterase inhibition, acetylcholinesterase activity, and respiratory, eye, and central nervous system symptoms. Increased symptom prevalence was found at acetylcholinesterase

An Emotional Go/No-Go fMRI study in adolescents with depressive symptoms following concussion.

PubMed

Ho, Rachelle A; Hall, Geoffrey B; Noseworthy, Michael D; DeMatteo, Carol

2017-10-03

Following concussion, adolescents may experience both poor inhibitory control and increased depressive symptoms. fMRI research suggests that adolescents with major depressive disorder have abnormal physiological responses in the frontostriatal pathway, and exhibit poorer inhibitory control in the presence of negatively-aroused images. The scarcity of information surrounding depression following concussion in adolescents makes it difficult to identify patients at risk of depression after injury. This is the first study to examine neural activity patterns in adolescents with post-concussive depressive symptoms. To explore the effect of depressive symptoms on inhibitory control in adolescents with concussion in the presence of emotional stimuli using fMRI. Using a prospective cohort design, 30 adolescents diagnosed with concussion between 10 and 17years were recruited. The Children's Depression Inventory questionnaire was used to divide participants into two groups: average or elevated levels of depressive symptoms. Participants completed an Emotional Go/No-Go task involving angry or neutral faces in a 3Telsa MRI scanner. Eleven participants had elevated depressive symptoms, of which 72% were hit in the occipital region of the head at the time of injury. fMRI results from the Emotional Go/No-Go task revealed activity patterns in the overall sample. Faces activated regions associated with both facial and cognitive processing. However, frontal regions that are usually associated with inhibitory control were not activated. Adolescents with elevated levels of depressive symptoms engaged more frontal lobe regions during the task than the average group. They also showed a trend towards worse symptoms following MRI scanning. Adolescents with elevated depressive symptoms engaged brain regions subserving evaluative processing of social interactions. This finding provides insight into the role the environment plays in contributing to the cognitive demands placed on adolescents

Reporting of symptoms in randomized controlled trials of atopic eczema treatments: a systematic review.

PubMed

Gerbens, L A A; Chalmers, J R; Rogers, N K; Nankervis, H; Spuls, P I

2016-10-01

'Symptoms' is a core outcome domain for atopic eczema (AE) trials, agreed by consensus as part of the Harmonising Outcome Measures for Eczema (HOME) initiative. To standardize and validate the core domain symptoms and symptom instruments for AE trials the HOME roadmap is followed. Its first step is to establish if and how symptoms have been measured in published AE treatment trials. Therefore the Global Resource for Eczema Trials database was used to collect all randomized controlled trials (RCTs) of treatments for AE between January 2000 and April 2014. Study selection and data extraction were performed by three reviewers independently. We identified the use of symptoms in 295 of 378 trials (78%). Symptoms as a primary end point were applied by 147 RCTs (50%). Seventeen different symptoms were measured, but mostly itch and sleep loss. Symptoms were assessed by only 37% of trials by a stand-alone symptom measurement. Overall 63% of RCTs used a composite instrument, and 30 different instruments were identified. The Scoring Atopic Dermatitis (SCORAD) index was the most commonly applied, but only 23% of RCTs reported the SCORAD symptom score separately. This systematic review demonstrates that symptoms, most frequently itch and sleep loss, are commonly reported in AE treatment trials, but are measured using many different instruments. Often symptoms are evaluated as part of a composite instrument, and currently it is not possible to extract symptoms-only data from most published studies. Future trials should report symptom scores to permit meta-analysis of the core outcomes. © 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

The prevalence of self-reported premenstrual symptoms and evaluation of regular exercise with premenstrual symptoms among female employees in Taiwan.

PubMed

Tsai, Su-Ying; Kuo, Fu-Chen; Kuo, Hsin-Chih; Liao, Li-Ling

2018-03-01

Few studies have focused on premenstrual symptoms in employees. This study explored the prevalence of premenstrual symptoms in 7,193 female employees aged 18-55 years in a large electronics manufacturer in Taiwan from August 2014 to December 2014 and examined whether regular exercise was associated with premenstrual symptoms. Information was collected on demographics, lifestyle, menstrual history, menstrual pain, and premenstrual symptoms. Half of the participants reported irregular menstruation; 79.4% reported a moderate menstruation amount, and half reported little impact of menstrual pain at work. In order of prevalence, symptoms were "easy to fatigue" (24%), "backache" (21.2%), and "abdominal bloating" (17.4%). Participants who engaged in regular exercise reported fewer backaches (adjusted odds ratio [aOR] = 0.79, 95% confidence interval [CI] = 0.68-0.91), somatic discomfort (aOR = 0.78, 95% CI = 0.63-0.96), headache (OR = 0.82, 95% CI = 0.69-0.98), diarrhea (aOR = 0.76, 95% CI = 0.60-0.96), constipation (aaOR = 0.59, 95% CI = 0.44-0.78), less irritability (aOR = 0.78, 95% CI = 0.65-0.94), feeling morose and depressed (aOR = 0.75, 95% CI = 0.58-0.95), crying (aOR = 0.51, 95% CI = 0.27-0.87), and emotional lability (aOR = 0.73, 95% CI = 0.58-0.91). Regular exercise was associated with decreased menstrual pain (aOR = 0.85, 95% CI = 0.76-0.96). Our findings provide a better understanding of premenstrual symptoms in female workers, allowing for the development of premenstrual health programs to improve their health and quality of life.

Residual effects of combat-related mild traumatic brain injury.

PubMed

Kontos, Anthony P; Kotwal, Russ S; Elbin, R J; Lutz, Robert H; Forsten, Robert D; Benson, Peter J; Guskiewicz, Kevin M

2013-04-15

Mild traumatic brain injury (mTBI) has gained considerable notoriety during the past decade of conflict in Afghanistan and Iraq. However, the relationship between combat-related mTBI and residual mTBI symptoms, post-traumatic stress disorder (PTSD) symptoms, and neurocognitive deficits remains unclear. The purpose of the study was to compare residual mTBI and PTSD symptoms, and neurocognitive deficits among U.S. Army Special Operations Command (USASOC) personnel with diagnosed blunt, blast, and blast-blunt combination mTBIs. This study involved a retrospective medical records review of 27,169 USASOC personnel who completed a military version of the Immediate Post-Concussion Assessment Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), and PTSD Checklist (PCL) between November 2009 and December 2011. Of the 22,203 personnel who met criteria for the study, 2,813 (12.7%) had a diagnosis of at least one mTBI. A total of 28% (n=410) of USASOC personnel with a history of diagnosed mTBI reported clinical levels of PTSD symptoms. Personnel with a history of diagnosed blunt (OR=3.58), blast (OR=4.23) or combination (OR=5.73) mTBI were at significantly (p=0.001) greater risk of reporting clinical levels of PTSD symptoms than those with no history of mTBI. A dose-response gradient for exposure to blast/combination mTBI on clinical levels of PTSD symptoms was also significant (p=0.001). Individuals with blast/combination mTBIs scored higher in residual mTBI (p=0.001) and PTSD symptoms (p=0.001), and performed worse on tests of visual memory (p=0.001), and reaction time (p=0.001) than those with blunt or no mTBI history. Individuals with combination mTBIs scored lower in verbal memory (p=0.02) than those with blunt mTBIs. Residual PTSD and mTBI symptoms appear to be more prevalent in personnel with blast mTBI. A dose-response gradient for blast mTBI and symptoms suggests that repeated exposures to these injuries may have lingering effects.

Sleep disturbance and neurocognitive function during the recovery from a sport-related concussion in adolescents.

PubMed

Kostyun, Regina O; Milewski, Matthew D; Hafeez, Imran

2015-03-01

Sleep disturbances are a hallmark sign after a sport-related concussion (SRC). Poor sleep has been shown to adversely affect baseline neurocognitive test scores, but it is not comprehensively understood how neurocognitive function is affected by disrupted sleep during recovery from a concussion. To identify the correlation between adolescent athletes' neurocognitive function and their self-reported sleep quantity and sleep disturbance symptoms during recovery from SRC. Cross-sectional study; Level of evidence, 3. Immediate Post-Concussion Assessment and Cognition Testing (ImPACT) data were retrospectively collected for 545 adolescent athletes treated for SRC at a sports medicine concussion clinic. Patients were stratified into groups based on 2 criteria: self-reported sleep duration and self-reported sleep disturbance symptoms during postinjury ImPACT testing. Sleep duration was classified as short (<7 hours), intermediate (7-9 hours), and long (>9 hours). Sleep disturbance symptoms were self-reported as part of the Post-Concussion Symptom Scale (PCSS) as either sleeping less than normal, sleeping more than normal, or having trouble falling asleep. One-way analyses of variance were conducted to examine the effects that sleep duration as well as self-reported sleep disturbance symptoms had on composite scores. A total of 1067 ImPACT tests were analyzed: test 1, 545; test 2, 380; and test 3, 142. Sleeping fewer than 7 hours the night before testing correlated with higher PCSS scores (P < .001), whereas sleeping longer than 9 hours correlated with worse visual memory (P = .01), visual motor speed (P <.001), and reaction time (P = .04) composite scores. With regard to self-reported sleep disturbance symptoms, patients demonstrated worse composite scores during ImPACT testing when they self-reported sleeping more than normal (ImPACT test 1: verbal memory, P < .001; visual motor speed, P = .05; reaction time, P = .01; ImPACT test 2: verbal memory, P < .001; visual memory

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion

PubMed Central

Leddy, John; Baker, John G.; Haider, Mohammad Nadir; Hinds, Andrea; Willer, Barry

2017-01-01

Management of the athlete with postconcussion syndrome (PCS) is challenging because of the nonspecificity of PCS symptoms. Ongoing symptoms reflect prolonged concussion pathophysiology or conditions such as migraine headaches, depression or anxiety, chronic pain, cervical injury, visual dysfunction, vestibular dysfunction, or some combination of these. In this paper, we focus on the physiological signs of concussion to help narrow the differential diagnosis of PCS in athletes. The physiological effects of exercise on concussion are especially important for athletes. Some athletes with PCS have exercise intolerance that may result from altered control of cerebral blood flow. Systematic evaluation of exercise tolerance combined with a physical examination of the neurologic, visual, cervical, and vestibular systems can in many cases identify one or more treatable postconcussion disorders. PMID:28387557

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion.

PubMed

Leddy, John; Baker, John G; Haider, Mohammad Nadir; Hinds, Andrea; Willer, Barry

2017-03-01

Management of the athlete with postconcussion syndrome (PCS) is challenging because of the nonspecificity of PCS symptoms. Ongoing symptoms reflect prolonged concussion pathophysiology or conditions such as migraine headaches, depression or anxiety, chronic pain, cervical injury, visual dysfunction, vestibular dysfunction, or some combination of these. In this paper, we focus on the physiological signs of concussion to help narrow the differential diagnosis of PCS in athletes. The physiological effects of exercise on concussion are especially important for athletes. Some athletes with PCS have exercise intolerance that may result from altered control of cerebral blood flow. Systematic evaluation of exercise tolerance combined with a physical examination of the neurologic, visual, cervical, and vestibular systems can in many cases identify one or more treatable postconcussion disorders.

What Do Patients With Glaucoma See? Visual Symptoms Reported by Patients With Glaucoma

PubMed Central

Hu, Cindy X.; Zangalli, Camila; Hsieh, Michael; Gupta, Lalita; Williams, Alice L.; Richman, Jesse

2014-01-01

Abstract: Background: Vision loss from glaucoma has traditionally been described as loss of “peripheral vision.” In this prospective study, we aimed to improve our clinical understanding of the visual symptoms caused by glaucoma by asking patients specific detailed questions about how they see. Methods: Patients who were clinically diagnosed with various types and stages of glaucoma were included. All had a comprehensive ocular examination, including Octopus visual field testing. Patients were excluded if they had other ocular conditions that affected their vision, including cornea, lens or retina pathologies. Patients responded to an oral questionnaire about their visual symptoms. We investigated the visual symptoms described by patients with glaucoma and correlated the severity of visual field loss with visual symptoms reported. Results: Ninety-nine patients completed the questionnaire. Most patients (76%) were diagnosed with primary open-angle glaucoma. The most common symptoms reported by all patients, including patients with early or moderate glaucoma, were needing more light and blurry vision. Patients with a greater amount of field loss (Octopus mean defect >+9.4 dB) were more likely to report difficulty seeing objects to one or both sides, as if looking through dirty glasses and trouble differentiating boundaries and colors. Conclusions: Vision loss in patients with glaucoma is not as simple as the traditional view of loss of peripheral vision. Needing more light and blurry vision were the most common symptoms reported by patients with glaucoma. PMID:24992392

Self reported symptoms and inhibition of acetylcholinesterase activity among Kenyan agricultural workers

PubMed Central

Ohayo-Mitoko, G.; Kromhout, H.; Simwa, J.; Boleij, J.; Heederik, D.

2000-01-01

OBJECTIVES—This study was part of the East African pesticides project. The general objective was to assess health hazards posed by handling, storage, and use of pesticides, on agricultural estates and small farms with a view to developing strategies for prevention and control of pesticide poisoning. The aim of this paper is to describe the prevalence of symptoms in this population, to relate levels of inhibition to reported symptoms and evaluate at which levels of inhibition symptoms become increased.
METHODS—Complete data were available for 256 exposed subjects and 152 controls from four regions in Kenya. A structured questionnaire on symptoms experienced at the time of interview was given to all subjects and controls. Information was also obtained on sex, age, main occupation, and level of education. Symptoms reported during the high exposure period, were initially clustered in broader symptom categories from reference literature on health effects of pesticides that inhibit cholinesterase (organophosphate and carbamate). Prevalence ratios were estimated for symptoms with changes in cholinesterase activity in serum.
RESULTS—Symptom prevalence in exposed subjects was higher during the high exposure period than the low exposure period, although these differences were not significant. Interestingly, a clear and significant change in symptoms prevalence was found in the controls with a higher prevalence in the low exposure period. Analysis of the relation between cholinesterase inhibition and symptoms showed that prevalence ratios were significantly >1 for respiratory, eye, and central nervous system symptoms for workers with >30% inhibition. Similar results were found for analyses with the actual level of acetylcholinesterase activity.
CONCLUSION—The results suggest the presence of a relation between exposure and acetylcholinesterase inhibition, acetylcholinesterase activity, and respiratory, eye, and central nervous system symptoms. Increased symptom

Relationship between self-reported adherence, antiretroviral drug concentration measurement and self-reported symptoms in patients treated for HIV-1 infection.

PubMed

Fabbiani, Massimiliano; Di Giambenedetto, Simona; Cingolani, Antonella; Fanti, Iuri; Colafigli, Manuela; Tamburrini, Enrica; Cauda, Roberto; Navarra, Pierluigi; De Luca, Andrea; Murri, Rita

2016-01-01

The aim of the study was to explore relationships between self-reported adherence, antiretroviral drug concentration measurement (TDM) and self-reported symptoms. We systematically administered to human immunodeficiency (HIV)-infected outpatients a questionnaire evaluating measures of self-reported adherence (missing doses during last week, deviations from the prescribed timing of therapy, self-initiated discontinuations for > 24 or 48 h, exhausting drugs and present sense of how patients are taking therapy) and a panel of referred symptoms (a symptom score was built summing self-reported scores for each listed symptom). We selected patients who completed the questionnaire and also had a TDM (mainly reflecting adherence in the past few days or weeks), thus comparing these two tools as measures of adherence. A total of 130 patients (64.6% males, median age 44 years, 76.2% with HIV RNA < 50 copies/ml, median CD4 540 cells/μl) were included. Mean self-reported adherence (on a 0-100 visual analogue scale) was 80% (standard deviation, 18.7). Drug concentration was subtherapeutic in 16 patients (12.3%), of which 7 (5.4%) had undetectable drug levels (< 0.05 mg/L). Of these last seven patients, five (71.4%) reported an adherence below 80%. In a multivariable analysis, females and patients with undetectable drug levels (mean change -18.43%, 95% confidence intervals (CIs) -31.83 to -5.03, p = 0.007) showed a lower self-reported adherence, while those with HIV RNA < 50 copies/ml showed a higher adherence. Lower self-reported adherence (odds ratio 0.62 per 10% increase, 95% CI = 0.43-0.89, p = 0.009) and longer time from last drug intake were independently related to the development of undetectable drug levels. We also found that a higher symptom score was associated with a lower self-reported adherence and with a higher proportion of undetectable drug levels. Self-reported adherence and TDM showed a correlation and seemed to be comparable tools for adherence estimation

The Motivation and Pleasure Scale-Self-Report (MAP-SR): reliability and validity of a self-report measure of negative symptoms.

PubMed

Llerena, Katiah; Park, Stephanie G; McCarthy, Julie M; Couture, Shannon M; Bennett, Melanie E; Blanchard, Jack J

2013-07-01

The Clinical Assessment Interview for Negative Symptoms (CAINS) is an empirically developed interview measure of negative symptoms. Building on prior work, this study examined the reliability and validity of a self-report measure based on the CAINS-the Motivation and Pleasure Scale-Self-Report (MAP-SR)-that assesses the motivation and pleasure domain of negative symptoms. Thirty-seven participants with schizophrenia or schizoaffective disorder completed the 18-item MAP-SR, the CAINS, and other measures of functional outcome. Item analyses revealed three items that performed poorly. The revised 15-item MAP-SR demonstrated good internal consistency and convergent validity with the clinician-rated Motivation and Pleasure scale of the CAINS, as well as good discriminant validity, with little association with psychotic symptoms or depression/anxiety. MAP-SR scores were related to social anhedonia, social closeness, and clinician-rated social functioning. The MAP-SR is a promising self-report measure of severity of negative symptoms. Copyright © 2013 Elsevier Inc. All rights reserved.

Video Educational Intervention Improves Reporting of Concussion and Symptom Recognition

ERIC Educational Resources Information Center

Hunt, Tamerah N.

2015-01-01

Context: Concussion management is potentially complicated by the lack of reporting due to poor educational intervention in youth athletics. Objective: Determine if a concussion-education video developed for high school athletes will increase the reporting of concussive injuries and symptom recognition in this group. Design: Cross-sectional,…

Concussion symptoms and neurocognitive performance of high school and college athletes who incur multiple concussions.

PubMed

Covassin, Tracey; Moran, Ryan; Wilhelm, Kristyn

2013-12-01

Multiple concussions have been associated with prolonged symptoms, recovery time, and risk for future concussions. However, very few studies have examined the effect of multiple concussions on neurocognitive performance and the recently revised symptom clusters using a large database. To examine concussed athletes with a history of 0, 1, 2, or ≥3 concussions on neurocognitive performance and the recently revised symptom clusters. Cohort study (prognosis); Level of evidence, 2. The independent variables were concussion group (0, 1, 2, and ≥3 concussions) and time (baseline, 3 days, and 8 days). The dependent variables were neurocognitive test scores as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test battery (verbal and visual memory, processing speed, and reaction time) and 4 concussion symptom clusters (migraine-cognitive-fatigue, affective, somatic, and sleep). All concussed athletes (n = 596) were administered the ImPACT test at a mean 2.67 ± 1.98 and 7.95 ± 4.46 days after injury. A series of 4 (concussion group) × 3 (time) repeated-measures analyses of covariance (age = covariate) were performed on ImPACT composite scores and symptom clusters. Concussed athletes with ≥3 concussions were still impaired 8 days after a concussion compared with baseline scores on verbal memory (P < .001), reaction time (P < .001), and migraine-cognitive-fatigue symptoms (P < .001). There were no significant findings on the remaining dependent variables. Concussed athletes with a history of ≥3 concussions take longer to recover than athletes with 1 or no previous concussion. Future research should concentrate on validating the new symptom clusters on multiple concussed athletes, examining longer recovery times (ie, >8 days) among athletes with multiple concussions.

Northern Ireland: political violence and self-reported physical symptoms in a community sample.

PubMed

Cairns, E; Wilson, R

1991-01-01

In order to investigate the possible relationship between physical health and political violence in Northern Ireland a random sample of residents of four electoral areas (two with relatively high violence and two with relatively low violence) was interviewed at home. Each person was asked to rate their health in terms of common physical symptoms, to indicate their use of family doctor and hospital services, and to rate the level of political violence in their neighbourhood. Analysis of covariance (with a measure of psychological well-being, a measure of trait neuroticism plus age and socioeconomic status as covariates) revealed that women reported more physical symptoms than did men, people in the 'high' violence areas reported more symptoms than did those in the 'low' violence areas, while those who rated their own neighbourhood most highly in terms of perceived violence also reported the greatest number of physical symptoms. However, a series of chi 2 tests revealed no association between political violence or perceived political violence and uptake of services.

'Rules' for boys, 'guidelines' for girls: Gender differences in symptom reporting during childhood and adolescence.

PubMed

Maclean, Alice; Sweeting, Helen; Hunt, Kate

2010-02-01

The emergence of higher reported morbidity in females compared with males is a feature of adolescent health in a large proportion of the world's industrialised countries. In this paper, qualitative data from twenty-five single-sex focus groups (90 participants in total) conducted with 10-, 13-, and 15-year olds in two Scottish schools is used to explore whether symptom reporting is influenced by perceived societal gender- and age-related expectations and the social context of symptom experiences. The degree to which these factors can help explain quantitative evidence of increases in gender differences in symptom reporting during adolescence is also examined. Accounts suggested gender-related expectations act as strict 'rules' for boys and less prohibitive 'guidelines' for girls. An unexpected finding was the extent of similarity between these 'rules' and 'guidelines'. Both boys and girls presented themselves as pressured to react to symptoms in stoic, controlled and independent ways, particularly when in the company of their peers, and both perceived that boys and girls could incur negative consequences if seen to have physical (e.g. stomach ache) or, especially, psychological symptoms (e.g. feeling like crying). These qualitative findings do not suggest that girls are simply more willing than boys to report their symptoms as they get older, which is one potential explanation for the quantitative evidence of increasing gender differences in symptom reporting in adolescence. Rather, the findings suggest a need to highlight both the potentially damaging effects of gender stereotypes which make boys reluctant to seek help for physical and, particularly, psychological symptoms, and the misconception that girls are not similarly reluctant to report illness. Copyright 2009 Elsevier Ltd. All rights reserved.

Perceived stress and reported cognitive symptoms among Georgia patients with systemic lupus erythematosus.

PubMed

Plantinga, L; Lim, S S; Bowling, C B; Drenkard, C

2017-09-01

Objective To examine associations of perceived stress with cognitive symptoms among adults with systemic lupus erythematosus (SLE). Methods Among 777 adult (≥18 years) SLE patients, the association of Perceived Stress Scale (PSS) scores with two self-reported cognitive symptoms was examined: forgetfulness (severe/moderate vs. mild/none; from the Systemic Lupus Activity Questionnaire) and difficulty concentrating (all/most vs. some/little/none of the time; from the Lupus Impact Tracker). The study used multivariable logistic regression to estimate the odds ratios (ORs) per minimal important difference (MID = 0.5*SD) of PSS score and cognitive symptoms. Results Forgetfulness and difficulty concentrating were reported by 41.7% and 29.5%, respectively. Women and those with less education and high disease activity had higher PSS scores and were more likely to report cognitive symptoms than their counterparts. With adjustment for age, race, sex, education, and disease activity, each MID increase in PSS score was associated with higher prevalence of forgetfulness (OR = 1.43, 95% CI 1.29-1.47) and difficulty concentrating (OR = 2.19, 95% CI 1.90-2.52). No substantial differences in this association by age, race, sex, or disease activity were noted. Conclusions SLE patients, particularly those with high disease activity, report a high burden of cognitive symptoms, for which stress may be a modifiable risk factor.

Functional Recovery and Life Satisfaction in the First Year After Severe Traumatic Brain Injury: A Prospective Multicenter Study of a Norwegian National Cohort.

PubMed

Anke, Audny; Andelic, Nada; Skandsen, Toril; Knoph, Rein; Ader, Tiina; Manskow, Unn; Sigurdardottir, Solrun; Røe, Cecilie

2015-01-01

(1) To examine the impact of demographic and acute injury-related variables on functional recovery and life satisfaction after severe traumatic brain injury (sTBI) and (2) to test whether postinjury functioning, postconcussive symptoms, emotional state, and functional improvement are related to life satisfaction. Prospective national multicenter study. Level 1 trauma centers in Norway. 163 adults with sTBI. Functional recovery between 3 and 12 months postinjury measured with Glasgow Outcome Scale Extended, Rivermead Postconcussion Symptoms Questionnaire, Hospital Anxiety and Depression Scale, and satisfaction with life situation. 60% of cases experienced functional improvement from 3 to 12 months postinjury. Multivariate logistic regression analysis revealed that discharge to a rehabilitation department from acute care (odds ratio [OR] = 2.14; P < .05) and fewer days with artificial ventilation (OR = 1.04; P < .05) were significantly related to improvement. At 12 months postinjury, 85% were independent in daily activities. Most participants (63%) were satisfied with their life situation. Regression analysis revealed that older age (>65 years), low education, better functional outcome, and the absence of depressive and postconcussion symptoms were significant (P < .05) predictors of life satisfaction. Functional improvement was significantly associated with emotional state but not to life satisfaction. Following sTBI, approximately two-thirds of survivors improve between 3 and 12 months postinjury and are satisfied with their life. Direct discharge from acute care to specialized rehabilitation appears to increase functional recovery.

Associations between reporting of cancer alarm symptoms and socioeconomic and demographic determinants: a population-based, cross-sectional study

PubMed Central

2012-01-01

Background Reporting of symptoms which may signal cancer is the first step in the diagnostic pathway of cancer diseases. Cancer alarm symptoms are common in the general population. Public awareness and knowledge of cancer symptoms are sparse, however, and many people do not seek medical help when having possible cancer symptoms. As social inequality is associated with cancer knowledge, cancer awareness, and information-seeking, our hypothesis is that social inequality may also exist in the general population with respect to reporting of cancer alarm symptoms. The aim of this study was to investigate possible associations between socioeconomic and demographic determinants and reporting of common cancer alarm symptoms. Methods A cross-sectional questionnaire survey was performed based on a stratified sample of the Danish general population. A total of 13 777 randomly selected persons aged 20 years and older participated. Our main outcome measures were weighted prevalence estimates of self-reporting one of the following cancer alarm symptoms during the preceding 12 months: a lump in the breast, coughing for more than 6 weeks, seen blood in urine, or seen blood in stool. Logistic regression models were used to calculate unadjusted and adjusted odds ratios with 95% confidence intervals for the associations between each covariate and reporting of cancer alarm symptoms. Results A total of 2 098 (15.7%) of the participants reported one or more cancer alarm symptoms within the preceding 12 months. Women, subjects out of the workforce, and subjects with a cancer diagnosis had statistically significantly higher odds of reporting one or more cancer alarm symptoms. Subjects with older age and subjects living with a partner had lower odds of reporting one or more cancer alarm symptoms. When analysing the four alarm symptoms of cancer separately most tendencies persisted. Conclusions Socioeconomic and demographic determinants are associated with self-reporting of common cancer

Quantifying alcohol consumption: Self-report, transdermal assessment, and prediction of dependence symptoms.

PubMed

Simons, Jeffrey S; Wills, Thomas A; Emery, Noah N; Marks, Russell M

2015-11-01

Research on alcohol use depends heavily on the validity of self-reported drinking. The present paper presents data from 647 days of self-monitoring with a transdermal alcohol sensor by 60 young adults. We utilized a biochemical measure, transdermal alcohol assessment with the WrisTAS, to examine the convergent validity of three approaches to collecting daily self-report drinking data: experience sampling, daily morning reports of the previous night, and 1-week timeline follow-back (TLFB) assessments. We tested associations between three pharmacokinetic indices (peak concentration, area under the curve (AUC), and time to reach peak concentration) derived from the transdermal alcohol signal and within- and between- person variation in alcohol dependence symptoms. The WrisTAS data corroborated 85.74% of self-reported drinking days based on the experience sampling data. The TLFB assessment and combined experience sampling and morning reports agreed on 87.27% of drinking days. Drinks per drinking day did not vary as a function of wearing or not wearing the sensor; this indicates that participants provided consistent reports of their drinking regardless of biochemical verification. In respect to self-reported alcohol dependence symptoms, the AUC of the WrisTAS alcohol signal was associated with dependence symptoms at both the within- and between- person level. Furthermore, alcohol dependence symptoms at baseline predicted drinking episodes characterized in biochemical data by both higher peak alcohol concentration and faster time to reach peak concentration. The results support the validity of self-report alcohol data, provide empirical data useful for optimal design of daily process sampling, and provide an initial demonstration of the use of transdermal alcohol assessment to characterize drinking dynamics associated with risk for alcohol dependence. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reporter Discrepancies Among Parents, Adolescents, and Peers: Adolescent Attachment and Informant Depressive Symptoms as Explanatory Factors

PubMed Central

Ehrlich, Katherine B.; Cassidy, Jude; Dykas, Matthew J.

2010-01-01

The issue of informant discrepancies about child and adolescent functioning is an important concern for clinicians, developmental psychologists, and others who must consider ways of handling discrepant reports of information, but reasons for discrepancies in reports have been poorly understood. Adolescent attachment and informant depressive symptoms were examined as two explanations for absolute and directional discrepancies about adolescent symptoms, relationships, and social behavior in a sample of 189 eleventh-grade students (mean age = 16.5 years). Adolescent attachment predicted absolute discrepancies, with greater attachment coherence associated with fewer discrepancies in reports of adolescent depressive symptoms, parent-adolescent conflict, and adolescent externalizing behavior. Parents’ but not adolescents’ depressive symptoms sometimes predicted absolute discrepancies. Mothers’ depressive symptoms and adolescent attachment predicted the direction of discrepancies for mother-peer reports only. PMID:21410916

Self-Reported Adult Attention-Deficit/Hyperactivity Disorder Symptoms among College Students

ERIC Educational Resources Information Center

Garnier-Dykstra, Laura M.; Pinchevsky, Gillian M.; Caldeira, Kimberly M.; Vincent, Kathryn B.; Arria, Amelia M.

2010-01-01

Objective: Report the distribution of scores from the Adult ADHD Self-Report Scale (ASRS) and estimate the prevalence of self-reported attention-deficit/hyperactivity disorder (ADHD) symptoms as compared to clinical diagnoses. Participants: Participants were 1,080 college students, divided into 3 groups: (1) no ADHD diagnosis (n = 972), (2)…

The effects of oncology massage on symptom self-report for cancer patients and their caregivers.

PubMed

Lopez, Gabriel; Liu, Wenli; Milbury, Kathrin; Spelman, Amy; Wei, Qi; Bruera, Eduardo; Cohen, Lorenzo

2017-12-01

Massage has shown benefit for symptomatic relief in cancer patients and their caregivers. We explored the effects of a single massage session on self-reported symptoms in an outpatient clinic at a comprehensive cancer center. Patients and caregivers receiving oncology massage treatments (30 or 60-min duration) at our Integrative Medicine Center outpatient clinic from September 2012 to January 2015 completed the Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre and post massage. ESAS individual items and subscales of physical distress (PHS), psychological distress (PSS), and global distress (GDS) were analyzed. We used paired t tests with a p value correction (i.e., p < .001) to examine symptoms pre/post massage. Initial massage visits for 343 patients and 87 caregivers were analyzed. The highest symptom burdens (means) at baseline for patients were sleep 4.22, fatigue 3.57, and pain 2.94; for caregivers, sleep 3.77, well-being 3.01, and pain 2.59. Although patients reported significantly greater global distress and physical symptoms (p < .0001) compared to caregivers at baseline, groups did not differ in regard to psychological symptom burden (p = .66) and individual symptom scores (e.g., pain, sleep, spiritual pain). Massage therapy was associated with statistically (p < .0001) and clinically significant improvements in symptoms of pain, fatigue, anxiety, well-being, and sleep and ESAS subscales for both patients and caregivers. Greater massage duration (30 vs 60 min) did not lead to greater symptom reduction. Patients and caregivers reported a moderately high symptom burden. A single massage treatment resulted in acute relief of self-reported symptoms in both groups. Further study is warranted regarding optimal massage dose and frequency.

The Relationship Between Concussion Knowledge and the High School Athlete's Intention to Report Traumatic Brain Injury Symptoms.

PubMed

Taylor, Mary Ellen; Sanner, Jennifer E

2017-02-01

Sports-related concussion or traumatic brain injury (TBI) is a frequent occurrence among high school athletes. Long-term and short-term effects of TBI on the athlete's developing brain can be minimized if the athlete reports and is effectively treated for TBI symptoms. Knowledge of concussion symptoms and a school culture of support are critical in order to promote the student's intention to report TBI symptoms. The purpose of this systematic review is to examine the relationship between the high school athlete's concussion knowledge and an intention to report TBI symptoms. One hundred eleven articles were retrieved and four articles met established criteria and were included in this systematic review. A link appears to exist between high school athlete concussion knowledge and an intention to report TBI symptoms. School nurses can provide a supportive environment and concussion knowledge to the high school athlete in order to ultimately facilitate TBI symptom reporting.

The impact of an electronic health questionnaire on symptom management and behavior reporting for breast cancer survivors.

PubMed

Bock, Meredith; Moore, Dan; Hwang, Jimmy; Shumay, Dianne; Lawson, Laurell; Hamolsky, Deborah; Esserman, Laura; Rugo, Hope; Chien, A Jo; Park, John; Munster, Pamela; Melisko, Michelle

2012-08-01

Breast cancer (BC) patients experience multiple symptoms as a result of diagnosis and treatment. While surveillance for detecting cancer recurrence is fundamental to follow-up care, managing symptoms, and promoting health behaviors are equally important. UCSF has implemented a secure online health questionnaire enabling BC patients to provide updates of their health history and symptoms. We randomly selected a sample of stage I-III BC patients (n = 106) who completed a questionnaire before a medical oncology visit between August 2010 and January 2011 and consented to have data used for research. We conducted a chart review calculating the number of symptoms reported in the questionnaire, the clinic note only, and both questionnaire and clinic note, excluding chronic symptoms addressed previously. Self-reported data on exercise and alcohol consumption was compared to documentation of these lifestyle factors in clinic notes. Patients reported significantly more symptoms using the online questionnaire (mean = 3.8, range 0-13) than were documented by the provider in clinic notes (mean = 1.8, range 0-7; p < 0.001 for the difference). A regression plot comparing the percentage of symptoms agreed upon by the patient and provider and the percentage of symptoms addressed yields a slope of 0.56 (95 % CI 0.41-0.71). The number of self-reported symptoms correlates with self-reported Karnofsky scale such that the number of symptoms reported by the patient increases linearly with this score until a threshold and it then plateaus (p < 0.001). Exercise behavior and alcohol consumption were reported in 100 % of the online questionnaires, but was documented in only 30/106 (28 %) and 75/106 (70 %) of charts reviewed. In 19/75 (25 %) charts with alcohol consumption documented, there was substantial discordance between patient and clinician reporting. Electronic data collection of BC patient-reported outcomes has a positive effect on symptom management and identification of

Content Validity of the Hypogonadism Impact of Symptoms Questionnaire (HIS-Q): A Patient-Reported Outcome Measure to Evaluate Symptoms of Hypogonadism.

PubMed

Gelhorn, Heather L; Vernon, Margaret K; Stewart, Katie D; Miller, Michael G; Brod, Meryl; Althof, Stanley E; DeRogatis, Leonard R; Dobs, Adrian; Seftel, Allen D; Revicki, Dennis A

2016-04-01

Hypogonadism, or low testosterone, is a common disorder. There are currently no patient-reported outcome (PRO) instruments designed to comprehensively evaluate the symptoms of hypogonadism and to detect changes in these symptoms in response to treatment. The purpose of this study was to develop a PRO instrument, the Hypogonadism Impact of Symptoms Questionnaire (HIS-Q) and to assess its content validity. A literature review, expert clinician input, and qualitative concept elicitation with 39 male hypogonadism patients (four focus groups: n = 25; individual interviews: n = 14; mean age 52.3 ± 14.3 years) from the USA were used to develop the draft HIS-Q. Subsequent cognitive interviews (n = 29; mean age 51.5 ± 15.4 years) were used to evaluate content validity. Emergent discussion with participants yielded symptoms within the sexual, physical, energy, sleep, cognition, and mood domains. Low libido and tiredness were most commonly reported. The initial version of the HIS-Q includes 53 items that were consistently understood by the participants, who found the instrument to be relevant to their experiences with hypogonadism and comprehensive in the content coverage of symptoms. The HIS-Q is a comprehensive PRO measure of hypogonadism symptom severity in males. Its design elements, including the response options and recall period, were suitable, and content validity was confirmed.

Self-reported concussion symptoms and training routines in mixed martial arts athletes.

PubMed

Heath, Christopher J; Callahan, Jennifer L

2013-01-01

Mixed martial arts (MMA) is a full-contact, fighting sport that has risen in popularity over recent years, resulting in an increase in both training facilities and sport participants. To date, little research has examined the complications and vulnerability to head trauma, or concussive symptomatology, in MMA athletes. In this study, we assessed relationships between training routines and concussive symptoms, as well as medical care, in MMA athletes. A sample (N = 119) of MMA athletes reported concussive symptoms, training routines, and medical histories through an online survey. Nearly 15% of the MMA athletes reported history of a knockout, and nearly one-third reported a technical knockout. Subjective ratings of concussive symptoms were high for these athletes, with many of them waiting only a brief time after such incidents to return to competition. These findings have important implications for informing the medical treatment and safety decision for returning to participation for these athletes.

SSRI and SNRI withdrawal symptoms reported on an internet forum.

PubMed

Stockmann, Tom; Odegbaro, Dolapo; Timimi, Sami; Moncrieff, Joanna

2018-05-09

Antidepressant withdrawal symptoms are well-recognised, but their potential duration remains uncertain. We aimed to describe the characteristics of withdrawal associated with two popular classes of antidepressants, including duration. We analysed the content of a sample of posts on an antidepressant withdrawal website. We compared the characteristics of withdrawal associated with SSRIs and SNRIs, including time of onset, duration and nature of symptoms. 110 posts about SSRI withdrawal, and 63 concerning SNRI withdrawal, were analysed. The mean duration of withdrawal symptoms was significantly longer with SSRIs than SNRIs: 90.5 weeks (standard deviation, SD, 150.0) and 50.8 weeks (SD 76.0) respectively; p = 0.043). Neurological symptoms, such as 'brain zaps,' were more common among SNRI users (p = 0.023). Psychosexual/genitourinary symptoms may be more common among SSRI users (p = 0.054). The website aims to help people with antidepressant withdrawal, and is therefore likely to attract people who have difficulties. Length of prior use of antidepressants was long, with a mean of 252.2 weeks (SD 250.8). People accessing antidepressant withdrawal websites report experiencing protracted withdrawal symptoms. There are some differences in the characteristics of withdrawal associated with different classes of antidepressants.

Self-reported sexual symptoms in women attending menopause clinics.

PubMed

Nappi, Rossella E; Verde, Jole Baldero; Polatti, Franco; Genazzani, Andrea R; Zara, Carlo

2002-01-01

The aim of the present cross-sectional study was to investigate the frequency of self-reported sexual symptoms in women (n = 355; age range 46-60 years) attending menopausal clinics in Italy and to relate them to other vasomotor, psychological, physical, and genital complaints. Each subject completed a visual scale for sexual symptoms and for other complaints frequently occurring at menopause. Pain during sexual intercourse (29.8%) and low libido/lack of arousal (22%) were significantly more frequent with age (chi(2) = 8.0, p < 0.02; chi(2) = 6.2, p < 0.04, respectively) and years since menopause (chi(2) = 13.0, p < 0.005; chi(2) = 11.3, p < 0.01, respectively). Reduction of sexual pleasure/satisfaction (45.9%) was common with age, but was more frequent with longer time since the menopause (chi(2) = 19.9, p < 0.001). By examining the intensity of sexual symptoms according to the presence of other complaints, we found that physical, psychological, and genital well-being significantly affects components of sexual response after the menopause. For example, loss of fitness, urogenital symptoms, a negative self-image (increase of facial hair), and depressive symptoms were more common in women with sexual complaints. Given the concomitant role of hormonal and aging determinants, a comprehensive approach to female health is needed when facing climacteric sexual dysfunction. Copyright 2002 S. Karger AG, Basel

Development of a Symptom-Focused Patient-Reported Outcome Measure for Functional Dyspepsia: The Functional Dyspepsia Symptom Diary (FDSD)

PubMed Central

Taylor, Fiona; Higgins, Sophie; Carson, Robyn T; Eremenco, Sonya; Foley, Catherine; Lacy, Brian E; Parkman, Henry P; Reasner, David S; Shields, Alan L; Tack, Jan; Talley, Nicholas J

2018-01-01

Objectives: The Functional Dyspepsia Symptom Diary (FDSD) was developed to address the lack of symptom-focused, patient-reported outcome (PRO) measures designed for use in functional dyspepsia (FD) patients and meeting Food and Drug Administration recommendations for PRO instrument development. Methods: Concept elicitation interviews were conducted with FD participants to identify symptoms important and relevant to FD patients. A preliminary version of the FDSD was constructed, then completed by FD participants on an electronic device in cognitive interviews to evaluate the readability, comprehensibility, relevance, and comprehensiveness of the FDSD, and to preliminarily evaluate its measurement properties. Results: During concept elicitation interviews, 45 participants spontaneously reported 19 symptom concepts. Of those, seven symptoms were selected for assessment by the eight-item FDSD. Cognitive interviews with 57 participants confirmed that participants were able to comprehend and provide meaningful responses to the FDSD, and that the handheld electronic FDSD format was suitable for use in the target population. Scores of the FDSD were well-distributed among response options, item discrimination indices suggested that the FDSD items differentiate among patients with varying degrees of FD severity, and inter-item correlations suggested that no items of the FDSD were capturing redundant information. Internal consistency estimates (0.87) and construct-related validity estimates using known-groups methods were within acceptable ranges. Conclusions: The FDSD is a content-valid PRO measure, with preliminary psychometric evidence providing support for the FDSD’s items and total score. Further psychometric evaluations are recommended to more fully test the FDSD’s score performance and other measurement properties in the target patient population. PMID:28925989

The importance of proper administration and interpretation of neuropsychological baseline and postconcussion computerized testing.

PubMed

Moser, Rosemarie Scolaro; Schatz, Philip; Lichtenstein, Jonathan D

2015-01-01

Media coverage, litigation, and new legislation have resulted in a heightened awareness of the prevalence of sports concussion in both adult and youth athletes. Baseline and postconcussion testing is now commonly used for the assessment and management of sports-related concussion in schools and in youth sports leagues. With increased use of computerized neurocognitive sports concussion testing, there is a need for standards for proper administration and interpretation. To date, there has been a lack of standardized procedures by which assessments are administered. More specifically, individuals who are not properly trained often interpret test results, and their methods of interpretation vary considerably. The purpose of this article is to outline factors affecting the validity of test results, to provide examples of misuse and misinterpretation of test results, and to communicate the need to administer testing in the most effective and useful manner. An increase in the quality of test administration and application may serve to decrease the prevalence of invalid test results and increase the accuracy and utility of baseline test results if an athlete sustains a concussion. Standards for test use should model the American Psychological Association and Centers for Disease Control and Prevention guidelines, as well as the recent findings of the joint position paper on computerized neuropsychological assessment devices.

Patient-Reported Symptoms and Quality of Life in Adults With Acute Leukemia: A Systematic Review

PubMed Central

Bryant, Ashley Leak; Walton, AnnMarie L.; Shaw-Kokot, Julia; Mayer, Deborah K.; Reeve, Bryce B.

2018-01-01

Purpose/Objectives Systematically summarize findings from research conducted on adult acute leukemia survivors as they relate to symptoms and quality of life (QOL). Data Sources Systematic review of the literature from 1990–2013 found in the PubMed, PsycINFO®, EMBASE, and CINAHL® databases, as well as manual searches. Data Synthesis The review identified 16 quantitative studies and 1 qualitative study published from 1990–2013 that used a self-reported QOL or symptom questionnaire. Fatigue was the most commonly assessed and reported symptom, followed by depression. Conclusions Acute leukemia and its treatment have a significant impact in all QOL domains. Future studies should include longitudinal research, more than one recruitment site, increased minority representation, and home-based exercise interventions as ways to improve all domains of QOL. Implications for Nursing This review increases awareness of commonly reported symptoms faced by adults with acute leukemia. Oncology nurses are central in monitoring and reporting symptoms to the interdisciplinary team that may contribute to changes in function, with the overall goal of optimizing QOL over time. PMID:25806895

Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma.

PubMed

Mammen, Jennifer R; Rhee, Hyekyun; Norton, Sally A; Butz, Arlene M

2017-03-01

Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N = 28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens' decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. Teen's perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns.

Energy drinks and youth self-reported hyperactivity/inattention symptoms.

PubMed

Schwartz, Deborah L; Gilstad-Hayden, Kathryn; Carroll-Scott, Amy; Grilo, Stephanie A; McCaslin, Catherine; Schwartz, Marlene; Ickovics, Jeannette R

2015-01-01

To describe patterns in sweetened beverage consumption by race/ethnicity and sex, documenting both the amount and types of sweetened beverages consumed; and to examine the association of sweetened beverage consumption with hyperactivity/inattention symptoms among middle school students in a single urban school district. Middle school students (n = 1649; 47% Hispanic and 38% black, non-Hispanic) from 12 schools, randomly selected out of 27 district schools, completed health behavior surveys in fall 2011. Students reported quantity and types of sweetened beverages consumed in the past 24 hours and completed the 5-item Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire to measure symptoms. Amount and variety of reported sweetened beverage consumption (including energy drinks) were greater among boys versus girls and among black and Hispanic versus white students. Risk of hyperactivity/inattention increased by 14% for each additional sweetened beverage consumed, adjusting for age, race/ethnicity, sex, school lunch eligibility, family structure, and sugary food consumption. Students reporting consumption of energy drinks were 66% more likely to be at risk for hyperactivity/inattention after adjusting for number of drinks, other types of drinks consumed, and other potential confounders. Results support recommendations to limit consumption of sweetened beverages and to avoid consumption of energy drinks among children. Interventions to reduce sweetened beverage consumption should explicitly focus on energy drinks and other emerging sweetened beverages such as sports and sweetened coffee drinks. More research is needed to understand the direction of effects and the mechanisms behind the association between sweetened beverages and hyperactivity/inattention symptoms. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Patient-reported symptoms and changes up to 1 year after meniscal surgery.

PubMed

Skou, Søren T; Pihl, Kenneth; Nissen, Nis; Jørgensen, Uffe; Thorlund, Jonas Bloch

2018-06-01

Background and purpose - Detailed information on the symptoms and limitations that patients with meniscal tears experience is lacking. This study was undertaken to map the most prevalent self-reported symptoms and functional limitations among patients undergoing arthroscopic meniscal surgery and investigate which symptoms and limitations had improved most at 1 year after surgery. Patients and methods - Patients aged 18-76 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing arthroscopic meniscal surgery were included in this analysis of individual subscale items from the Knee Injury and Osteoarthritis Outcome Score and 1 question on knee stability. Severity of each item was scored as none, mild, moderate, severe, or extreme. Improvements were evaluated using Wilcoxon's signed-rank test and effect size (ES). Results - The most common symptoms were knee grinding and clicking, knee pain in general, pain when twisting and bending the knee and climbing stairs (88-98%), while the most common functional limitations were difficulty bending to the floor, squatting, twisting, kneeling, and knee awareness (97-99%). Knee pain in general and knee awareness improved most 1 year after meniscal surgery (ES -0.47 and -0.45; p < 0.001), while knee instability and general knee difficulties improved least (ES 0.10 and -0.08; p < 0.006). Interpretation - Adults undergoing surgery for a meniscal tear commonly report clinical symptoms and functional limitations related to their daily activities. Moderate improvements were observed in some symptoms and functional limitations and small to no improvement in others at 1 year after surgery. These findings can assist the clinical discussion of symptoms, treatments, and patients' expectations.

Self-reported Symptoms after Induced and Inhibited Bronchoconstriction in Athletes

PubMed Central

SIMPSON, ANDREW J.; ROMER, LEE M.; KIPPELEN, PASCALE

2015-01-01

ABSTRACT Purpose A change in the perception of respiratory symptoms after treatment with inhaled beta2 agonists is often used to aid diagnosis of exercise-induced bronchoconstriction (EIB). Our aim was to test the association between subjective ratings of respiratory symptoms and changes in airway caliber after induced and inhibited bronchoconstriction in athletes with EIB. Methods Eighty-five athletes with diagnosed or suspected EIB performed a eucapnic voluntary hyperpnea (EVH) challenge with dry air. Of the 45 athletes with hyperpnea-induced bronchoconstriction [i.e., post-EVH fall in forced expiratory volume in 1 s (FEV1) ≥10%, EVH−], 36 were randomized in a double-blind, placebo-controlled, crossover study. Terbutaline (0.5 mg) or placebo was administered by inhalation 15 min before EVH. Spirometry (for FEV1) was performed before and after EVH, and respiratory symptoms were recorded 15 min after EVH on visual analog scales. Results Terbutaline inhibited bronchoconstriction (i.e., maximal fall in FEV1 <10% after EVH) in 83% of the EVH-positive athletes, with an average degree of bronchoprotection of 53% (95% confidence interval [CI], 45% to 62%). Terbutaline reduced group mean symptom scores (P < 0.01), but the degree of bronchoprotection did not correlate with individual differences in symptom scores between terbutaline and placebo. Of the 29 athletes who had less than 10% FEV1 fall after EVH in the terbutaline condition, almost half (48%) rated at least one respiratory symptom higher under terbutaline, and more than one quarter (28%) had a higher total symptom score under terbutaline. Conclusion Self-reports of respiratory symptoms in conditions of induced and inhibited bronchoconstriction do not correlate with changes in airway caliber in athletes with EIB. Therefore, subjective ratings of respiratory symptoms after treatment with inhaled beta2 agonists should not be used as the sole diagnostic tool for EIB in athletes. PMID:25710876

Culture and symptom reporting at menopause.

PubMed

Melby, Melissa K; Lock, Margaret; Kaufert, Patricia

2005-01-01

The purpose of the present paper is to review recent research on the relationship of culture and menopausal symptoms and propose a biocultural framework that makes use of both biological and cultural parameters in future research. Medline was searched for English-language articles published from 2000 to 2004 using the keyword 'menopause' in the journals--Menopause, Maturitas, Climacteric, Social Science and Medicine, Medical Anthropology Quarterly, Journal of Women's Health, Journal of the American Medical Association, American Journal of Epidemiology, Lancet and British Medical Journal, excluding articles concerning small clinical samples, surgical menopause or HRT. Additionally, references of retrieved articles and reviews were hand-searched. Although a large number of studies and publications exist, methodological differences limit attempts at comparison or systematic review. We outline a theoretical framework in which relevant biological and cultural variables can be operationalized and measured, making it possible for rigorous comparisons in the future. Several studies carried out in Japan, North America and Australia, using similar methodology but different culture/ethnic groups, indicate that differences in symptom reporting are real and highlight the importance of biocultural research. We suggest that both biological variation and cultural differences contribute to the menopausal transition, and that more rigorous data collection is required to elucidate how biology and culture interact in female ageing.

Reports of "satisfactory relief" by IBS patients receiving usual medical care are confounded by baseline symptom severity and do not accurately reflect symptom improvement.

PubMed

Whitehead, William E; Palsson, Olafur S; Levy, Rona L; Feld, Andrew D; VonKorff, Michael; Turner, Marsha

2006-05-01

Treatment trials for irritable bowel syndrome (IBS) usually define a responder as a patient who reports satisfactory relief or adequate relief of symptoms at the end of the trial. However, these measures have not been adequately validated. (1) Compare a binary satisfactory relief measure to alternative ways of defining a treatment responder. (2) Determine whether baseline IBS symptom severity or psychological distress influence the sensitivity of these outcome measures. A total of 350 patients (81% females, average age 50 yr) who had a medical diagnosis of IBS and satisfied Rome II criteria, were recruited from Group Health Cooperative of Puget Sound. At baseline the Irritable Bowel Severity Scale (IBSS) was used to assess symptom severity and to classify patients as mild, moderate, or severe. Psychological distress and IBS-specific quality of life (IBS-QOL) were also assessed. After 6 months treatment with standard medical care, IBSS and IBS-QOL were reassessed, and patients were asked whether they had experienced satisfactory relief and whether they were somewhat or markedly better. Initial severity of IBS significantly affected the proportion who reported satisfactory relief (mild, 72%; moderate, 53%; severe, 44%) and the proportion who were somewhat or markedly better (mild, 62%; moderate, 44%; severe, 38%), but did not affect the proportion with a 50% reduction in symptoms (mild, 26%; moderate, 25%; severe, 23%). Although mild patients were the most likely to report satisfactory relief, they showed no average decrease in symptom severity or improvement in IBS-QOL. Conversely, severe patients, who were the least likely to report satisfactory relief, had the largest reductions in IBS symptom severity and the largest improvements in IBS-QOL. Psychological distress had no significant effect on the responder rate after adjusting for IBS symptom severity. These data from a descriptive study suggest that satisfactory relief is confounded with initial IBS symptom

Caregiver reports of common symptoms in children following a traumatic brain injury.

PubMed

Hooper, Stephen R; Alexander, Joshua; Moore, Daniel; Sasser, Howell C; Laurent, Sherry; King, Jennifer; Bartel, Sheri; Callahan, Beth

2004-01-01

This study describes the common symptoms in children and adolescents following a traumatic brain injury (TBI) as reported by their primary caregivers. Utilizing data from a large-scale state demonstration project, 681 children who had sustained a TBI were ascertained from both Hospital Emergency Departments (n = 409) and Pediatric Inpatient settings (n = 272). The sample ranged in age from infancy to 18 years, was largely male (59.7%), and had equal numbers of Caucasian and minority patients. Most of the participants experienced a mild TBI (83%), with about 5.1% being moderate and 12% severe. Caregivers described the presence of current symptoms (neurological, neurocognitive, behavioral, school problems) using a series of dichotomous questions regarding their child via a structured telephone interview at 1, 4, and 10 months post-injury. Inpatient children were described as manifesting more symptoms at each of the follow-up time points than their ED counterparts. At 1 month inpatients were described as having more symptoms across all 4 domains. At 4 and 10 months, the inpatients were described as having more neurocognitive symptoms and as not returning to school on a full-time basis, with behavior problems approaching significance at the 10-month point. A large number of individuals from both groups also reported persistent symptoms 10 months post-injury including headaches, attention and memory problems, low frustration tolerance, sleep problems, personality changes, and new school problems. Practical implications of these findings for the ongoing management of these children are discussed.

Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma

PubMed Central

Mammen, Jennifer R.; Rhee, Hyekyun; Norton, Sally A.; Butz, Arlene M.

2016-01-01

Background Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. Objectives To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. Methods A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N=28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) two-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. Results Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens’ decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. Conclusions Teen’s perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns. PMID:27337035

Indicators of complicated mild TBI predict MMPI-2 scores after 23 years.

PubMed

Hessen, Erik; Nestvold, Knut

2009-03-01

Research suggests that post-concussive syndrome may become persistent after mild traumatic brain injury (mTBI). The aim of this study was to investigate determinants of subjective complaints, characteristic for post-concussive syndrome, 23 years after mTBI. The study was a follow-up after a prospective head injury study at a general hospital in Norway. Ninety-seven patients were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 23 years after sustaining primarily mTBI. A good overall outcome was found with scores close to the normative mean, average length of education and normal employment rate. However, the patients that sustained complicated mTBI showed somewhat more pathological scores, well-matched with mild post-concussive syndrome. The most important predictors of poor outcome were a combination of post-traumatic amnesia >30 minutes and EEG pathology within 24 hours after TBI. No influence of pre- and post-injury risk factors on current MMPI-2 profiles was found. The results are in line with previous research findings and support the notion of potentially differential impact of uncomplicated vs. complicated mTBI. The findings suggest that complicated mTBI may cause subtle chronic symptoms typical of post-concussive syndrome.

Discordance Between Physician Assessment and Patient-Reported Depressive Symptoms in Parkinson Disease.

PubMed

Lachner, Christian; Armstrong, Melissa J; Gruber-Baldini, Ann L; Rezvani, Zahra; Reich, Stephen G; Fishman, Paul S; Salazar, Richard; Shulman, Lisa M

2017-07-01

To assess concordance between physician assessment and patient-reported symptoms when screening for depression in Parkinson disease (dPD). Depression in Parkinson disease is highly prevalent (∼40%) and has a significant impact on quality of life and disability, yet physician recognition and treatment remain inadequate. One thousand seventy-six patients with PD completed the Brief Symptom Inventory-18 (BSI-18), a screening questionnaire for psychiatric symptoms, which was compared to item #3 (depression) on the Unified Parkinson's Disease Rating Scale (UPDRS). The mean BSI-18 depression score was 51.4 (9.7). Of the 170 (16%) patients screening positive for dPD on the BSI-18, 104 (61%) were not recognized as depressed by neurologists on the UPDRS. Factors associated with lower neurologist recognition included male gender, better mental health quality of life, and lack of antidepressant use. More than 60% of patients screening positive for depression on self-report were not recognized by neurologists on the UPDRS. A patient-reported screening tool for depression may improve recognition and management of dPD.

Self-Reported Decline in Everyday Function, Cognitive Symptoms, and Cognitive Function in People With HIV.

PubMed

Laverick, Rosanna; Haddow, Lewis; Daskalopoulou, Marina; Lampe, Fiona; Gilson, Richard; Speakman, Andrew; Antinori, Andrea; Bruun, Tina; Vassilenko, Anna; Collins, Simon; Rodger, Alison

2017-11-01

We determined factors associated with self-reported decline in activities of daily living (ADLs) and symptoms of cognitive impairment in HIV positive adults in 5 European clinics. HIV+ adults underwent computerized and pen-and-paper neuropsychological tests and questionnaires of cognitive symptoms and ADLs. We considered cognitive function in 5 domains, psychosocial factors, and clinical parameters as potentially associated with symptoms. Separate regression analyses were used to determine factors associated with a decline in ADL (defined as self-reported decline affecting ≥2 ADLs and attributed to cognitive difficulties) and self-reported frequency of symptoms of cognitive impairment. We also estimated the diagnostic accuracy of both questionnaires as tests for cognitive impairment. Four hundred forty-eight patients completed the assessments [mean age 45.8 years, 84% male, 87% white, median CD4 count 550 cells/mm, median time since HIV diagnosis 9.9 years, 81% virologically suppressed (HIV-1 plasma RNA <50 copies/mL)]. Ninety-six (21.4%) reported decline in ADLs and attributed this to cognitive difficulties. Self-reported decline in ADLs and increased symptoms of cognitive impairment were both associated with worse performance on some cognitive tests. There were also strong associations with financial difficulties, depressive and anxiety symptoms, unemployment, and longer time since HIV diagnosis. Both questionnaires performed poorly as diagnostic tests for cognitive impairment. Patients' own assessments of everyday function and symptoms were associated with objectively measured cognitive function. However, there were strong associations with other psychosocial issues including mood and anxiety disorders and socioeconomic hardship. This should be considered when assessing HIV-associated cognitive impairment in clinical care or research studies.

Increased symptom reporting persists in 1990-1991 Gulf War veterans 20 years post deployment.

PubMed

Gwini, Stella M; Forbes, Andrew B; Kelsall, Helen L; Ikin, Jillian F; Sim, Malcolm R

2015-12-01

Following the 1990-1991 Gulf War, Gulf War veterans (veterans) reported health symptoms more commonly than non-deployed groups. This article examines symptom persistence, incidence and prevalence 20 years on. In 2000-2003 and 2011-2012, a 63-item symptom checklist was administered to 697 veterans and 659 comparison group. Symptomatology was compared using log-binomial regression. Both veterans and comparison group reported significantly increased prevalence (3-52%) over time in more than half the symptoms, with a similar overall rate of increase. Half the symptoms had higher incidence (risk-ratios ranged 1.43-1.50) and a quarter were more persistent (risk-ratios ranged 1.12-1.20) in veterans than the comparison group. Symptomatology increased in both groups over time, but persisted to a similar extent and had higher incidence among veterans than the comparison group. The gap in symptom prevalence between the two groups remained unchanged. These findings suggest enduring health consequences of Gulf War service. © 2015 Commonwealth of Australia. American Journal of Industrial Medicine © 2015 Wiley Periodicals, Inc.

Prevalence of self-reported musculoskeletal pain symptoms among school-age adolescents: age and sex differences.

PubMed

Keeratisiroj, Orawan; Siritaratiwat, Wantana

2018-04-25

Non-specific musculoskeletal pain symptoms are common in adolescents and may differ between the sexes, and be related to age and daily activities. It is critical to examine the prevalence and frequency of symptoms in adolescent students who tend to have pain which interferes with their routine activities. This study aimed to explore the prevalence and frequency of self-reported musculoskeletal pain symptoms by age and sex, and we also examined the association of symptoms with routine activities of school-age adolescents by area of pain. A cross-sectional survey was conducted among Thai students aged 10-19 years. All 2,750 students were asked to report previous 7-day and/or 12-month pain using the Standardized Nordic Questionnaire (Thai version) in 10 body areas. Multivariable logistic regression adjusted for age and sex was used to analyze the association between daily activity and musculoskeletal pain symptoms. A total of 76.1% (n=2,093) of students reported experiencing pain in the previous 7 days, 73.0% (n=2,007) reported in the previous 12-month period and 83.8% (n=2,304) reported pain in both 7-day and 12-month periods. The most common pain area was from a headache, with other areas being neck and shoulders, in that order, for both periods of time. The prevalence of musculoskeletal pain was especially higher in older groups and females. Participants reported frequency of pain as "sometimes in different areas" ranging from 78.4% to 88% and severity of pain at 3.82±2.06 out of 10 (95% CI 3.74-3.91). Routine daily activities associated with symptoms of headache, neck, shoulders, and ankles or feet pain were computer use (head, OR=2.22), school bag carrying (neck, OR=2.05), school bag carrying (shoulder, OR=3.09), and playing sports (ankle or foot, OR=2.68). The prevalence of musculoskeletal pain symptoms was high in both the previous 7-day and 12-month periods, especially in females and older adolescents, although most of them sometimes experienced pain

A survey of information given to head‐injured patients on direct discharge from emergency departments in Scotland

PubMed Central

Kerr, Jacques; Swann, Ian J; Pentland, Brian

2007-01-01

Aim To survey the information provided to head‐injured patients on discharge from emergency departments (EDs) in Scotland. Methods EDs throughout Scotland were asked to supply a copy of their head injury advice pamphlet for analysis. Each pamphlet was assessed against a template and an Excel spreadsheet was created. Results All 30 (100%) Scottish EDs responded. The frequency with which specific features appeared varied widely, with most pamphlets concentrating on emergency features, with less emphasis on postconcussion symptoms. Conclusions Head injury discharge advice should be standardised throughout EDs, with more emphasis given to postconcussion features. PMID:17452698

Sex-Based Differences as a Predictor of Recovery Trajectories in Young Athletes After a Sports-Related Concussion.

PubMed

Ono, Kim E; Burns, Thomas G; Bearden, Donald J; McManus, Susan M; King, Harold; Reisner, Andrew

2016-03-01

To date, few studies have delineated clear sex-based differences in symptom resolution after a sports-related concussion (SRC), and equivocal results have been identified in sex-based differences on baseline assessments. To assess whether female athletes displayed prolonged recovery and more symptoms at baseline and after an SRC compared with male athletes. Cohort study; Level of evidence, 3. The current study assessed 135 male and 41 female athletes (10-18 years old) who participated in high-impact sports in metropolitan Atlanta middle and high schools. All athletes completed a baseline assessment and at least 1 postconcussion assessment from the Immediate Post-Concussion Assessment and Cognitive Testing battery. Longitudinal hierarchical linear modeling was employed to examine individual-level variables and their associations with adolescents' rates of recovery in concussive symptoms after controlling for age and number of prior concussions. Aggregate symptoms were rated as higher in female athletes compared with male athletes at baseline (mean ± SD: females, 13.49 ± 11.20; males, 4.88 ± 8.74; F(1,175) = 10.59, P < .001) and immediately after a concussion (females: 16.75 ± 18.08; males: 10.58 ± 14.21; F(1,175) = 3.99, P = .05). There were no group differences in the slope of recovery between male and female athletes, indicating generally similar trajectories of change for both groups. Post hoc analyses revealed higher baseline levels of migraine and neuropsychological symptoms in female athletes. Although female athletes in the current study reported increased symptoms, identical recovery patterns were observed in both sexes, suggesting that sex-based differences in concussion recovery are better explained by increased symptom frequency among female athletes when compared with their male counterparts. © 2015 The Author(s).

Using Acute Performance on a Comprehensive Neurocognitive, Vestibular, and Ocular Motor Assessment Battery to Predict Recovery Duration After Sport-Related Concussions.

PubMed

Sufrinko, Alicia M; Marchetti, Gregory F; Cohen, Paul E; Elbin, R J; Re, Valentina; Kontos, Anthony P

2017-04-01

A sport-related concussion (SRC) is a heterogeneous injury that requires a multifaceted and comprehensive approach for diagnosis and management, including symptom reports, vestibular/ocular motor assessments, and neurocognitive testing. To determine which acute (eg, within 7 days) vestibular, ocular motor, neurocognitive, and symptom impairments predict the duration of recovery after an SRC. Cohort study (prognosis); Level of evidence, 2. Sixty-nine patients with a mean age of 15.3 ± 1.9 years completed a neurocognitive, vestibular/ocular motor, and symptom assessment within 7 days of a diagnosed concussion. Patients were grouped by recovery time: ≤14 days (n = 27, 39.1%), 15-29 days (n = 25, 36.2%), and 30-90 days (n = 17, 24.6%). Multinomial regression was used to identify the best subset of predictors associated with prolonged recovery relative to ≤14 days. Acute visual motor speed and cognitive-migraine-fatigue symptoms were associated with an increased likelihood of recovery times of 30-90 days and 15-29 days relative to a recovery time of ≤14 days. A model with visual motor speed and cognitive-migraine-fatigue symptoms within the first 7 days of an SRC was 87% accurate at identifying patients with a recovery time of 30-90 days. The current study identified cognitive-migraine-fatigue symptoms and visual motor speed as the most robust predictors of protracted recovery after an SRC according to the Post-concussion Symptom Scale, Immediate Post-concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening (VOMS). While VOMS components were sensitive in identifying a concussion, they were not robust predictors for recovery. Clinicians may consider particular patterns of performance on clinical measures when providing treatment recommendations and discussing anticipated recovery with patients.

Associations between proximity to livestock farms, primary health care visits and self-reported symptoms.

PubMed

van Dijk, Christel E; Smit, Lidwien A M; Hooiveld, Mariette; Zock, Jan-Paul; Wouters, Inge M; Heederik, Dick J J; Yzermans, C Joris

2016-02-19

Living in a neighbourhood with a high density of livestock farms has been associated with adverse respiratory health effects, but less is known about healthcare utilisation. This study aimed at investigating the associations between livestock exposure and primary health care visits and self-reported symptoms. In addition, we examined the potentially confounding effect of distance from home to general practice. Contact data between 2006 and 2009 were obtained from electronic medical records of 54,777 persons registered within 16 general practices in an area with a high density of livestock farms in the Netherlands. Data on self-reported symptoms were used from a cross-sectional sample of 531 patients in 2010. Livestock presence in a 500 m radius from home was computed using Geographic Information System data. In general, livestock exposure was associated with fewer contacts and self-reported symptoms for respiratory and other conditions. The number of poultry within 500 m was positively associated with the number of contacts. A longer distance to general practice was associated with fewer contacts, but did not confound associations. People living close to livestock farms less often see their general practitioner and report symptoms.

Pesticide Use and Self-Reported Health Symptoms Among Rice Farmers in Zanzibar.

PubMed

da Silva, Marisa; Stadlinger, Nadja; Mmochi, Aviti J; Stålsby Lundborg, Cecilia; Marrone, Gaetano

2016-01-01

The agrarian population in low- and middle-income countries suffers from a number of adverse health effects due to pesticide exposure. In Zanzibar, the government subsidizes pesticides to enhance local rice production. The objectives of this study were to assess Zanzibar smallholder rice farmers' pesticide use and self-reported health symptoms in relation to pesticide exposure, training, and use of protective measures and to raise awareness for future local policy formulation. An exploratory cross-sectional interviewer-administered study was conducted among 99 rice farmers. Participants were selected based on convenience sampling and stratified by expected exposure category. The study participants reported using pesticides in World Health Organization (WHO) Class II. Of pesticide users, 61% reported one or more symptoms of possible acute pesticide poisoning. Only 50% of pesticide users had received training in safe handling and application of pesticides, but those who had displayed a higher use of protective measures. Farmers who did not use protective measures were more likely to have reported skin irritation and headache, which, together with eye irritation, were the most commonly reported acute symptoms. The main sociodemographic differences between the expected exposure categories of pesticide users and nonusers were in gender and education level. Scaling up of training in safe handling and application of pesticides is needed. Further studies are required to better understand the mechanisms behind the choice to use pesticides or not.

Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism.

PubMed

Hurtig, Tuula; Kuusikko, Sanna; Mattila, Marja-Leena; Haapsamo, Helena; Ebeling, Hanna; Jussila, Katja; Joskitt, Leena; Pauls, David; Moilanen, Irma

2009-11-01

The aim of the study was to examine psychiatric symptoms in high-functioning adolescents with autism spectrum disorders reported by multiple informants. Forty-three 11- to 17-year-old adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and 217 typically developed adolescents completed the Youth Self-Report (YSR), while their parents completed the Child Behavior Checklist (CBCL). Teachers of adolescents with AS/HFA completed the Teacher Report Form (TRF). The informants reported significantly more psychiatric symptoms, especially withdrawn, anxious/depressed, social and attention problems, in adolescents with AS/HFA than in controls. In contrast to findings in the general population, the psychiatric problems of adolescents with AS/HFA are well acknowledged by multiple informants, including self-reports. However, anxiety and depressive symptoms were more commonly reported by adolescents with AS/HFA and their teachers than their parents, indicating that some emotional distress may be hidden from their parents.

Training Attention Improves Decision Making in Individuals with Elevated Self-Reported Depressive Symptoms

PubMed Central

Cooper, Jessica A.; Gorlick, Marissa A.; Denny, Taylor; Worthy, Darrell A.; Beevers, Christopher G.; Maddox, W. Todd

2013-01-01

Depression is often characterized by attentional biases toward negative items and away from positive items, which likely affects reward and punishment processing. Recent work reported that training attention away from negative stimuli reduced this bias and reduced depressive symptoms. However, the effect of attention training on subsequent learning has yet to be explored. In the current study, participants were required to learn to maximize reward during decision-making. Undergraduates with elevated self-reported depressive symptoms received attention training toward positive stimuli prior to performing the decision-making task (n=20; active training). The active training group was compared to two groups: undergraduates with elevated self-reported depressive symptoms who received placebo training (n=22; placebo training) and control subjects with low levels of depressive symptoms (n=33; non-depressive control). The placebo-training depressive group performed worse and switched between options more than non-depressive controls on the reward maximization task. However, depressives that received active training performed as well as non-depressive controls. Computational modeling indicated that the placebo-trained group learned more from negative than from positive prediction errors, leading to more frequent switching. The non-depressive control and active training depressive groups showed similar learning from positive and negative prediction errors, leading to less frequent switching and better performance. Our results indicate that individuals with elevated depressive symptoms are impaired at reward maximization, but that the deficit can be improved with attention training toward positive stimuli. PMID:24197612

Training attention improves decision making in individuals with elevated self-reported depressive symptoms.

PubMed

Cooper, Jessica A; Gorlick, Marissa A; Denny, Taylor; Worthy, Darrell A; Beevers, Christopher G; Maddox, W Todd

2014-06-01

Depression is often characterized by attentional biases toward negative items and away from positive items, which likely affects reward and punishment processing. Recent work has reported that training attention away from negative stimuli reduced this bias and reduced depressive symptoms. However, the effect of attention training on subsequent learning has yet to be explored. In the present study, participants were required to learn to maximize reward during decision making. Undergraduates with elevated self-reported depressive symptoms received attention training toward positive stimuli prior to performing the decision-making task (n = 20; active training). The active-training group was compared to two other groups: undergraduates with elevated self-reported depressive symptoms who received placebo training (n = 22; placebo training) and a control group with low levels of depressive symptoms (n = 33; nondepressive control). The placebo-training depressive group performed worse and switched between options more than did the nondepressive controls on the reward maximization task. However, depressives that received active training performed as well as the nondepressive controls. Computational modeling indicated that the placebo-trained group learned more from negative than from positive prediction errors, leading to more frequent switching. The nondepressive control and active-training depressive groups showed similar learning from positive and negative prediction errors, leading to less-frequent switching and better performance. Our results indicate that individuals with elevated depressive symptoms are impaired at reward maximization, but that the deficit can be improved with attention training toward positive stimuli.

Self-reported transient ischemic attack and stroke symptoms: methods and baseline prevalence. The ARIC Study, 1987-1989.

PubMed

Toole, J F; Lefkowitz, D S; Chambless, L E; Wijnberg, L; Paton, C C; Heiss, G

1996-11-01

As part of the Atherosclerosis Risk in Communities (ARIC) Study assessment of the etiology and sequelae of atherosclerosis, a standardized questionnaire on transient ischemic attack (TIA) and nonfatal stroke and a computerized diagnostic algorithm simulating clinical reasoning were developed and tested at the four ARIC field centers: Forsyth County, North Carolina; Minneapolis, Minnesota; Jackson, Mississippi; and Washington County, Maryland. The diagnostic algorithm used participant responses to a series of questions about six neurologic trigger symptoms to identify symptoms of TIA or stroke and their vascular distribution. Among 12,205 ARIO participants reporting their lifetime occurrence of one or more symptoms probably due to cerebrovascular causes, nearly half (47%) reported the sudden onset of at least one symptom sometime prior to their ARIC examination. Of those with at least one symptom, only 12.9% were classified by the computer algorithm as having symptoms of TIA or stroke. Dizziness/loss of balance was the most frequently reported symptom (36%); 1.2% of these persons were classified by the algorithm as having a TIA/stroke event. Positive symptoms of speech dysfunction were classified most often (77.%) as being symptoms of TIA or stroke. Symptoms suggesting TIA were reported more frequently than symptoms suggesting stroke by both sexes. TIA or stroke-like phenomena were more frequent (p < 0.001) in females (7%) than in males (5%) and increased with age in both sexes (p = 0.13 for females; p = 0.02 for males). In Forsyth County, TIA and stroke symptoms were greater in African Americans than in Caucasians (p = 0.05, controlling for sex). The association of algorithmically defined symptoms of TIA or stroke with traditional cerebrovascular risk factors is the subject of a companion paper.

Pathological changes in the subsynovial connective tissue increase with self-reported carpal tunnel syndrome symptoms.

PubMed

Tat, Jimmy; Wilson, Katherine E; Keir, Peter J

2015-05-01

Fibrosis and thickening of the subysnovial connective tissue are the most common pathological findings in carpal tunnel syndrome. The relationship between subsynovial connective tissue characteristics and self-reported carpal tunnel syndrome symptoms was assessed. Symptoms were characterized using the Boston Carpal Tunnel Questionnaire and Katz hand diagram in twenty-two participants (11 with symptoms, 11 with no symptoms). Using ultrasound, the thickness of the subsynovial connective tissue was measured using a thickness ratio (subsynovial thickness/tendon thickness) and gliding function was assessed using a shear strain index ((Displacement(tendon)-Displacement(subsynovial))/Displacement(tendon)x 100). For gliding function, participants performed 10 repeated flexion-extension cycles of the middle finger at a rate of one cycle per second. Participants with symptoms had a 38.5% greater thickness ratio and 39.2% greater shear strain index compared to participants without symptoms (p<0.05). Ultrasound detected differences the SSCT in symptomatic group that was characterized by low self-reported symptom severity scores. This study found ultrasound useful for measuring structural and functional changes in the SSCT that could provide insight in the early pathophysiology associated with carpal tunnel syndrome symptoms. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors influencing mother-child reports of depressive symptoms and agreement among clinically referred depressed youngsters in Hungary

PubMed Central

Kiss, Eniko; Gentzler, Amy M.; George, Charles; Kapornai, Krisztina; Tamás, Zsuzsanna; Kovacs, Maria; Vetró, Ágnes

2007-01-01

Background Psychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers’ and children’s report of children’s depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female. Methods Subjects were 354 children (158 girls; mean age 11.69 years, s.d.: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms. Results Maternal reports were significantly higher than their son’s but not daughters’. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers’ reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older. Limitations The same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation. Conclusions During a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child. PMID:17125844

Factors influencing mother-child reports of depressive symptoms and agreement among clinically referred depressed youngsters in Hungary.

PubMed

Kiss, Eniko; Gentzler, Amy M; George, Charles; Kapornai, Krisztina; Tamás, Zsuzsanna; Kovacs, Maria; Vetró, Agnes

2007-06-01

Psychiatric assessments of children typically involve two informants, the child and the parent. Understanding discordance in their reports has been of interest to clinicians and researchers. We examine differences between mothers' and children's report of children's depressive symptom severity, and factors that may influence their reports and level of agreement. We hypothesized that agreement between mother and child would improve if (1) the mother is depressed, due to improved recall of mood congruent symptoms, (2) the child is older, due to better social-cognitive and communication skills, and (3) the child is a female. Subjects were 354 children (158 girls; mean age 11.69 years, SD: 2.05 years) with Major Depressive Disorder. Depressive symptoms were evaluated by a semi-structured interview separately with the mother and the child. Agreement on symptom severity was based on concordance of the presence and extent of symptoms. Maternal reports were significantly higher than their son's but not daughters'. Girls, particularly with increasing age, reported higher levels of symptoms; however mothers' reports were not affected by child sex or age. Maternal depression predicted more severe symptom reports for both children and mothers. Agreement between the mother and the child increased as children got older. The same clinician interviewed the mother and the child, which might inflate rates of agreement. However, this method mirrors clinical evaluation. During a clinical interview one must consider the age and sex of the child and the depressive state of the mother in assimilating information about the child.

Evaluation of the CAARS Infrequency Index for the Detection of Noncredible ADHD Symptom Report in Adulthood

ERIC Educational Resources Information Center

Fuermaier, Anselm B. M.; Tucha, Lara; Koerts, Janneke; Weisbrod, Matthias; Grabemann, Marco; Zimmermann, Marco; Mette, Christian; Aschenbrenner, Steffen; Tucha, Oliver

2016-01-01

The reliance on self-reports in detecting noncredible symptom report of attention-deficit/hyperactivity disorder in adulthood (aADHD) has been questioned due to findings showing that symptoms can easily be feigned on self-report scales. In response, Suhr and colleagues developed an infrequency index for the Conners' Adult ADHD Rating Scale (CII)…

Socio-economic factors, health care consumption and rating of abdominal symptom severity. A report from the abdominal symptom study.

PubMed

Agréus, L

1993-06-01

A study of the abdominal/gastrointestinal symptom panorama in relation to socio-economic factors and health care consumption in the general population was performed in Osthammar, Sweden. A postal questionnaire was sent to a representative sample of the adult population (n = 1260). The response rate was 87%. The responders with symptoms (52.1%) subjectively rated their illness on visual analogue scales. All responders were classified as asymptomatic or having 'minor' or 'major' abdominal symptoms. Those having dyspepsia, reflux or irritable bowel syndrome were also ranked as 'minors' or 'majors'. The proportion of subjects with abdominal/gastrointestinal complaints decreased with age, mainly due to a decrease of 'major' symptoms. Also, the proportion of complainers increased among the more educated. Those on sick leave and students had more and worse symptoms than the others, despite the former seldom stating abdominal discomfort as the main reason for sick listing. Fifty-five per cent of all persons reporting abdominal/gastrointestinal symptoms had at some time consulted a doctor because of such complaints, the proportion increasing with severity, as did drug consumption and the rate of previous abdominal operations, with appendectomy as an exception. The results show that it is possible to rank the illness along a severity dimension among persons with abdominal/gastrointestinal complaints in epidemiological research.

Comparison of 7-day recall and daily diary reports of COPD symptoms and impacts.

PubMed

Bennett, Antonia V; Amtmann, Dagmar; Diehr, Paula; Patrick, Donald L

2012-05-01

Patient reporting of symptoms in a questionnaire with a 7-day recall period was expected to differ from symptom reporting in a 7-day symptom diary on the basis of cognitive theory of memory processes and several studies of symptoms and health behaviors. A total of 101 adults with chronic obstructive pulmonary disease (COPD) completed a daily diary of items measuring symptoms and impacts of COPD for 7 days, and on the seventh day they completed a questionnaire of the same items with a 7-day recall period. The analysis examined concordance of 7-day recall with summary descriptors of the daily responses, examined the magnitude and covariates (patient characteristics and response patterns) of the difference between 7-day recall and mean of daily responses, and compared the discriminant ability and ability to detect change of 7-day recall and mean of daily responses. A 7-day recall was moderately concordant with the mean and maximum of daily responses and was 0.34 to 0.50 SDs higher than the mean of daily responses. Only the weekly report itself was a covariate of the difference. The discriminant ability and ability to detect change were equivalent. In measuring the weeklong experience of COPD symptoms and impacts on groups of patients, the 7-day recall scores were higher than the daily diary scores, but equivalent in detecting change over time. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Attention deficit hyperactivity disorder symptoms reporting in Malaysian adolescents: do adolescents, parents and teachers agree with each other?

PubMed

Wan Salwina, Wan Ismail; Baharudin, Azlin; Nik Ruzyanei, Nik Jaafar; Midin, Marhani; Rahman, Fairuz Nazri Abdul

2013-12-01

Attention Deficit Hyperactivity Disorder (ADHD) is a clinical diagnosis relying on persistence of symptoms across different settings. Information are gathered from different informants including adolescents, parents and teachers. In this cross-sectional study involving 410 twelve-year old adolescents, 37 teachers and 367 parents from seven schools in the Federal Territory of Kuala Lumpur, reliability of ADHD symptoms among the various informants were reported. ADHD symptoms (i.e. predominantly hyperactive, predominantly inattentive and combined symptoms) were assessed by adolescents, teachers and parents, using Conners-Wells' Adolescent Self-report Scale (CASS), Conner's Teachers Rating Scale (CTRS) and Conner's Parents Rating Scale (CPRS) respectively. For predominantly hyperactive symptoms, there were statistically significant, weak positive correlations between parents and teachers reporting (r=0.241, p<0.01). Statistically significant, weak positive correlations were found between adolescents and parents for predominantly inattentive symptoms (r=0.283, p<0.01). Correlations between adolescents and parents reporting were statistically significant but weak (r=0.294, p<0.01). Weak correlations exist between the different informants reporting ADHD symptoms among Malaysian adolescents. While multiple informant ratings are required to facilitate the diagnosis of ADHD, effort should be taken to minimize the disagreement in reporting and better utilize the information. Copyright © 2013 Elsevier B.V. All rights reserved.

Self-reported acute health symptoms and exposure to companion animals#

EPA Science Inventory

Self-reported acute health symptoms and exposure to companion animalsWhitney S. Krueger1,2, Elizabeth D. Hilborn2, Timothy J. Wade21Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA2Environmental Public Health Division, Office of Research and Development, U...

Meta-analysis of self-reported health symptoms in 1990–1991 Gulf War and Gulf War-era veterans

PubMed Central

Maule, Alexis L; Janulewicz, Patricia A; Sullivan, Kimberly A; Krengel, Maxine H; Yee, Megan K; McClean, Michael; White, Roberta F

2018-01-01

Objectives Across diverse groups of Gulf War (GW) veterans, reports of musculoskeletal pain, cognitive dysfunction, unexplained fatigue, chronic diarrhoea, rashes and respiratory problems are common. GW illness is a condition resulting from GW service in veterans who report a combination of these symptoms. This study integrated the GW literature using meta-analytical methods to characterise the most frequently reported symptoms occurring among veterans who deployed to the 1990–1991 GW and to better understand the magnitude of ill health among GW-deployed veterans compared with non-deployed GW-era veterans. Design Meta-analysis. Methods Literature databases were searched for peer-reviewed studies published from January 1990 to May 2017 reporting health symptom frequencies in GW-deployed veterans and GW-era control veterans. Self-reported health symptom data were extracted from 21 published studies. A binomial-normal meta-analytical model was used to determine pooled prevalence of individual symptoms in GW-deployed veterans and GW-era control veterans and to calculate combined ORs of health symptoms comparing GW-deployed veterans and GW-era control veterans. Results GW-deployed veterans had higher odds of reporting all 56 analysed symptoms compared with GW-era controls. Odds of reporting irritability (OR 3.21, 95% CI 2.28 to 4.52), feeling detached (OR 3.59, 95% CI 1.83 to 7.03), muscle weakness (OR 3.19, 95% CI 2.73 to 3.74), diarrhoea (OR 3.24, 95% CI 2.51 to 4.17) and rash (OR 3.18, 95% CI 2.47 to 4.09) were more than three times higher among GW-deployed veterans compared with GW-era controls. Conclusions The higher odds of reporting mood-cognition, fatigue, musculoskeletal, gastrointestinal and dermatological symptoms among GW-deployed veterans compared with GW-era controls indicates these symptoms are important when assessing GW veteran health status. PMID:29440208

Discriminating military and civilian traumatic brain injuries.

PubMed

Reid, Matthew W; Velez, Carmen S

2015-05-01

Traumatic brain injury (TBI) occurs at higher rates among service members than civilians. Explosions from improvised explosive devices and mines are the leading cause of TBI in the military. As such, TBI is frequently accompanied by other injuries, which makes its diagnosis and treatment difficult. In addition to postconcussion symptoms, those who sustain a TBI commonly report chronic pain and posttraumatic stress symptoms. This combination of symptoms is so typical they have been referred to as the "polytrauma clinical triad" among injured service members. We explore whether these symptoms discriminate civilian occurrences of TBI from those of service members, as well as the possibility that repeated blast exposure contributes to the development of chronic traumatic encephalopathy (CTE). This article is part of a Special Issue entitled 'Traumatic Brain Injury'. Copyright © 2015 Elsevier Inc. All rights reserved.

Validation of a self-reported HIV symptoms list: the ISS-HIV symptoms scale.

PubMed

Bucciardini, Raffaella; Pugliese, Katherina; Francisci, Daniela; Costantini, Andrea; Schiaroli, Elisabetta; Cognigni, Miriam; Tontini, Chiara; Lucattini, Stefano; Fucili, Luca; Di Gregorio, Massimiliano; Mirra, Marco; Fragola, Vincenzo; Pompili, Sara; Murri, Rita; Vella, Stefano

2016-01-01

To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results.

Patient-reported speech in noise difficulties and hyperacusis symptoms and correlation with test results.

PubMed

Spyridakou, Chrysa; Luxon, Linda M; Bamiou, Doris E

2012-07-01

To compare self-reported symptoms of difficulty hearing speech in noise and hyperacusis in adults with auditory processing disorders (APDs) and normal controls; and to compare self-reported symptoms to objective test results (speech in babble test, transient evoked otoacoustic emission [TEOAE] suppression test using contralateral noise). A prospective case-control pilot study. Twenty-two participants were recruited in the study: 10 patients with reported hearing difficulty, normal audiometry, and a clinical diagnosis of APD; and 12 normal age-matched controls with no reported hearing difficulty. All participants completed the validated Amsterdam Inventory for Auditory Disability questionnaire, a hyperacusis questionnaire, a speech in babble test, and a TEOAE suppression test using contralateral noise. Patients had significantly worse scores than controls in all domains of the Amsterdam Inventory questionnaire (with the exception of sound detection) and the hyperacusis questionnaire (P < .005). Patients also had worse TEOAE suppression test results in both ears than controls; however, this result was not significant after Bonferroni correction. Strong correlations were observed between self-reported symptoms of difficulty hearing speech in noise and speech in babble test results in the right ear (ρ = 0.624, P = .002), and between self-reported symptoms of hyperacusis and TEOAE suppression test results in the right ear (ρ = -0.597 P = .003). There was no significant correlation between the two tests. A strong correlation was observed between right ear speech in babble and patient-reported intelligibility of speech in noise, and right ear TEOAE suppression by contralateral noise and hyperacusis questionnaire. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Symptom Reporting Patterns of US Military Service Members with a History of Concussion According to Duty Status.

PubMed

Lu, Lisa H; Cooper, Doug B; Reid, Matthew W; Khokhar, Bilal; Tsagaratos, Jennifer E; Kennedy, Jan E

2018-03-28

To compare symptom reporting patterns of service members with a history of concussion based on work status: full duty, limited duty, or in the Medical Evaluation Board (MEB)/disability process. Retrospective analysis of 181 service members with a history of concussion (MEB n = 56; limited duty n = 62; full duty n = 63). Neurobehavioral Symptom Inventory (NSI) Validity-10 cutoff (>22) and Mild Brain Injury Atypical Symptoms Scale (mBIAS) cutoffs (≥10 and ≥8) were used to evaluate potential over-reporting of symptoms. The MEB group displayed significantly higher NSI scores and significantly higher proportion scored above the mBIAS ≥10 cutoff (MEB = 15%; limited duty = 3%; full duty = 5%). Validity-10 cutoff did not distinguish between groups. MEB but not limited duty status was associated with increased risk of over-reporting symptoms in service members with a history of concussion. Results support the use of screening measures for over-reporting in the MEB/disability samples.

Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles.

PubMed

Shannon, M P; Lonigan, C J; Finch, A J; Taylor, C M

1994-01-01

To determine the range and severity of post-traumatic stress disorder (PTSD) symptoms exhibited by children after exposure to a natural disaster. Three months after Hurricane Hugo struck Berkeley County, South Carolina, 5,687 school-aged children were surveyed about their experiences and reactions related to the storm. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index. Significant variation in the prevalence of PTSD symptoms was found across race, gender, and age groups. Self-reported symptoms were used to derive a post-traumatic stress syndrome classification according to DSM-III-R guidelines for the diagnosis of PTSD. More than 5% of the sample reported sufficient symptoms to be classified as exhibiting this post-traumatic stress syndrome. Females and younger children were more likely to receive this classification. At the symptom level, females reported more symptoms associated with emotional processing and emotional reaction to the trauma. Males were more likely to report symptoms related to cognitive and behavioral factors. Younger children were more likely to report symptoms overall. Children exposed to a high magnitude natural disaster report sufficient symptoms to establish a DSM-III-R derived classification of a PTSD syndrome. Differences between gender, age, and race groups appear to be related to differential risk of exposure, reporting biases, as well as a differential risk for developing post-traumatic symptoms.

Deficits in Visual System Functional Connectivity after Blast-Related Mild TBI are Associated with Injury Severity and Executive Dysfunction

DTIC Science & Technology

2016-08-24

participation, participants were also asked whether they had experienced memory problems, poor balance, irritability, tinnitus , sensitivity to light/noise...of consciousness (LOC) less than 30 min, post-traumatic amnesia (PTA) up to 24 h, and neurological symptoms (e.g., headache, tinnitus , nausea...unavailable for all subjects). 3A total of eight postconcussive symptoms were assessed: memory problems, poor balance, irritability, tinnitus , sensitivity

Association of Maternal Report of Infant and Toddler Gastrointestinal Symptoms With Autism

PubMed Central

Bresnahan, Michaeline; Hornig, Mady; Schultz, Andrew F.; Gunnes, Nina; Hirtz, Deborah; Lie, Kari Kveim; Magnus, Per; Reichborn-Kjennerud, Ted; Roth, Christine; Schjølberg, Synnve; Stoltenberg, Camilla; Surén, Pål; Susser, Ezra; Lipkin, W. Ian

2016-01-01

IMPORTANCE Gastrointestinal (GI) comorbidities are frequently described in association with autism spectrum disorder (ASD). However, the prevalence of GI disturbances and the age at which such problems first appear are unclear, and their specificity for ASD compared with other neurodevelopmental disorders is uncertain. OBJECTIVE To compare maternal report of GI symptoms during the first 3 years of life in children with ASD, developmental delay (DD), and typical development (TD). DESIGN, SETTING, AND PARTICIPANTS This large prospective cohort study consists of participants in the Norwegian Mother and Child Cohort Study. During a 10-year period (January 1, 1999, through December 31, 2008), women throughout Norway were recruited at the first prenatal ultrasonographic visit (approximately 18 weeks’ gestation). The study enrolled 95 278 mothers, 75 248 fathers, and 114 516 children. Our analyses are based on MoBa data released through October 1, 2013, and NPR diagnoses registered through December 31, 2012, and include children born from January 1, 2002, through December 31, 2008, with completed age 18- and 36-month questionnaires. EXPOSURES We defined 3 groups of children: children with ASD (n = 195), children with DD and delayed language and/or motor development (n = 4636), and children with TD (n = 40 295). MAIN OUTCOMES AND MEASURES The GI symptoms were based on maternal report of constipation, diarrhea, and food allergy/intolerance. RESULTS Children with ASD were at significantly increased odds of maternally reported constipation (adjusted odds ratio [aOR], 2.7; 95% CI, 1.9–3.8; P < .001) and food allergy/intolerance (aOR, 1.7; 95% CI, 1.1–2.6; P = .01) in the 6- to 18-month-old age period and diarrhea (aOR, 2.3; 95% CI, 1.5–3.6; P < .001), constipation (aOR, 1.6; 95% CI, 1.2–2.3; P < .01), and food allergy/intolerance (aOR, 2.0; 95% CI, 1.3–3.1; P < .01) in the 18- to 36-month-old age period compared with children with TD. Similar results for these

Caregivers’ depressive symptoms and parent-report of child executive function among young children in Uganda

PubMed Central

Familiar, Itziar; Nakasujja, Noeline; Bass, Judith; Sikorskii, Alla; Murray, Sarah; Ruisenor-Escudero, Horacio; Bangirana, Paul; Opoka, Robert; Boivin, Michael J.

2015-01-01

Maternal mental health (particularly depression) may influence how they report on their child’s behavior. Few research studies have focused on Sub-Saharan countries where pediatric HIV concentrates and impacts child neuropsychological development and caregiver mental health. We investigated the associations between caregivers’ depressive symptoms and neuropsychological outcomes in HIV-infected (n=118) and HIV-exposed (n=164) Ugandan children aged 2–5 years. We compared performance-based tests of development (Mullen Scales of Early Learning, Color Object Association Test), to a caregiver report of executive function (Behavior Rating Inventory of Executive Function, BRIEF). Caregivers were assessed with Hopkins Symptom Checklist-25 depression subscale. The associations between all BRIEF indices and caregiver’s depression symptoms were differential according to child’s HIV status. Caregivers with greater depressive symptoms reported their HIV-infected children as having more behavioral problems related to executive functioning. Assessment of behavior of HIV-infected children should incorporate a variety of sources of information and screening of caregiver mental health. PMID:27175052

Caregivers' depressive symptoms and parent-report of child executive function among young children in Uganda.

PubMed

Familiar, Itziar; Nakasujja, Noeline; Bass, Judith; Sikorskii, Alla; Murray, Sarah; Ruisenor-Escudero, Horacio; Bangirana, Paul; Opoka, Robert; Boivin, Michael J

2016-02-01

Maternal mental health (particularly depression) may influence how they report on their child's behavior. Few research studies have focused on Sub-Saharan countries where pediatric HIV concentrates and impacts child neuropsychological development and caregiver mental health. We investigated the associations between caregivers' depressive symptoms and neuropsychological outcomes in HIV-infected (n=118) and HIV-exposed (n=164) Ugandan children aged 2-5 years. We compared performance-based tests of development (Mullen Scales of Early Learning, Color Object Association Test), to a caregiver report of executive function (Behavior Rating Inventory of Executive Function, BRIEF). Caregivers were assessed with Hopkins Symptom Checklist-25 depression subscale. The associations between all BRIEF indices and caregiver's depression symptoms were differential according to child's HIV status. Caregivers with greater depressive symptoms reported their HIV-infected children as having more behavioral problems related to executive functioning. Assessment of behavior of HIV-infected children should incorporate a variety of sources of information and screening of caregiver mental health.

Return to Learning After a Concussion and Compliance With Recommendations for Cognitive Rest.

PubMed

Olympia, Robert P; Ritter, Jed T; Brady, Jodi; Bramley, Harry

2016-03-01

To determine the compliance of schools and school nurses in the United States with national recommendations for cognitive rest in students who sustain a concussion. Cross-sectional questionnaire based. Members of the National Association of School Nurses working at the high school level. A questionnaire, developed by the authors and based on recommendations for cognitive rest, was electronically distributed 3 times during the 2012 to 2013 academic year. Self-reported responses were collected regarding demographics and compliance of schools and school nurses with recommendations for the management of the postconcussion student, including the presence of specific guidelines for individualized care and the responsibility of the nurse for the prevention, detection, and management of concussions. Analysis was performed on 1033 completed questionnaires (36% usable response rate). Fifty-three percent of schools have guidelines to assist students when returning to school after a concussion. These guidelines include extension of assignment deadlines (87%), rest periods during the school day (84%), postponement or staggering of tests (75%), reduced workload (73%), and accommodation for light or noise sensitivity (64%). Sixty-six percent of nurses in our sample have had special training in the recognition and management of concussions. Nurses reported involvement in the following roles: identifying suspected concussions (80%), providing emotional support for recovering students dealing with concussion-related depression (59%), and guiding the student's postconcussion graduated academic and activity re-entry process (58%). We detected a wide variability in compliance of schools and school nurses with national recommendations for cognitive rest. Ensuring that schools have policies established for a student's return to learning, having specific guidelines to provide an individualized approach to return to learning based on postconcussion signs/symptoms, training school nurses in

Symptom reporting in cancer patients: the role of negative affect and experienced social stigma.

PubMed

Koller, M; Kussman, J; Lorenz, W; Jenkins, M; Voss, M; Arens, E; Richter, E; Rothmund, M

1996-03-01

Recent research suggests that patients' appraisal of somatic symptoms is more closely related to emotional variables (particularly negative affect) than to their actual health as determined by external criteria. Sixty surgical cancer patients who at the time of a routine follow-up examination filled out the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire-C30, which included a positive/negative affect scale and a scale tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgement on a standardized scale at the end of the examination, and an additional two external physicians later rated the patients based on the findings listed in the medical record. Patients' reports of somatic symptoms were strongly correlated with two measures of negative affect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported symptoms and the examining or external physicians' ratings were considerably weaker (r = 0.31 and r = 0.19). According to a multiple linear regression with 6 predictors, negative affect was the best single predictor of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negative affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect constituted two additional separate factors. Cancer patients' reporting of somatic symptoms by means of a standardized quality of life questionnaire is closely related to emotional and social distress and is not equivalent to health status as determined from a clinical perspective. Researchers and practitioners have to be aware of this fact when

Reliability of self-reported antisocial personality disorder symptoms among substance abusers.

PubMed

Cottler, L B; Compton, W M; Ridenour, T A; Ben Abdallah, A; Gallagher, T

1998-02-01

It is estimated that from 20 to 60% of substance abusers meet criteria for Antisocial Personality Disorder (APD). An accurate and reliable diagnosis is important because persons meeting criteria for APD, by the nature of their disorder, are less likely to change behaviors and more likely to relapse to both substance abuse and high risk behaviors. To understand more about the reliability of the disorder and symptoms of APD, the Diagnostic Interview Schedule Version III-R (DIS) was administered to 453 substance abusers ascertained from treatment programs and from the general population (St Louis Epidemiological Catchment Area (ECA) follow-up study). Estimates of the 1 week, test-retest reliability for the childhood conduct disorder criterion, the adult antisocial behavior criterion, and APD diagnosis fell in the good agreement range, as measured by kappa. The internal consistency of these DIS symptoms was adequate to acceptable. Individual DIS criteria designed to measure childhood conduct disorder ranged from fair to good for most items; reliability was slightly higher for the adult antisocial behavior symptom items. Finally, self-reported 'liars' were no more unreliable in their reports of their behaviors than 'non-liars'.

Expectancy Effects on Self-Reported Attention-Deficit/Hyperactivity Disorder Symptoms in Simulated Neurofeedback: A Pilot Study.

PubMed

Lee, Grace J; Suhr, Julie A

2018-03-31

Expectancy is a psychological factor that can impact treatment effectiveness. Research on neurofeedback for attention-deficit/hyperactivity disorder (ADHD) suggests expectancy may contribute to treatment outcomes, though evidence for expectancy as an explanatory factor is sparse. This pilot study investigated the effects of expectancies on self-reported ADHD symptoms in simulated neurofeedback. Forty-six adults who were concerned that they had ADHD expected to receive active neurofeedback, but were randomly assigned to receive a placebo with false feedback indicating attentive (positive false feedback) or inattentive (negative false feedback) states. Effects of the expectancy manipulation were measured on an ADHD self-report scale. Large expectancy effects were found, such that individuals who received positive false feedback reported significant decreases in ADHD symptoms, whereas individuals who received negative false feedback reported significant increases in ADHD symptoms. Findings suggest that expectancy should be considered as an explanatory mechanism for ADHD symptom change in response to neurofeedback.

Self-Reported Depressive Symptoms in Lesbian Birth Mothers and Comothers

ERIC Educational Resources Information Center

Maccio, Elaine M.; Pangburn, Jaimee A.

2012-01-01

Despite the frequency of postpartum depression, little is known about the experiences of lesbian birth mothers and their female partners, or comothers. In this modest yet important exploratory investigation, 20 lesbian mothers completed a survey of self-reported postpartum depressive symptoms (PDS) and related risk factors. Results indicate that…

Reports on depressive symptoms in older adults with chronic conditions.

PubMed

Zauszniewski, Jaclene A; Morris, Diana L; Preechawong, Sunida; Chang, Hsiu-Ju

2004-01-01

Depression is the most common mental disorder among older adults in the United States and one of the most disabling conditions worldwide. Chronic conditions and related functional limitations are associated with late-life depression, but assessment of depression is complicated by the absence of measures that capture the range of depressive emotions older adults may express. This descriptive, correlational study of 314 older adults with chronic conditions examined three measures to assess depressive symptoms: the Center for Epidemiological Studies Depression Scale (CES-D), the short form of the Center for Epidemiological Studies Depression Scale (CES-D-10), and an Emotional Symptom Checklist (ESC). The measures were correlated with each other and with a number of chronic conditions and functional impairments. Men and women scored similarly on all measures, though correlations between depressive symptoms and negative emotions were stronger for men. About 12% of the older adults exceeded the CES-D criteria for severe depressive symptoms, with the greatest percentage among those aged 75 to 84. The most frequently reported negative emotions were sadness (by women and elders through age 84) and loneliness (by men and elders age 85 and over). The findings suggest the need for multiple assessment strategies to identify older adults at risk for late-life depression.

Multivariate assessment of subjective and objective measures of social and family satisfaction in Veterans with history of traumatic brain injury.

PubMed

Orff, Henry J; Hays, Chelsea C; Twamley, Elizabeth W

2016-01-01

Approximately 20% of current-era Veterans have sustained a traumatic brain injury (TBI), which can result in persistent postconcussive symptoms. These symptoms may disrupt family and social functioning. We explored psychiatric, postconcussive, and cognitive factors as correlates of objective functioning and subjective satisfaction in family and social relationships. At entry into a supported employment study, 50 unemployed Veterans with a history of mild to moderate TBI and current cognitive impairment were administered baseline assessments. Multivariate stepwise regressions determined that higher levels of depressive symptomatology were strongly associated with less frequent social contact, as well as lower subjective satisfaction with family and social relationships. Worse verbal fluency predicted less frequent social contact, whereas worse processing speed and switching predicted higher levels of subjective satisfaction with family relationships. The pattern of results remained similar when examining those Veterans with only mild TBI. Depressive symptoms and cognitive functioning may impact Veterans' social contact and satisfaction with family and social relationships. Evidence-based interventions addressing depression and cognition may therefore aid in improving community reintegration and satisfaction with social and family relationships.

Distinct dimensions defining the Adult ADHD Self-Report Scale: Implications for assessing inattentive and hyperactive/impulsive symptoms.

PubMed

Stanton, Kasey; Forbes, Miriam K; Zimmerman, Mark

2018-06-07

There has been growing interest in studying attention-deficit/hyperactivity disorder (ADHD) in adulthood as a result of research indicating that ADHD often persists into adulthood and frequently is comorbid with other psychiatric disorders. Adult ADHD symptoms are most commonly assessed via self-report, but prior research examining the structure of self-reported adult ADHD symptoms has yielded discrepant results. Explicating the factor structure of ADHD symptom measures is essential to determine if such self-report measures assess symptom dimensions showing distinctive relations with other psychopathology and psychosocial functioning. Consequently, we examined the structure of adult ADHD symptoms in a large sample of adult outpatients (N = 1,094). Symptoms were assessed via the Adult ADHD Self-Report Scale (ASRS; Kessler et al., 2005), which has become the most widely used self-report ADHD measure. Additionally, we extended prior research by examining the relations for emergent ADHD dimensions with other psychopathology and psychosocial impairment. Results indicated that the ASRS's items define a bifactor structure with specific dimensions of inattentiveness, motor hyperactivity/impulsivity, and verbal hyperactivity/impulsivity. Our results indicate that specific ADHD factors show distinctive relations in some ways. For example, verbal hyperactivity/impulsivity showed negative relations with major depressive disorder, whereas inattentiveness showed positive relations with major depression. These results highlight the need for future research determining the extent to which making distinctions among various ADHD symptom types (i.e., distinguishing motor and verbal hyperactivity/impulsivity) is empirically warranted and clinically useful. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Tic Symptoms Induced by Atomoxetine in Treatment of ADHD: A Case Report and Literature Review.

PubMed

Yang, Rongwang; Li, Rong; Gao, Weijia; Zhao, Zhengyan

Patients with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for tic disorders. Atomoxetine (ATX) has been accepted as an alternative medication for patients with ADHD and a comorbid tic disorder. It is rarely reported that tic symptoms are induced by ATX. This present report described a boy with ADHD who developed tic symptoms during ATX initiation. We used an ABAB trial to confirm the tics were related to ATX administration. In addition, we reviewed the published literature of patients whose tic symptoms were confirmed or suspected of relating to ATX usage. This present case with an ABAB design showed on-off control of tics with or without ATX, which allowed us to make a strong conclusion that the tics were related to ATX administration. Literature review also indicated that ATX might induce tic symptoms in children with ADHD, especially in those being boys and having a history of tics. The time from starting ATX to tics symptoms appearing was approximately 19 days. The most common tic symptoms were eye blinking, vocal tics, or throat clearing, and neck movements. These tics symptoms in most cases could be resolved after discontinuing ATX without further pharmacotherapy. Pediatricians and child psychiatrists should be well aware of this potential adverse effect in children with ADHD receiving ATX.

Recommended Patient-Reported Core Set of Symptoms to Measure in Adult Cancer Treatment Trials

PubMed Central

Mitchell, Sandra A.; Dueck, Amylou C.; Basch, Ethan; Cella, David; Reilly, Carolyn Miller; Minasian, Lori M.; Denicoff, Andrea M.; O’Mara, Ann M.; Fisch, Michael J.; Chauhan, Cynthia; Aaronson, Neil K.; Coens, Corneel; Bruner, Deborah Watkins

2014-01-01

Background The National Cancer Institute’s Symptom Management and Health-Related Quality of Life Steering Committee held a clinical trials planning meeting (September 2011) to identify a core symptom set to be assessed across oncology trials for the purposes of better understanding treatment efficacy and toxicity and to facilitate cross-study comparisons. We report the results of an evidence-synthesis and consensus-building effort that culminated in recommendations for core symptoms to be measured in adult cancer clinical trials that include a patient-reported outcome (PRO). Methods We used a data-driven, consensus-building process. A panel of experts, including patient representatives, conducted a systematic review of the literature (2001–2011) and analyzed six large datasets. Results were reviewed at a multistakeholder meeting, and a final set was derived emphasizing symptom prevalence across diverse cancer populations, impact on health outcomes and quality of life, and attribution to either disease or anticancer treatment. Results We recommend that a core set of 12 symptoms—specifically fatigue, insomnia, pain, anorexia (appetite loss), dyspnea, cognitive problems, anxiety (includes worry), nausea, depression (includes sadness), sensory neuropathy, constipation, and diarrhea—be considered for inclusion in clinical trials where a PRO is measured. Inclusion of symptoms and other patient-reported endpoints should be well justified, hypothesis driven, and meaningful to patients. Conclusions This core set will promote consistent assessment of common and clinically relevant disease- and treatment-related symptoms across cancer trials. As such, it provides a foundation to support data harmonization and continued efforts to enhance measurement of patient-centered outcomes in cancer clinical trials and observational studies. PMID:25006191

Dynamic imaging in mild traumatic brain injury: support for the theory of medial temporal vulnerability.

PubMed

Umile, Eric M; Sandel, M Elizabeth; Alavi, Abass; Terry, Charles M; Plotkin, Rosette C

2002-11-01

To determine whether patients with mild traumatic brain injury (TBI) and persistent postconcussive symptoms have evidence of temporal lobe injury on dynamic imaging. Case series. An academic medical center. Twenty patients with a clinical diagnosis of mild TBI and persistent postconcussive symptoms were referred for neuropsychologic evaluation and dynamic imaging. Fifteen (75%) had normal magnetic resonance imaging (MRI) and/or computed tomography (CT) scans at the time of injury. Neuropsychologic testing, positron-emission tomography (PET), and single-photon emission-computed tomography (SPECT). Temporal lobe findings on static imaging (MRI, CT) and dynamic imaging (PET, SPECT); neuropsychologic test findings on measures of verbal and visual memory. Testing documented neurobehavioral deficits in 19 patients (95%). Dynamic imaging documented abnormal findings in 18 patients (90%). Fifteen patients (75%) had temporal lobe abnormalities on PET and SPECT (primarily in medial temporal regions); abnormal findings were bilateral in 10 patients (50%) and unilateral in 5 (25%). Six patients (30%) had frontal abnormalities, and 8 (40%) had nonfrontotemporal abnormalities. Correlations between neuropsychologic testing and dynamic imaging could be established but not consistently across the whole group. Patients with mild TBI and persistent postconcussive symptoms have a high incidence of temporal lobe injury (presumably involving the hippocampus and related structures), which may explain the frequent finding of memory disorders in this population. The abnormal temporal lobe findings on PET and SPECT in humans may be analogous to the neuropathologic evidence of medial temporal injury provided by animal studies after mild TBI. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Psychometric properties and normative data for the Brief Symptom Inventory-18 (BSI-18) in high school and collegiate athletes

PubMed Central

McCrea, Michael A.; Nelson, Lindsay D.

2016-01-01

Objective Assessment of emotional functioning is important in sport-related concussion (SRC) management, although few standardized measures have been validated in this population, and appropriate normative data are lacking. We investigated the psychometric properties of the Brief Symptom Inventory-18 (BSI-18) in high school and collegiate athletes at risk of SRC and compiled normative data. Method Athletes (n = 2,031) completed the BSI-18 and other measures of concussion symptoms, cognition, and psychological functioning. A subset of healthy individuals was re-evaluated at approximately 7, 30, 45, and 165 days. Psychometric analyses of test–retest reliability, internal consistency reliability, and concurrent validity were performed. Given significant differences between sexes and education levels (high school or college student) on the BSI-18 Global Severity Index and all subscales, normative conversion tables were produced after stratifying by these variables. Results The BSI-18 showed good internal consistency, fair to poor test–retest reliability, and good convergent validity with other measures of emotional functioning. Conclusions These data indicate that the BSI-18 may be a valuable measure of emotional state in concussed athletes and may provide unique information beyond post-concussive symptoms for research on the role of psychological factors in SRC recovery. The limited divergent validity of the BSI-18 depression and anxiety scales implies that they tap into general distress more so than specific mood or anxiety symptoms; therefore, BSI-18 scores should be not relied upon for differential diagnosis of mood and anxiety disorders. Normative data provided can be readily applied to clinical cases with high school and collegiate athletes. PMID:26924037

The National Institute of Neurological Disorders and Stroke and Department of Defense Sport-Related Concussion Common Data Elements Version 1.0 Recommendations.

PubMed

Broglio, Steven P; Kontos, Anthony P; Levin, Harvey; Schneider, Kathryn; Wilde, Elisabeth A; Cantu, Robert C; Feddermann-Demont, Nina; Fuller, Gordon; Gagnon, Isabelle; Gioia, Gerry; Giza, Christopher C; Griesbach, Grace Sophia; Leddy, John J; Lipton, Michael L; Mayer, Andrew; McAllister, Thomas; McCrea, Michael; McKenzie, Lara; Putukian, Margot; Signoretti, Stefano; Suskauer, Stacy J; Tamburro, Robert; Turner, Michael; Yeates, Keith Owen; Zemek, Roger; Ala'i, Sherita; Esterlitz, Joy; Gay, Katelyn; Bellgowan, Patrick S F; Joseph, Kristen

2018-05-02

Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), and Department of Defense (DoD), the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of clinical research studies and clinical treatment outcomes, increase data quality, facilitate data sharing across studies, reduce study start-up time, more effectively aggregate information into metadata results, and educate new clinical investigators. The SRC CDE Working Group consisted of 34 worldwide experts in concussion from varied fields of related expertise, divided into three Subgroups: Acute (<72 hours post-concussion), Subacute (3 days-3 months post-concussion) and Persistent/Chronic (>3 months post-concussion). To develop CDEs, the Subgroups reviewed various domains, and then selected from, refined, and added to existing CDEs, case report forms and field-tested data elements from national registries and funded research studies. Recommendations were posted to the NINDS CDE Website for Public Review from February 2017 to April 2017. Following an internal Working Group review of recommendations, along with consideration of comments received from the Public Review period, the first iteration (Version 1.0) of the NINDS SRC CDEs was completed in June 2017. The recommendations include Core and Supplemental - Highly Recommended CDEs for cognitive data elements and symptom checklists, as well as other outcomes and endpoints (e.g., vestibular, oculomotor, balance, anxiety, depression) and sample case report forms (e.g., injury reporting, demographics, concussion history) for domains typically included in clinical research studies. The NINDS SRC CDEs and supporting documents are publicly available on the NINDS CDE website https://www.commondataelements.ninds.nih.gov/. Widespread use of CDEs by researchers and clinicians will

Exposures and reported symptoms associated with occupational deployment to the Buncefield fuel depot fire, England 2005.

PubMed

Morgan, O; Verlander, N Q; Kennedy, F; Moore, M; Birch, S; Kearney, J; Lewthwaite, P; Lewis, R; O'Brian, S; Osman, J; Reacher, M

2008-06-01

An explosion at the Buncefield fuel depot outside London occurred on 11 December 2005. We conducted a retrospective cohort study of airborne exposures and health status for workers deployed. Deployed individuals were identified through their occupational health departments. We sent a self-completion questionnaire asking about health symptoms during the burn and post-burn phases. The prevalence of health symptoms in workers was compared to symptoms in local residents not under the smoke plume. Of 1949 eligible individuals, 815 returned questionnaires (response rate 44%). Respiratory protection was used by 39%. Symptoms were reported by 41% of individuals during the burn phase compared with 26% in the post-burn phase. In a final multivariable model, reporting of any symptoms was associated with deployment inside the inner fire cordon during the burn phase (OR 2.07, 95% CI 1.24 to 3.47) and wearing a face mask (OR 2.33, 95% CI 1.67 to 3.26). Compared with the general public, eye irritation (prevalence ratio (PR) 2.1, 95% CI 1.5 to 3.0), coughing (PR 1.3, 95% CI 1.0 to 1.8) and headaches (PR 1.7, 95% CI 1.2 to 2.5) were more common in workers deployed during the burn phase but not the post-burn phase. Increased reporting of symptoms close to the fire during the burn phase was consistent with increased exposure to products of combustion, although no major acute illness was reported. That only a minority of individuals used face masks, which were not protective for symptoms, raises questions about the availability of adequate respiratory protection for such incidents.

Constipation and other common symptoms reported by women and men in methadone and buprenorphine maintenance treatment.

PubMed

Haber, Paul S; Elsayed, Mahmoud; Espinoza, David; Lintzeris, Nicholas; Veillard, Anne-Sophie; Hallinan, Richard

2017-12-01

Opioid substitution treatment (OST) is often continued long-term and, therefore, opioid-associated symptoms are of interest. Symptoms associated with methadone maintenance treatment (MMT) in men are well described, but there are fewer reports concerning symptoms associated with buprenorphine maintenance treatment (BMT) and very few reports among women. Recipients of BMT (n=113) and MMT (n=184), non-opioid users (n=105) and opioid users not receiving OST (n=87) completed the Patient Assessment of Constipation (PAC-SYM) and a general symptom checklist. Multivariate analysis included other potential moderators of opioid-associated symptoms. Opioid users reported a higher frequency and severity of symptoms than non-opioid users. Constipation, dry mouth, decreased appetite, sweating and fatigue were highly prevalent in the previous 30days (51-80%). Nausea, itchy skin, trouble urinating, menstrual problems, lightheadedness, blurred vision, heart racing were also common (30-50%). Non-OST opioid users had significantly higher frequency and severity than OST recipients of nausea, vomiting, diarrhoea, decreased appetite, sweating and itchy skin. Sweating was significantly more common in MMT than BMT. Constipation scores were higher in women, otherwise most sex differences were small. Higher PAC-SYM scores were associated with vomiting (OR=1.04) and sweating (OR=1.06). Cannabis use was associated with vomiting (OR=2.19). Constipation (OR=1.07), insomnia (OR=2.5) and depression (OR=2.82) were associated with fatigue. Men and women receiving OST report similarly high rates of somatic symptoms, though less than opioid users not receiving OST. There were few differences between BMT and MMT. Buprenorphine might be preferred where sweating is problematic. Several modifiable factors were identified. Copyright © 2017 Elsevier B.V. All rights reserved.

Self-reported depression and anxiety symptoms and usage of computers and mobile phones among working-age Finns.

PubMed

Korpinen, Leena; Pääkkönen, Rauno

2015-01-01

The aim of the work is to study self-reported depression and anxiety symptoms among working-age Finns using logistical regression models. The study was carried out as a cross-sectional study by posting a questionnaire to 15,000 working-age persons. The responses (6121) revealed that 101 (1.7%) Finnish working-age persons suffered depression very often and 77 (1.3%) suffered anxiety very often during the last 12 months. Symptoms uncovered in the comparative analysis of respondents who had quite often or more often depression to respondents who had less depression showed differentiation. The same result was obtained in the analysis of self-reported anxiety symptoms. With the logistical regression models (from depression and anxiety), we found associations between physical symptoms (in shoulder) and depression and between different mental symptoms and anxiety or depression. In the future, it is important to take into accout that persons with physical symptoms can also have mental symptoms (depression or anxiety).

The health of Australian veterans of the 1991 Gulf War: factor analysis of self-reported symptoms.

PubMed

Forbes, A B; McKenzie, D P; Mackinnon, A J; Kelsall, H L; McFarlane, A C; Ikin, J F; Glass, D C; Sim, M R

2004-12-01

A recent report showed that Australian veterans of the 1991 Gulf War displayed a greater prevalence of a multitude of self-reported symptoms than a randomly sampled comparison group of military personnel who were eligible for deployment but were not deployed to the Gulf. To investigate whether the pattern, rather than frequency, of symptom reporting in these Australian Gulf War veterans differed from that of the comparison group personnel. Factor analysis was used to determine whether the co-occurrence of 62 symptoms in 1322 male Gulf War veterans can be explained by a number of underlying dimensions, called factors. The methodology was also applied to 1459 male comparison group subjects and the factor solutions of the two groups were compared. For the Gulf War veterans, a three factor solution displayed replicability and construct validity. The three factors were labelled as psycho-physiological distress, somatic distress, and arthro-neuromuscular distress, and were broadly similar to those described in previous studies of Gulf War veterans. A concordant three factor solution was also found for the comparison group subjects, with strong convergence of the factor loadings and factor scores across the two groups being displayed. Results did not display evidence of a unique pattern of self-reported symptoms among Gulf War veterans. Results also indicated that the differences between the groups lie in the degrees of expression of the three underlying factors, consistent with the well documented evidence of increased self-reported symptom prevalence in Gulf War veterans.

[Drug rash with eosinophilia and systemic symptoms syndrome induced by carbamazepine: Case report].

PubMed

Marín, Jorge Alonso; Ortega, Mayra Alexandra; Sánchez, Isaura Pilar; Pacheco, José Armando

2017-06-01

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a hypersensitivity reaction associated with a variety of drugs, mainly anticonvulsants, which is characterized by systemic symptoms and erythematous lesions, common to other toxicodermas. It is an uncommon clinical entity that requires a high suspicion by clinical staff given its varied initial presentation, and the fact that symptoms can overlap with those of other adverse cutaneous reactions to drugs. Without early diagnosis and appropriate treatment, mortality increases.We report the case of a 22-year-old patient with impaired neurodevelopment who received treatment with carbamazepine. Two months later he presented with general symptoms and skin erythematous lesions that began on his trunk. The patient received outpatient care with antihistamines and antipyretics without an appropriate response. His case progressed with increased skin lesions and systemic symptoms that met the diagnostic criteria for DRESS syndrome. He was hospitalized and received medical treatment according to recommended guidelines. The patient's condition improved as his symptoms and associated complications resolved. He was discharged with gradual clearing of the steroid therapy.

Use of mobile device technology to continuously collect patient-reported symptoms during radiation therapy for head and neck cancer: A prospective feasibility study.

PubMed

Falchook, Aaron D; Tracton, Gregg; Stravers, Lori; Fleming, Mary E; Snavely, Anna C; Noe, Jeanne F; Hayes, David N; Grilley-Olson, Juneko E; Weiss, Jared M; Reeve, Bryce B; Basch, Ethan M; Chera, Bhishamjit S

2016-01-01

Accurate assessment of toxicity allows for timely delivery of supportive measures during radiation therapy for head and neck cancer. The current paradigm requires weekly evaluation of patients by a provider. The purpose of this study is to evaluate the feasibility of monitoring patient reported symptoms via mobile devices. We developed a mobile application for patients to report symptoms in 5 domains using validated questions. Patients were asked to report symptoms using a mobile device once daily during treatment or more often as needed. Clinicians reviewed patient-reported symptoms during weekly symptom management visits and patients completed surveys regarding perceptions of the utility of the mobile application. The primary outcome measure was patient compliance with mobile device reporting. Compliance is defined as number of days with a symptom report divided by number of days on study. There were 921 symptom reports collected from 22 patients during treatment. Median reporting compliance was 71% (interquartile range, 45%-80%). Median number of reports submitted per patient was 34 (interquartile range, 21-53). Median number of reports submitted by patients per week was similar throughout radiation therapy and there was significant reporting during nonclinic hours. Patients reported high satisfaction with the use of mobile devices to report symptoms. A substantial percentage of patients used mobile devices to continuously report symptoms throughout a course of radiation therapy for head and neck cancer. Future studies should evaluate the impact of mobile device symptom reporting on improving patient outcomes.

Dissimilarity in Vulnerability: Self-Reported Symptoms among Children with Experiences of Intimate Partner Violence

ERIC Educational Resources Information Center

Georgsson, Anna; Almqvist, Kjerstin; Broberg, Anders G.

2011-01-01

Children with experiences of intimate partner violence (IPV) are at risk. Not all children, however, display symptoms, and differences connected to gender and age have been demonstrated. In this exploratory study, children's own reports of symptoms were used. The 41 recruited children, between 7 and 19 years old, were entered into a group program…

Self-reported symptoms associated with exposure to electromagnetic fields: a questionnaire study.

PubMed

Küçer, Nermin; Pamukçu, Tuğba

2014-01-01

Abstract In the last years, it has been discussed frequently whether there are any harmful effects of electromagnetic fields on human health. Electromagnetic fields are generated by several natural and man-made sources. Part of the electromagnetic spectrum called Radiofrequency is used in communication systems such as mobile (cellular) phone and computer. The aim of our study was to explore different self-reported symptoms that may be associated with exposure to electromagnetic fields. This survey study was conducted, using a questionnaire, on 350 people aged +9 years in Turkey. The chi-square test was used for data analysis. Self-reported symptoms were headache, vertigo/dizziness, fatigue, forgetfulness, sleep disturbance-insomnia, tension-anxiety, joint and bone pain, lacrimation of the eyes, hearing loss and tinnitus. As a result of the survey, the study has shown that users of mobile phone and computer more often complained of headache, joint and bone pain, hearing loss, vertigo/dizziness, tension-anxiety symptoms according to time of daily usage (p < 0.05). In users of mobile phone and computer, women significantly (p < 0.05) complained more often of headache, vertigo/dizziness, fatigue, forgetfulness and tension-anxiety than men.

The power of positive and negative expectations to influence reported symptoms and mood during exposure to wind farm sound.

PubMed

Crichton, Fiona; Dodd, George; Schmid, Gian; Gamble, Greg; Cundy, Tim; Petrie, Keith J

2014-12-01

Wind farm developments have been hampered by claims that sound from wind turbines causes symptoms and negative health reports in nearby residents. As scientific reviews have failed to identify a plausible link between wind turbine sound and health effects, psychological expectations have been proposed as an explanation for health complaints. Building on recent work showing negative expectations can create symptoms from wind turbines, we investigated whether positive expectations can produce the opposite effect, in terms of a reduction in symptoms and improvements in reported health. 60 participants were randomized to either positive or negative expectation groups and subsequently exposed to audible wind farm sound and infrasound. Prior to exposure, negative expectation participants watched a DVD incorporating TV footage about health effects said to be caused by infrasound produced by wind turbines. In contrast, positive expectation participants viewed a DVD that outlined the possible therapeutic effects of infrasound exposure. During exposure to audible windfarm sound and infrasound, symptoms and mood were strongly influenced by the type of expectations. Negative expectation participants experienced a significant increase in symptoms and a significant deterioration in mood, while positive expectation participants reported a significant decrease in symptoms and a significant improvement in mood. The study demonstrates that expectations can influence symptom and mood reports in both positive and negative directions. The results suggest that if expectations about infrasound are framed in more neutral or benign ways, then it is likely reports of symptoms or negative effects could be nullified.

Longitudinal assessment of white matter abnormalities following sports-related concussion.

PubMed

Meier, Timothy B; Bergamino, Maurizio; Bellgowan, Patrick S F; Teague, T K; Ling, Josef M; Jeromin, Andreas; Mayer, Andrew R

2016-02-01

There is great interest in developing physiological-based biomarkers such as diffusion tensor imaging to aid in the management of concussion, which is currently entirely dependent on clinical judgment. However, the time course for recovery of white matter abnormalities following sports-related concussion (SRC) is unknown. We collected diffusion tensor imaging and behavioral data in forty concussed collegiate athletes on average 1.64 days (T1; n = 33), 8.33 days (T2; n = 30), and 32.15 days post-concussion (T3; n = 26), with healthy collegiate contact-sport athletes (HA) serving as controls (n = 46). We hypothesized that fractional anisotropy (FA) would be increased acutely and partially recovered by one month post-concussion. Mood symptoms were assessed using structured interviews. FA differences were assessed using both traditional and subject-specific analyses. An exploratory analysis of tau plasma levels was conducted in a subset of participants. Results indicated that mood symptoms improved over time post-concussion, but remained elevated at T3 relative to HA. Across both group and subject-specific analyses, concussed athletes exhibited increased FA in several white matter tracts at each visit post-concussion with no longitudinal evidence of recovery. Increased FA at T1 and T3 was significantly associated with an independent, real-world outcome measure for return-to-play. Finally, we observed a nonsignificant trend for reduced tau in plasma of concussed athletes at T1 relative to HA, with tau significantly increasing by T2. These results suggest white matter abnormalities following SRC may persist beyond one month and have potential as an objective biomarker for concussion outcome. Hum Brain Mapp 37:833-845, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Exploratory factor analysis of self-reported symptoms in a large, population-based military cohort

PubMed Central

2010-01-01

Background US military engagements have consistently raised concern over the array of health outcomes experienced by service members postdeployment. Exploratory factor analysis has been used in studies of 1991 Gulf War-related illnesses, and may increase understanding of symptoms and health outcomes associated with current military conflicts in Iraq and Afghanistan. The objective of this study was to use exploratory factor analysis to describe the correlations among numerous physical and psychological symptoms in terms of a smaller number of unobserved variables or factors. Methods The Millennium Cohort Study collects extensive self-reported health data from a large, population-based military cohort, providing a unique opportunity to investigate the interrelationships of numerous physical and psychological symptoms among US military personnel. This study used data from the Millennium Cohort Study, a large, population-based military cohort. Exploratory factor analysis was used to examine the covariance structure of symptoms reported by approximately 50,000 cohort members during 2004-2006. Analyses incorporated 89 symptoms, including responses to several validated instruments embedded in the questionnaire. Techniques accommodated the categorical and sometimes incomplete nature of the survey data. Results A 14-factor model accounted for 60 percent of the total variance in symptoms data and included factors related to several physical, psychological, and behavioral constructs. A notable finding was that many factors appeared to load in accordance with symptom co-location within the survey instrument, highlighting the difficulty in disassociating the effects of question content, location, and response format on factor structure. Conclusions This study demonstrates the potential strengths and weaknesses of exploratory factor analysis to heighten understanding of the complex associations among symptoms. Further research is needed to investigate the relationship between

The symptom experiences of Puerto Rican children undergoing cancer treatments and alleviation practices as reported by their mothers.

PubMed

Gonzalez-Mercado, Velda J; Williams, Phoebe D; Williams, Arthur R; Pedro, Elsa; Colon, Gloria

2017-02-01

Although symptoms during cancer treatments are prevalent and are important clinical outcomes of childhood cancer, the symptom experiences of Puerto Rican children along with the symptom alleviation/care practices that parents provide during cancer treatments have received limited attention. To examine the occurrence/severity of symptoms on the Therapy-Related Symptom Checklist-Children (TRSC-C), reported by mothers of Puerto Rican children undergoing cancer treatments and identifying mothers' symptom alleviation/management strategies. Descriptive study conducted between January and May 2012. Mothers of 65 Puerto Rican children/adolescents undergoing cancer treatments responded to the Spanish versions of the TRSC-C, Symptom Alleviation: Self-Care Methods, and a Demographic and Health form. The children/adolescents' mean age was 9.2 (1-17) years; 62% were boys; 56 had chemotherapy; 9 had chemoradiotherapy. Children diagnoses were 35.4% leukemia, 24.6% solid tumors, 24.6% nervous system tumors, and 15.4% other. On the TRSC-C, the symptoms experienced by 70% or more of the children were: irritability (77%), nausea (75%), and hair loss (72%). On the Symptom Alleviation: Self-Care Methods, the most commonly reported symptom alleviation category was "taking prescribed medicines." Puerto Rican mothers reported the use of alleviation practices to treat their children experiencing symptoms during pediatric cancer treatments. Patients and caregivers need to be educated about treatment-induced side effects, and the life-threatening consequences of underreporting and undermanagement. Symptoms should always be addressed at the time of initiation of primary or adjuvant cancer therapy because pretreatment symptoms may persist or get worse across the trajectory of treatment. A continuous assessment and management of symptoms during the childhood cancer trajectory can optimize clinical care and improve quality of life of patients and families. © 2016 John Wiley & Sons Australia

Cross-sectional study of anxiety symptoms and self-report of awake and sleep bruxism in female TMD patients.

PubMed

Tavares, Luisa Maria Faria; da Silva Parente Macedo, Leonora Cristina; Duarte, Cristina Maria Rabelais; de Goffredo Filho, Gilberto Senechal; de Souza Tesch, Ricardo

2016-11-01

The aim of this study was to assess the relationship between levels of anxiety symptoms and prevalence of self-report of awake and sleep bruxism in patients with temporomandibular disorders (TMD). One hundred and eighty-one female patients, aged 19-77 years, were consecutively evaluated. The patients were selected from among those who sought treatment at the TMD and Orofacial Pain Outpatient Clinic of the Petrópolis School of Medicine. All patients completed the questionnaire and underwent clinical examination, both components of the RDC/TMD, in addition to answering questions pertaining to the assessment of levels of anxiety symptoms, taken from the Symptom Check List 90 self-report instrument. The subjects were classified according to the presence of self-reported only awake bruxism, only sleep bruxism, both, or none. A logistic regression procedure was performed to evaluate the possible association through odds ratio between anxiety symptoms and self-reported awake or sleep bruxism. The cofactors for each outcome were age, self-reported bruxism during the circadian period other than the one being evaluated, and the use of selective serotonin reuptake inhibitors. It was possible to demonstrate the presence of a positive and statistically significant relationship between anxiety levels and self-reported awake bruxism. This finding was not observed in those subjects who reported sleep bruxism. A positive relationship was found between self-reported awake bruxism and levels of anxiety symptoms, but not between sleep bruxism and anxiety.

Parental Symptom Report and Periodic Limb Movements of Sleep in Children

PubMed Central

Martin, Bradley T.; Williamson, Bruce D.; Edwards, Natalie; Teng, Arthur Y

2008-01-01

Study Objectives: To examine the prevalence of raised periodic limb movements of sleep (PLMS) index in children referred for polysomnography (PSG) and whether parental report of symptoms correlates with objective measurement during PSG. Methods: Records of children undergoing PSG from January 2006 to July 2006 were retrospectively reviewed. At their initial sleep clinic visit, parents had been asked whether their child was restless or moved their legs excessively during sleep. Their response to these questions was compared to the child's PLMS index (number of periodic limb movements per hour) during a full PSG. PLMS were scored according to internationally accepted criteria. Results: Data were examined for 101 children (60 male) with mean age 6.5 years (range 1.2 to 17.6 years). Excessive leg movements were reported by parents in 50% and restlessness in 73%. A raised PLMS index (defined as >5 per hour) was noted in 10 cases (prevalence 10%). Asking parents about whether their child kicks their legs excessively in sleep had sensitivity 50%, specificity 51%, positive predictive value (PPV) 10%, negative predictive value (NPV) 90% and positive likelihood ratio (LR+) 1.02 when compared to objective analysis. Asking parents about whether their child is restless in sleep had sensitivity 70%, specificity 26%, PPV 9%, NPV 89% and LR+ 0.95. Conclusions: Asking parents about their child's symptoms is not an accurate predictor of raised PLMS index. We recommend that leg electromyography be used in all pediatric sleep studies to record PLMS. Citation: Martin BT; Williamson BD; Edwards N; Teng AY. Parental symptom report and periodic limb movements of sleep in children. J Clin Sleep Med 2008;4(1):57-61. PMID:18350964

Neuroborreliosis with extrapyramidal symptoms: a case report.

PubMed

Biesiada, Grazyna; Czapiel, Jacek; Sobczyk-Krupiarz, Iwona; Garlicki, Aleksander; Mach, Tomasz

2008-05-01

The disease of Lyme is a tick-borne infection. It involves skin, the nervous system, joints and the heart. Spirochaeta Borrelia burgdorferi is the etiologic agent of the disease. In the majority of cases, clinical symptoms, like migrating erythema, occur from 3 to 30 days, sometimes to 3 months after a bite from a tick. The early disseminated infection involves multiple migrating erythema, neuroborreliosis, arthritis, myocarditis and other organ-related symptoms. The late stage of chronic infection involves chronic atrophic leg dermatitis, neurological and rheumatological symptoms, and other organ-related symptoms which persist for above 12 months. The diagnosis of the disease of Lyme is based upon specific clinical symptoms confirmed by serologic tests. The two-step diagnostic protocol including the ELISA method, confirmed by the Western-blot test, is optimal. The present article describes a case of a 59-year-old man, a computer specialist, who often spends his free time walking in woods for recreation, and who was bitten by a tick 3 years before hospitalization. The bite resulted in migrating erythema that subsided without antimicrobial treatment. In spite of this, the man had not changed his hobby exposing himself to bites from ticks. One year later, multiple migrating erythema and extrapyramidalis symptoms appeared without any other organ malfunctions. In the current year, the patient was admitted to the Infectious Diseases Hospital, and received antibiotics (ceftriaxon) with following neurological improvement. Several months later, extrapyramidal symptoms increased. On the day of admission to the hospital, the neurologic examination showed abnormalities of upper and lower limbs movements (propulsive walking and the right lower leg traction), the right hand tremor, pouts of the face, and sleepiness.

Psychotic symptoms in acromegaly

PubMed Central

Pinto, Denzil; Safeekh, A.T.; Trivedi, Mohit

2005-01-01

Various psychiatric symptoms have been reported in patients with acromegaly. Most of them are personality changes characterized by lack of initiative and spontaneity. There are few case reports of the presence of auditory and visual hallucinations, and delusions in patients with acromegaly. We report a patient with acromegaly who had psychotic symptoms including Schneiderian first-rank symptoms.

A pilot randomized controlled trial of on-line interventions to improve sleep quality in adults after mild or moderate traumatic brain injury.

PubMed

Theadom, Alice; Barker-Collo, Suzanne; Jones, Kelly; Dudley, Margaret; Vincent, Norah; Feigin, Valery

2018-05-01

To explore feasibility and potential efficacy of on-line interventions for sleep quality following a traumatic brain injury (TBI). A two parallel-group, randomized controlled pilot study. Community-based. In all, 24 participants (mean age: 35.9 ± 11.8 years) who reported experiencing sleep difficulties between 3 and 36 months after a mild or moderate TBI. Participants were randomized to receive either a cognitive behaviour therapy or an education intervention on-line. Both interventions were self-completed for 20-30 minutes per week over a six-week period. The Pittsburgh Sleep Quality Index assessed self-reported sleep quality with actigraphy used as an objective measure of sleep quality. The CNS Vital Signs on-line neuropsychological test assessed cognitive functioning and the Rivermead Post-concussion Symptoms and Quality of Life after Brain Injury questionnaires were completed pre and post intervention. Both programmes demonstrated feasibility for use post TBI, with 83.3% of participants completing the interventions. The cognitive behaviour therapy group experienced significant reductions ( F = 5.47, p = 0.04) in sleep disturbance (mean individual change = -4.00) in comparison to controls post intervention (mean individual change = -1.50) with a moderate effect size of 1.17. There were no significant group differences on objective sleep quality, cognitive functioning, post-concussion symptoms or quality of life. On-line programmes designed to improve sleep are feasible for use for adults following mild-to-moderate TBI. Based on the effect size identified in this pilot study, 128 people (64 per group) would be needed to determine clinical effectiveness.

Reported respiratory symptom intensity in asthmatics during exposure to aerosolized Florida red tide toxins.

PubMed

Milian, Alexyz; Nierenberg, Kate; Fleming, Lora E; Bean, Judy A; Wanner, Adam; Reich, Andrew; Backer, Lorraine C; Jayroe, David; Kirkpatrick, Barbara

2007-09-01

Florida red tides are naturally occurring blooms of the marine dinoflagellate, Karenia brevis. K. brevis produces natural toxins called brevetoxins. Brevetoxins become part of the marine aerosol as the fragile, unarmored cells are broken up by wave action. Inhalation of the aerosolized toxin results in upper and lower airway irritation. Symptoms of brevetoxin inhalation include: eye, nose, and throat irritation, coughing, wheezing, chest tightness, and shortness of breath. Asthmatics appear to be more sensitive to the effects of inhaled brevetoxin. This study examined data from 97 asthmatics exposed at the beach for 1 hour during K. brevis blooms, and on separate occasions when no bloom was present. In conjunction with extensive environmental monitoring, participants were evaluated utilizing questionnaires and pulmonary function testing before and after a 1-hour beach walk. A modified Likert scale was incorporated into the questionnaire to create respiratory symptom intensity scores for each individual pre- and post-beach walk. Exposure to Florida red tide significantly increased the reported intensity of respiratory symptoms; no significant changes were seen during an unexposed period. This is the first study to examine the intensity of reported respiratory symptoms in asthmatics after a 1-hour exposure to Florida red tide.

Self-reported neck symptoms and use of personal computers, laptops and cell phones among Finns aged 18-65.

PubMed

Korpinen, Leena; Pääkkönen, Rauno; Gobba, Fabriziomaria

2013-01-01

The purpose of this study was to investigate the possible relation between self-reported neck symptoms (aches, pain or numbness) and use of computers/cell phones. The study was carried out as a cross-sectional study by posting a questionnaire to 15,000 working-age persons, and 15.1% of all respondents (6121) reported that they very often experienced physical symptoms in the neck. The results showed that they also had many other symptoms very often, and 49% used a computer daily at work and 83.9% used cell phones. We compared physical/mental symptoms of persons with symptoms in the neck quite often or more, with others. We found significant differences in the physical/mental symptoms and use of cell phones and computers. The results suggest taking into account in the future that those persons' symptoms in the neck can be associated with use of cell phones or computers. We investigated the possible relation between neck symptoms and use of computers/cell phones. We found that persons, who very often had symptoms in the neck, had also other symptoms very often (e.g. exhaustion at work). Their use of information and communication technology (e.g. computers) can associate with their symptoms.

Musculoskeletal symptoms amongst clinical radiologists and the implications of reporting environment ergonomics--a multicentre questionnaire study.

PubMed

Rodrigues, Jonathan C L; Morgan, Steven; Augustine, Katharine; Clague, Gavin; Pearce, Tim; Pollentine, Adrian; Wallis, Adam; Wilson, David; McCoubrie, Paul

2014-04-01

This multicentre study aimed to assess compliance of the reporting environment with best ergonomic practice and to determine the prevalence of musculoskeletal symptoms related to working as a radiologist. All 148 radiology trainees and consultants in 10 hospitals across the region were invited to complete a musculoskeletal symptoms and reporting ergonomics questionnaire. Best ergonomic reporting practice was defined, following literature review, as being able to alter the following: monitor, desk, chair and armrest height, chair back support, ambient light, and temperature. The frequency that these facilities were available and how often they were used was determined. One hundred and twenty-three out of 148 (83%) radiologists responded, and 38% reported radiology-associated occupational injury. Lower back discomfort was the commonest radiology associated musculoskeletal symptom (41%). Only 13% of those with occupational injury sought the advice of occupational health. No reporting environments conformed completely to best ergonomic practice. Where certain facilities were available, less than a third of radiologists made personal ergonomic adjustments prior to starting a reporting session. Radiologists who had good self-assessed knowledge of best ergonomic practice had significantly less back discomfort than those with poor self-assessed knowledge (P < 0.005). We demonstrated high prevalence of musculoskeletal symptoms amongst radiologists. Poor compliance of the reporting environment with best ergonomic practice, in combination with our other findings of a low level of ergonomic awareness, low rates of making ergonomic adjustments and seeking appropriate help, may be implicated. We hope this study raises awareness of this issue and helps prevent long-term occupational injury amongst radiologists from poor ergonomic practice.

Are there gender differences in cognitive function, chronic stress, and neurobehavioral symptoms after mild-to-moderate traumatic brain injury?

PubMed

Covassin, Tracey; Bay, Esther

2012-06-01

Research is inconclusive on whether gender differences exist in cognitive function in persons who sustain a mild-to-moderate traumatic brain injury (TBI). Furthermore, it is also unclear whether there is a relationship between chronic stress and cognitive function in these persons. The purpose of this integrative review is to determine whether gender differences exist in cognitive function, neurobehavioral symptoms, and chronic stress levels after a mild-to-moderate TBI. Participants (n = 72) were recruited from eight outpatient rehabilitation centers. Participants completed the demographic questions, the Immediate Postconcussion Assessment Cognitive Testing neurocognitive test battery, the Perceived Stress Scale-14, and the Neurobehavioral Functioning Inventory (NFI). Gender differences were present on verbal memory composite scores (p = .033), with women performing worse than men. There were no other between-gender differences on cognitive tasks, neurobehavioral symptoms, or chronic stress. Higher chronic stress levels result in a decrease in verbal memory (p = .015) and motor processing speed (p = .006) and slower reaction time (p = .007) for women. As male NFI cognition scores increased, motor processing speed scores decreased (p = .012) and reaction time got slower (p = .019), whereas women exhibited decreased verbal memory (p = .017) and slower reaction time (p = .034). As NFI motor symptoms increased, men exhibited decreased verbal memory (p = .005), visual memory (p = .002), and motor processing speed (p = .002) and slower reaction time (p = .002). Overall, this study only found gender differences on verbal memory composite scores, whereas the remaining cognitive tasks, neurobehavioral symptoms, and chronic stress did not indicate gender differences. Correlations between chronic stress, neurobehavioral symptoms, and cognitive function differed in both men and women with TBI. Persons in the chronic phase of recovery from a TBI may benefit from training in

Symptoms and Symptom Clusters Identified by Adolescents and Young Adults With Cancer Using a Symptom Heuristics App.

PubMed

Ameringer, Suzanne; Erickson, Jeanne M; Macpherson, Catherine Fiona; Stegenga, Kristin; Linder, Lauri A

2015-12-01

Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment. Because the typical approach to symptom assessment does not easily reflect the symptom experience of individuals, alternative approaches to enhancing communication between the patient and provider are needed. We developed an iPad-based application that uses a heuristic approach to explore AYAs' cancer symptom experiences. In this mixed-methods descriptive study, 72 AYAs (13-29 years old) with cancer receiving myelosuppressive chemotherapy used the Computerized Symptom Capture Tool (C-SCAT) to create images of the symptoms and symptom clusters they experienced from a list of 30 symptoms. They answered open-ended questions within the C-SCAT about the causes of their symptoms and symptom clusters. The images generated through the C-SCAT and accompanying free-text data were analyzed using descriptive, content, and visual analyses. Most participants (n = 70) reported multiple symptoms (M = 8.14). The most frequently reported symptoms were nausea (65.3%), feeling drowsy (55.6%), lack of appetite (55.6%), and lack of energy (55.6%). Forty-six grouped their symptoms into one or more clusters. The most common symptom cluster was nausea/eating problems/appetite problems. Nausea was most frequently named as the priority symptom in a cluster and as a cause of other symptoms. Although common threads were present in the symptoms experienced by AYAs, the graphic images revealed unique perspectives and a range of complexity of symptom relationships, clusters, and causes. Results highlight the need for a tailored approach to symptom management based on how the AYA with cancer perceives his or her symptom experience. © 2015 Wiley Periodicals, Inc.

Mindfulness in schizophrenia: Associations with self-reported motivation, emotion regulation, dysfunctional attitudes, and negative symptoms.

PubMed

Tabak, Naomi T; Horan, William P; Green, Michael F

2015-10-01

Mindfulness-based interventions are gaining empirical support as alternative or adjunctive treatments for a variety of mental health conditions, including anxiety, depression, and substance use disorders. Emerging evidence now suggests that mindfulness-based treatments may also improve clinical features of schizophrenia, including negative symptoms. However, no research has examined the construct of mindfulness and its correlates in schizophrenia. In this study, we examined self-reported mindfulness in patients (n=35) and controls (n=25) using the Five-Facet Mindfulness Questionnaire. We examined correlations among mindfulness, negative symptoms, and psychological constructs associated with negative symptoms and adaptive functioning, including motivation, emotion regulation, and dysfunctional attitudes. As hypothesized, patients endorsed lower levels of mindfulness than controls. In patients, mindfulness was unrelated to negative symptoms, but it was associated with more adaptive emotion regulation (greater reappraisal) and beliefs (lower dysfunctional attitudes). Some facets of mindfulness were also associated with self-reported motivation (behavioral activation and inhibition). These patterns of correlations were similar in patients and controls. Findings from this initial study suggest that schizophrenia patients may benefit from mindfulness-based interventions because they (a) have lower self-reported mindfulness than controls and (b) demonstrate strong relationships between mindfulness and psychological constructs related to adaptive functioning. Copyright © 2015 Elsevier B.V. All rights reserved.

[Narcolepsy in childhood and adolescence: symptoms, diagnosis, and therapy. A case report].

PubMed

Gehrmann, Jochen; Siegler, Dominik; Ignacy, Evelin; Reimer, Inga

2017-03-01

Narcolepsy is a rare, multifactorial disease of the hypothalamus characterized by its leading symptoms of excessive daytime sleepiness and cataplexy. Sleep-EEG and a HLA-DR-genotype serve to secure the diagnosis. We report here on a 14-year-old girl suffering from anxieties, depression, school refusal, social withdrawal as well as very frequent attacks of sleep during the day and cataplexy. Currently, there is no approved drug for children and adolescents suffering from narcolepsy. Our patient benefited significantly and quickly from an off-label treatment with methylphenidate in combination with psychoeducation, cognitive behavioral therapy, and family therapy. Narcolepsy is a very rare but probably underestimated differential diagnosis applied to unclear daytime sleepiness, anxieties, or depression in childhood and adolescence. Both the key symptoms and the comorbid symptoms improve significantly under treatment with stimulants, albeit at a higher dosage.

Extravehicular Mobility Unit Training Suit Symptom Study Report

NASA Technical Reports Server (NTRS)

Strauss, Samuel

2004-01-01

The purpose of this study was to characterize the symptoms and injuries experienced by NASA astronauts during extravehicular activity (space walk) spacesuit training at the Neutral Buoyancy Laboratory at Ellington Field, Houston, Texas. We identified the frequency and incidence rates of symptoms by each general body location and characterized mechanisms of injury and effective countermeasures. Based on these findings a comprehensive list of recommendations was made to improve training, test preparation, and current spacesuit components, and to design the next -generation spacesuit. At completion of each test event a comprehensive questionnaire was produced that documented suit symptom comments, identified mechanisms of injury, and recommended countermeasures. As we completed our study we found that most extravehicular mobility unit suit symptoms were mild, self-limited, and controlled by available countermeasures. Some symptoms represented the potential for significant injury with short- and long-term consequences regarding astronaut health and interference with mission objectives. The location of symptoms and injuries that were most clinically significant was in the hands, shoulders, and feet. Correction of suit symptoms issues will require a multidisciplinary approach to improve prevention, early medical intervention, astronaut training, test planning, and suit engineering.

Borderline but not Antisocial Personality Disorder Symptoms are Related to Self-Reported Partner Aggression in Late Middle-Age

PubMed Central

Weinstein, Yana; Gleason, Marci E. J.; Oltmanns, Thomas F.

2012-01-01

We examined the relationship between personality pathology and the frequency of self-reported psychological and physical partner aggression in a community sample of 872 adults aged 55–64. Previous research suggests that antisocial and borderline personality disorder (PD) symptoms are associated with partner aggression. Controlling for gender, education, alcohol dependence, and other personality pathology, we found that borderline PD symptoms, which include abandonment fears, unstable identity, and affective instability, were significantly related to the frequency of self-reported aggression towards one’s partner. This relationship was observed regardless of whether the participant’s personality was described by a clinical interviewer, the participant themselves, or an informant chosen by the participant. Further, the relationship between borderline PD symptoms and self-reported partner aggression was moderated by gender such that women were driving the association. Conversely, antisocial PD symptoms, which include deceitfulness, irresponsibility, disregard for rules, and lack of remorse did not significantly account for variance in self-reported partner aggression. PMID:22732005

Borderline but not antisocial personality disorder symptoms are related to self-reported partner aggression in late middle-age.

PubMed

Weinstein, Yana; Gleason, Marci E J; Oltmanns, Thomas F

2012-08-01

We examined the relationship between personality pathology and the frequency of self-reported psychological and physical partner aggression in a community sample of 872 adults aged 55-64. Previous research suggests that antisocial and borderline personality disorder (PD) symptoms are associated with partner aggression. Controlling for gender, education, alcohol dependence, and other personality pathology, we found that borderline PD symptoms, which include abandonment fears, unstable identity, and affective instability, were significantly related to the frequency of self-reported aggression toward one's partner. This relationship was observed regardless of whether the participant's personality was described by a clinical interviewer, the participant themselves, or an informant chosen by the participant. Further, the relationship between borderline PD symptoms and self-reported partner aggression was moderated by gender such that women were driving the association. Conversely, antisocial PD symptoms, which include deceitfulness, irresponsibility, disregard for rules, and lack of remorse did not significantly account for variance in self-reported partner aggression. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders.

PubMed

Erekson, Elisabeth A; Li, Fang-Yong; Martin, Deanna K; Fried, Terri R

2016-04-01

The primary objective of this study was to use the Vulvovaginal Symptom Questionnaire (VSQ) to estimate the prevalence and examine the emotional, lifestyle, and sexual impact of vulvovaginal symptoms in postmenopausal women. We administered the VSQ, a previous validated instrument to 358 postmenopausal women recruited from primary care physician offices and local senior centers. The first seven questions of the VSQ comprise the symptom subscale (itching, burning, hurting, irritation, dryness, discharge, and odor). Women who answered "Yes" to any of the first seven symptom questions were considered to have vulvovaginal symptoms. Two hundred seventy-nine women were recruited from primary care offices and 79 women were recruited from senior centers. One hundred eighty-three postmenopausal women (51.1%; 95% CI 45.9%, 56.3%) reported at least one vulvovaginal symptom. The most common symptom was being dry 35.8% (n/N = 128/358). Ten percent of women (n/N = 38/358) reported five or more symptoms and 6% of women reported all seven symptoms in the last week. For women reporting one or more vulvovaginal symptoms, 40.4% (n/N = 74/183) reported emotional impact (Yes to ≥1 out of 4 emotional impact subscale items) and 32.8% (n/N = 60/183) reported lifestyle impact (Yes to ≥1 out of 5 lifestyle impact subscale items) from these symptoms. For sexually active women reporting vulvovaginal symptoms, 75.3% (n/N = 67/89) reported sexual impact (Yes to ≥1 out of 4 sexual impact subscale items). Vulvovaginal symptoms were associated with increased co-occurrence of specific pelvic floor disorders, including pelvic organ prolapse (P = 0.001), anal incontinence to solid stool (P = 0.001), urinary frequency (P = 0.02), urgency urinary incontinence (P = 0.001), and dysuria (P < 0.001). Vulvovaginal symptoms are common and present in over 50% of postmenopausal women. Sizeable proportions of women with vulvovaginal symptoms report emotional, lifestyle, and sexual impact from these

Quantifying short-term dynamics of Parkinson's disease using self-reported symptom data from an Internet social network.

PubMed

Little, Max; Wicks, Paul; Vaughan, Timothy; Pentland, Alex

2013-01-24

Parkinson's disease (PD) is an incurable neurological disease with approximately 0.3% prevalence. The hallmark symptom is gradual movement deterioration. Current scientific consensus about disease progression holds that symptoms will worsen smoothly over time unless treated. Accurate information about symptom dynamics is of critical importance to patients, caregivers, and the scientific community for the design of new treatments, clinical decision making, and individual disease management. Long-term studies characterize the typical time course of the disease as an early linear progression gradually reaching a plateau in later stages. However, symptom dynamics over durations of days to weeks remains unquantified. Currently, there is a scarcity of objective clinical information about symptom dynamics at intervals shorter than 3 months stretching over several years, but Internet-based patient self-report platforms may change this. To assess the clinical value of online self-reported PD symptom data recorded by users of the health-focused Internet social research platform PatientsLikeMe (PLM), in which patients quantify their symptoms on a regular basis on a subset of the Unified Parkinson's Disease Ratings Scale (UPDRS). By analyzing this data, we aim for a scientific window on the nature of symptom dynamics for assessment intervals shorter than 3 months over durations of several years. Online self-reported data was validated against the gold standard Parkinson's Disease Data and Organizing Center (PD-DOC) database, containing clinical symptom data at intervals greater than 3 months. The data were compared visually using quantile-quantile plots, and numerically using the Kolmogorov-Smirnov test. By using a simple piecewise linear trend estimation algorithm, the PLM data was smoothed to separate random fluctuations from continuous symptom dynamics. Subtracting the trends from the original data revealed random fluctuations in symptom severity. The average magnitude of

Severity of depressive symptoms and accuracy of dietary reporting among obese women with major depressive disorder seeking weight loss treatment.

PubMed

Whited, Matthew C; Schneider, Kristin L; Appelhans, Bradley M; Ma, Yunsheng; Waring, Molly E; DeBiasse, Michele A; Busch, Andrew M; Oleski, Jessica L; Merriam, Philip A; Olendzki, Barbara C; Crawford, Sybil L; Ockene, Ira S; Lemon, Stephenie C; Pagoto, Sherry L

2014-01-01

An elevation in symptoms of depression has previously been associated with greater accuracy of reported dietary intake, however this association has not been investigated among individuals with a diagnosis of major depressive disorder. The purpose of this study was to investigate reporting accuracy of dietary intake among a group of women with major depressive disorder in order to determine if reporting accuracy is similarly associated with depressive symptoms among depressed women. Reporting accuracy of dietary intake was calculated based on three 24-hour phone-delivered dietary recalls from the baseline phase of a randomized trial of weight loss treatment for 161 obese women with major depressive disorder. Regression models indicated that higher severity of depressive symptoms was associated with greater reporting accuracy, even when controlling for other factors traditionally associated with reporting accuracy (coefficient  =  0.01 95% CI = 0.01 - 0.02). Seventeen percent of the sample was classified as low energy reporters. Reporting accuracy of dietary intake increases along with depressive symptoms, even among individuals with major depressive disorder. These results suggest that any study investigating associations between diet quality and depression should also include an index of reporting accuracy of dietary intake as accuracy varies with the severity of depressive symptoms.

Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss.

PubMed

Basaria, Shehzad; Jasuja, Ravi; Huang, Grace; Wharton, Whitney; Pan, Hong; Pencina, Karol; Li, Zhuoying; Travison, Thomas G; Bhawan, Jag; Gonthier, Renaud; Labrie, Fernand; Dury, Alain Y; Serra, Carlo; Papazian, Allen; O'Leary, Michael; Amr, Sami; Storer, Thomas W; Stern, Emily; Bhasin, Shalender

2016-12-01

Some men who use finasteride for hair loss report persistent sexual and other symptoms after discontinuing finasteride therapy. To determine whether these persistent symptoms after discontinuation of finasteride use are due to androgen deficiency, decreased peripheral androgen action, or persistent inhibition of steroid 5α-reductase (SRD5A) enzymes. Finasteride users, who reported persistent sexual symptoms after discontinuing finasteride (group 1); age-matched finasteride users who did not report sexual symptoms (group 2); and healthy men who had never used finasteride (group 3). Sexual function, mood, affect, cognition, hormone levels, body composition, functional magnetic resonance imaging (fMRI) response to sexually and affectively valenced stimuli, nucleotide sequences of androgen receptor (AR), SRD5A1, and SRD5A2; expression levels of androgen-dependent genes in skin. Academic medical center. Symptomatic finasteride users were similar in body composition, strength, and nucleotide sequences of AR, SRD5A1, and SRD5A2 genes to asymptomatic finasteride users and nonusers. Symptomatic finasteride users had impaired sexual function, higher depression scores, a more negative affectivity balance, and more cognitive complaints than men in groups 2 and 3 but had normal objectively assessed cognitive function. Testosterone, dihydrotestosterone, 5α-androstane-3α,17β-diol-glucuronide, testosterone to dihydrotestosterone and androsterone glucuronide to etiocholanolone glucuronide ratios, and markers of peripheral androgen action and expression levels of AR-dependent genes in skin did not differ among groups. fMRI blood oxygen level-dependent responses to erotic and nonerotic stimuli revealed abnormal function in brain circuitry linked to sexual arousal and major depression. We found no evidence of androgen deficiency, decreased peripheral androgen action, or persistent peripheral inhibition of SRD5A in men with persistent sexual symptoms after finasteride use

How Informative Are Self-Reported Adult Attention-Deficit/Hyperactivity Disorder Symptoms? An Examination of the Agreement Between the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale V1.1 and Adult Attention-Deficit/Hyperactivity Disorder Investigator Symptom Rating Scale.

PubMed

Silverstein, Michael J; Faraone, Stephen V; Alperin, Samuel; Biederman, Joseph; Spencer, Thomas J; Adler, Lenard A

2018-06-01

Assess agreement between self-ratings via the adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS)-v1.1 Symptom Checklist and clinician ratings via the adult ADHD Investigator Symptom Rating Scale (AISRS) expanded version using DSM-5 adult ADHD patients (referred sample) and ADHD controls (recruited from a primary care physician practice). The ASRS v1.1 Symptom Checklist was administered to measure self-reported ADHD symptoms and impairment, the Adult ADHD Clinical Diagnostic Scale v1.2 was used to establish an adult ADHD diagnosis and the childhood and adult/current sections of the scale were used to provide scores to measure symptoms of childhood ADHD and recent symptoms of adult ADHD, the AISRS to measure ADHD current symptom severity. Participants (n = 299; range 18-58), of which 171 were ADHD+ and 128 ADHD-. ASRS and AISRS total scores and individual subsections examining inattention, hyperactivity, emotional dysfunction (EF), and emotional dyscontrol (EC) were all significantly correlated (Spearman's ρ's = 0.78-0.89, ps < 0.01). Correlations remained significant when controlling for demographic factors and psychiatric conditions. The ASRS (self) and AISRS (clinician rated) scales have high agreement. This agreement extended not only the to the core 18 DSM symptoms, but also to the additional 13 symptoms that examine EC and EF.

Challenges in Determining the Role of Rest and Exercise in the Management of Mild Traumatic Brain Injury.

PubMed

Wells, Elizabeth M; Goodkin, Howard P; Griesbach, Grace S

2016-01-01

Current consensus guidelines recommending physical and cognitive rest until a patient is asymptomatic after a sports concussion (ie, a mild traumatic brain injury) are being called into question, particularly for patients who are slower to recover and in light of preclinical and clinical research demonstrating that exercise aids neurorehabilitation. The pathophysiological response to mild traumatic brain injury includes a complex neurometabolic cascade of events resulting in a neurologic energy deficit. It has been proposed that this energy deficit leads to a period of vulnerability during which the brain is at risk for additional injury, explains why early postconcussive symptoms are exacerbated by cognitive and physical exertion, and is used to rationalize absolute rest until all symptoms have resolved. However, at some point, rest might no longer be beneficial and exercise might need to be introduced. At both extremes, excessive exertion and prolonged avoidance of exercise (physical and mental) have negative consequences. Individuals who have experienced a concussion need guidance for avoidance of triggers of severe symptoms and a plan for graduated exercise to promote recovery as well as optimal functioning (physical, educational, and social) during the postconcussion period. © The Author(s) 2015.

Parent-Reported Gastro-Intestinal Symptoms in Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Chandler, Susie; Carcani-Rathwell, Iris; Charman, Tony; Pickles, Andrew; Loucas, Tom; Meldrum, David; Simonoff, Emily; Sullivan, Peter; Baird, Gillian

2013-01-01

The objective of this study is to investigate whether parentally-reported gastro-intestinal (GI) symptoms are increased in a population-derived sample of children with autism spectrum disorders (ASD) compared to controls. Participants included 132 children with ASD and 81 with special educational needs (SEN) but no ASD, aged 10-14 years plus 82…

Parent- and Teacher-Reported Symptoms of ADHD in School-Aged Children With Active Epilepsy: A Population-Based Study.

PubMed

Reilly, Colin; Atkinson, Patricia; Das, Krishna B; Chin, Richard F M; Aylett, Sarah E; Burch, Victoria; Gillberg, Christopher; Scott, Rod C; Neville, Brian G R

2017-09-01

Provide data on the distribution of parent- and teacher-reported symptoms of ADHD in childhood epilepsy and describe coexisting cognitive and behavioral disorders in children with both epilepsy and ADHD. Eighty-five (74% of those eligible) children (5-15 years) in a population-based sample with active epilepsy underwent psychological assessment. The ADHD Rating Scale-IV (ADHD-RS-IV) scale was completed by parents ( n = 69) and teachers ( n = 67) of participating children with an IQ > 34. ADHD was diagnosed with respect to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Parents reported significantly more symptoms of ADHD than teachers ( p < .001). Symptoms of inattention were more commonly reported than symptoms of hyperactivity-impulsivity ( p < .001). Neurobehavioral comorbidity was similar in those with ADHD and non-ADHD with the exception of oppositional defiant disorder (ODD) and developmental coordination disorder (DCD), which were more common in those with both epilepsy and ADHD. Symptoms of ADHD are very common in childhood epilepsy but prevalence is influenced by informant.

Relationship between ever reporting depressive symptoms and all-cause mortality in a cohort of HIV-infected adults in routine care.

PubMed

Bengtson, Angela M; Pence, Brian W; Moore, Richard; Mimiaga, Matthew J; Mathews, William Christopher; Heine, Amy; Gaynes, Bradley N; Napravnik, Sonia; Christopoulos, Katerina; Crane, Heidi M; Mugavero, Michael J

2017-04-24

The aim of this study was to assess whether ever reporting depressive symptoms affects mortality in the modern HIV treatment era. A cohort study of HIV-infected adults in routine clinical care at seven sites in the USA. We examined the effect of ever reporting depressive symptoms on all-cause mortality using data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We included individuals with at least one depression measure between 2005 and 2014. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ)-9. We used weighted Kaplan-Meier curves and marginal structural Cox models with inverse probability weights to estimate the effect of ever reporting depressive symptoms (PHQ-9 ≥10) on all-cause mortality. A total of 10 895 individuals were included. Participants were followed for a median of 3.1 years (35 621 total person-years). There were 491 (4.5%) deaths during the follow-up period (crude incidence rate 13.8/1000 person-years). At baseline, 28% of the population reported depressive symptoms. In the weighted analysis, there was no evidence that ever reporting depressive symptoms increased the hazard of all-cause mortality (hazard ratio 0.82, 95% confidence interval 0.55-1.24). In a large cohort of HIV-infected adults in care in the modern treatment era, we observed no evidence that ever reporting depressive symptoms increased the likelihood of all-cause mortality, controlling for a range of time-varying factors. Antiretroviral therapy that is increasingly robust to moderate adherence and improved access to depression treatment may help to explain changes in the relationship between depressive symptoms and mortality in the modern treatment era.

Neither self-reported atopy nor IgE-mediated allergy are linked to gastrointestinal symptoms in patients with irritable bowel syndrome.

PubMed

Nybacka, S; Öhman, L; Störsrud, S; Mybeck, M; Böhn, L; Wilpart, K; Winkvist, A; Bengtsson, U; Törnblom, H; Simrén, M

2018-06-01

Among patients with irritable bowel syndrome (IBS), atopic disease has been proposed as a common comorbidity increasing the IBS symptom burden. We therefore assessed the prevalence of self-reported atopy among patients with IBS as compared to non-IBS controls, and whether atopy and higher serum IgE levels were associated with increased IBS symptom severity. Levels of total and specific IgE in serum were measured and questionnaires assessing the presence of atopic disease (ie, eczema, asthma, rhinoconjunctivitis, and pollen allergy), gastrointestinal symptom burden, food intolerance, somatic, and psychological symptoms were completed. In total, 223 patients with IBS and 47 controls participated. Presence of atopic disease was reported in 55% of patients with IBS compared to 40% of controls (P = .07). IBS patients with atopic manifestations (N = 123) had higher total serum IgE levels (median 31 vs 16 kU A /L, P < .001) and higher prevalence of self-reported food intolerance (28% vs 9%, P = .002) than non-atopic IBS patients (N = 100), respectively, but no major difference in gastrointestinal or psychological symptom burden was noted. However, severe somatic symptoms were more common among atopic than non-atopic patients with IBS (38% vs 27%, P = .028). We found no associations between self-reported atopy and IBS symptom severity using linear regression models. Atopic disease is common in patients with IBS, but that is also true for subjects without IBS. The presence of atopic disease in IBS is associated with self-reported food intolerance and somatic symptom severity, but unrelated to IBS symptom severity. © 2018 John Wiley & Sons Ltd.

Reported Respiratory Symptom Intensity in Asthmatics During Exposure to Aerosolized Florida Red Tide Toxins

PubMed Central

Milian, Alexyz; Nierenberg, Kate; Fleming, Lora E.; Bean, Judy A.; Wanner, Adam; Reich, Andrew; Backer, Lorraine C.; Jayroe, David; Kirkpatrick, Barbara

2010-01-01

Florida red tides are naturally occurring blooms of the marine dinoflagellate, Karenia brevis. K. brevis produces natural toxins called brevetoxins. Brevetoxins become part of the marine aerosol as the fragile, unarmored cells are broken up by wave action. Inhalation of the aerosolized toxin results in upper and lower airway irritation. Symptoms of brevetoxin inhalation include: eye, nose, and throat irritation, coughing, wheezing, chest tightness, and shortness of breath. Asthmatics appear to be more sensitive to the effects of inhaled brevetoxin. This study examined data from 97 asthmatics exposed at the beach for 1 hour during K. brevis blooms, and on separate occasions when no bloom was present. In conjunction with extensive environmental monitoring, participants were evaluated utilizing questionnaires and pulmonary function testing before and after a 1-hour beach walk. A modified Likert scale was incorporated into the questionnaire to create respiratory symptom intensity scores for each individual pre- and post-beach walk. Exposure to Florida red tide significantly increased the reported intensity of respiratory symptoms; no significant changes were seen during an unexposed period. This is the first study to examine the intensity of reported respiratory symptoms in asthmatics after a 1-hour exposure to Florida red tide. PMID:17885863

Alexithymia as a potential source of symptom over-reporting: An exploratory study in forensic patients and non-forensic participants.

PubMed

Merckelbach, Harald; Prins, Chinouk; Boskovic, Irena; Niesten, Isabella; À Campo, Joost

2018-04-01

The traditional interpretation of symptom over-reporting is that it indicates malingering. We explored a different perspective, namely that over-reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS-20) and symptom over-reporting (SIMS), but also sleep quality (SLEEP-50) to forensic psychiatric outpatients (n = 40) and non-forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non-forensic participants. In the total sample as well as in subsamples, over-reporting correlated positively and significantly with alexithymia, with rs being in the 0.50-0.65 range. Sleep problems were also related to over-reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over-reporting over and above sleep problems. Although our study is cross-sectional in nature, its results indicate that alexithymia as a potential source of over-reporting merits systematic research. © 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

Applying an Evidence-Based Assessment Model to Identify Students at Risk for Perceived Academic Problems following Concussion.

PubMed

Ransom, Danielle M; Burns, Alison R; Youngstrom, Eric A; Vaughan, Christopher G; Sady, Maegan D; Gioia, Gerard A

2016-11-01

The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. Latent class analysis categorized participants into "high" (44%) and "low" (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038-1049).

Child and family characteristics moderate agreement between caregiver and clinician report of autism symptoms.

PubMed

Neuhaus, Emily; Beauchaine, Theodore P; Bernier, Raphael A; Webb, Sara J

2018-03-01

Rates of autism spectrum disorder (ASD) and age at first diagnosis vary considerably across the United States and are moderated by children's sex, race, ethnicity, and availability of services. We additionally suggest that degree of caregiver-clinician agreement on ASD symptoms may play a role in ASD assessment. Since gold standard ASD assessment integrates caregiver-reported developmental history with clinician observations, differential agreement between reporters across demographic groups may contribute to a host of detrimental outcomes. Here, we investigate whether caregiver-clinician agreement on ASD symptoms varies according to child and family characteristics. Comprehensive data from 2,759 families in the Simons Simplex Collection were analyzed. Linear models were created with caregiver reports predicting clinician reports, and moderating effects of child characteristics and family factors were examined. Poorer reporter correspondence was observed when children had higher IQ scores, stronger adaptive behavior, and more behavioral difficulties. Greater disagreement was also associated with African American racial status (for younger children), lower household income, and paternal social difficulties (for older children). Children's biological sex did not moderate caregiver-clinician agreement. Marked disagreement between caregivers and clinicians could lead to suboptimal or insufficient intervention services and negative experiences for families throughout development. Such families may also be less likely to qualify for research studies, and therefore be underrepresented in the ASD literature. Modified assessment procedures may be required to improve assessment accuracy and family experiences. Autism Res 2018, 11: 476-487. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Evaluation of autism spectrum disorder (ASD) incorporates both caregiver and clinician perspectives of symptoms, and disagreement between these perspectives could

Dissociative Symptoms and Reported Trauma Among Patients with Spirit Possession and Matched Healthy Controls in Uganda

PubMed Central

Nijenhuis, Ellert; Komproe, Ivan H.; Gernaat, Hajo B. P. E.; de Jong, Joop T.

2010-01-01

Spirit possession is a common, worldwide phenomenon with dissociative features. Studies in Europe and the United States have revealed associations among psychoform and somatoform dissociation and (reported) potential traumatic events. The aim of this study was to explore the relationships among spirit possession, dissociative symptoms and reported potentially traumatizing events in Uganda. One hundred nineteen persons with spirit possession, diagnosed by traditional healers, were compared to a matched control group of 71 nonpossessed persons. Assessments included demographic items and measures of dissociation and potentially traumatizing events. Compared to the nonpossessed group, the possessed group reported more severe psychoform dissociation and somatoform dissociation and more potentially traumatizing events. The associations between these events and both types of dissociation were significant. Yet, consistent with the cultural perception of dissociative symptoms, the participants subjectively did not associate dissociative symptoms with potentially traumatizing events. In conclusion, spirit possession deserves more interest as a possible idiom of distress and a culture-specific expression of dissociation related to potential traumatizing events. PMID:20401630

Brain magnetic resonance imaging CO2 stress testing in adolescent postconcussion syndrome.

PubMed

Mutch, W Alan C; Ellis, Michael J; Ryner, Lawrence N; Ruth Graham, M; Dufault, Brenden; Gregson, Brian; Hall, Thomas; Bunge, Martin; Essig, Marco; Fisher, Joseph A; Duffin, James; Mikulis, David J

2016-09-01

OBJECT A neuroimaging assessment tool to visualize global and regional impairments in cerebral blood flow (CBF) and cerebrovascular responsiveness in individual patients with concussion remains elusive. Here the authors summarize the safety, feasibility, and results of brain CO2 stress testing in adolescents with postconcussion syndrome (PCS) and healthy controls. METHODS This study was approved by the Biomedical Research Ethics Board at the University of Manitoba. Fifteen adolescents with PCS and 17 healthy control subjects underwent anatomical MRI, pseudo-continuous arterial spin labeling MRI, and brain stress testing using controlled CO2 challenge and blood oxygen level-dependent (BOLD) MRI. Post hoc processing was performed using statistical parametric mapping to determine voxel-by-voxel regional resting CBF and cerebrovascular responsiveness of the brain to the CO2 stimulus (increase in BOLD signal) or the inverse (decrease in BOLD signal). Receiver operating characteristic (ROC) curves were generated to compare voxel counts categorized by control (0) or PCS (1). RESULTS Studies were well tolerated without any serious adverse events. Anatomical MRI was normal in all study participants. No differences in CO2 stimuli were seen between the 2 participant groups. No group differences in global mean CBF were detected between PCS patients and healthy controls. Patient-specific differences in mean regional CBF and CO2 BOLD responsiveness were observed in all PCS patients. The ROC curve analysis for brain regions manifesting a voxel response greater than and less than the control atlas (that is, abnormal voxel counts) produced an area under the curve of 0.87 (p < 0.0001) and 0.80 (p = 0.0003), respectively, consistent with a clinically useful predictive model. CONCLUSIONS Adolescent PCS is associated with patient-specific abnormalities in regional mean CBF and BOLD cerebrovascular responsiveness that occur in the setting of normal global resting CBF. Future prospective

Self-Reported Sleep Duration in Relation to Incident Stroke Symptoms: Nuances by Body Mass and Race from the REGARDS Study

PubMed Central

Ruiter Petrov, Megan E.; Letter, Abraham J.; Howard, Virginia J.; Kleindorfer, Dawn

2013-01-01

Objectives Determine, amongst employed persons with low risk for obstructive sleep apnea (OSA), if sleep duration is associated with incident stroke symptoms, independent of body mass index (BMI), and if sleep duration mediates racial differences in stroke symptoms. Methods In 2008, 5,666 employed participants (US blacks and whites, ≥45years) from the longitudinal and nationally-representative REasons for Geographic And Racial Differences in Stroke (REGARDS) study, self-reported their average sleep duration. Participants had no history of stroke, transient ischemic attack, or stroke symptoms, and were low risk for OSA. After the sleep assessment, self-reported stroke symptoms were collected at six-month intervals, up to 3 years (M=751 days). Interval-censored, parametric survival models were conducted to estimate hazard ratios predicting time from sleep duration measurement (<6, 6-6.9, 7-7.9(reference), 8-8.9, ≥9 hours) to first stroke symptom. Adjusted models included demographics, stroke risk factors, psychological symptoms, health behaviors, and diet. Results During follow-up, 224 participants reported ≥1 stroke symptom. In the unadjusted model, short sleep (<6hrs) significantly predicted increased risk of stroke symptoms, but not in adjusted models. Stratification by BMI revealed a significant association between short sleep duration and stroke symptoms only for normal BMI persons in unadjusted (HR: 2.93, 95%CI: 1.38-6.22) and fully adjusted models (HR: 4.19, 95%CI: 1.62-10.84). The mediating effect of sleep duration on the relationship between race and stroke symptoms was borderline significant in normal weight participants. Conclusions Among middle-aged to older employed individuals of normal weight and low risk of OSA, self-reported short sleep duration is prospectively associated with increased risk of stroke symptoms. PMID:24119626

Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes.

PubMed

Berz, Kate; Divine, Jon; Foss, Kim Barber; Heyl, Rachel; Ford, Kevin R; Myer, Gregory D

2013-05-01

While research on adult recovery from concussion indicates sex-specific symptoms and recovery rates, there is little existing data on younger patient populations. To determine sex-specific differences in the severity of presenting symptoms and recovery rate between groups of young athletes who presented ≤ 7 or > 7 days after sports-related concussion. This study was a retrospective review of athletes aged 9 to 17 years who were referred for evaluation of a sports-related concussion over a 24-month period. The study groups were divided by sex and post-injury presentation to the clinic at ≤ 7 days and > 7 days from the date of injury. Athletes with learning disabilities were excluded from the study and data analysis. Age, height, and weight were recorded for each subject. Each subject also reported their initial degree of confusion, amnesia, or loss of consciousness, and whether a helmet was worn when the injury was sustained. A 22-item post-concussion symptom score (SS) scale was completed by both groups on initial assessment (SS1) and follow-up visit (SS2). The recovery rate (SSR) was calculated as (SS2-SS1)/days between SS2 and SS1. Sex and group comparisons for SS1 and SSR were performed using 2 × 2 analysis of variance. A similar analysis was also performed for effects of sex on SS1 and SSR in patients who were not wearing a helmet. Thirty-seven athletes aged 15.0 ± 1.9 years were evaluated. Males, regardless of day of presentation, had a lower SS1 evaluation than females (15.8 vs 30.9; P < 0.05). Males without helmets did not differ from females without helmets, but this was not significantly different (14.1 vs 29.6; P = 0.1). There was not a significant difference in SS1 evaluation between the groups who presented at ≤ 7 or > 7 days. The overall mean SSR was -1.2/day, with no significant difference seen between groups or sex. There were no significant differences in degree of loss of consciousness, amnesia, confusion, or age between the sexes or groups

Controlled human exposure to methyl tertiary butyl ether in gasoline: symptoms, psychophysiologic and neurobehavioral responses of self-reported sensitive persons.

PubMed Central

Fiedler, N; Kelly-McNeil, K; Mohr, S; Lehrer, P; Opiekun, R E; Lee, C; Wainman, T; Hamer, R; Weisel, C; Edelberg, R; Lioy, P J

2000-01-01

The 1990 Clean Air Act mandated oxygenation of gasoline in regions where carbon monoxide standards were not met. To achieve this standard, methyl tertiary butyl ether (MTBE) was increased to 15% by volume during winter months in many locations. Subsequent to the increase of MTBE in gasoline, commuters reported increases in symptoms such as headache, nausea, and eye, nose, and throat irritation. The present study compared 12 individuals selected based on self-report of symptoms (self-reported sensitives; SRSs) associated with MTBE to 19 controls without self-reported sensitivities. In a double-blind, repeated measures, controlled exposure, subjects were exposed for 15 min to clean air, gasoline, gasoline with 11% MTBE, and gasoline with 15% MTBE. Symptoms, odor ratings, neurobehavioral performance on a task of driving simulation, and psychophysiologic responses (heart and respiration rate, end-tidal CO(2), finger pulse volume, electromyograph, finger temperature) were measured before, during, and immediately after exposure. Relative to controls, SRSs reported significantly more total symptoms when exposed to gasoline with 15% MTBE than when exposed to gasoline with 11% MTBE or to clean air. However, these differences in symptoms were not accompanied by significant differences in neurobehavioral performance or psychophysiologic responses. No significant differences in symptoms or neurobehavioral or psychophysiologic responses were observed when exposure to gasoline with 11% MTBE was compared to clean air or to gasoline. Thus, the present study, although showing increased total symptoms among SRSs when exposed to gasoline with 15% MTBE, did not support a dose-response relationship for MTBE exposure nor the symptom specificity associated with MTBE in epidemiologic studies. Images Figure 1 Figure 2 PMID:10964796

Overlooked diagnosis of infected paratracheal air cysts in patients with respiratory symptoms: Case report.

PubMed

Bae, Kyungsoo; Jeon, Kyung N; Park, Mi J; Lee, Seung J; Kim, Ho C; Cha, Seung I; Byun, Joung H; Kim, Jong W

2017-07-01

Infected paratracheal air cysts as the focus of respiratory symptoms can be overlooked in practice because of nonspecific symptoms and physician's scant knowledge for this entity. We report 2 cases of infected paratracheal air cyst diagnosed at chest computed tomography (CT) and bronchoscopy/endobronchial ultrasound. Two patients visited our hospital with respiratory symptoms, including cough, sputum, and fever. Chest CT showed paratracheal cystic lesions with air-fluid level in the thoracic inlet. In the first patient, endobronchial ultrasound revealed a right paratracheal hypoechoic mass corresponding to the lesion on CT scan. In the second patient, bronchoscopy revealed purulent discharge from a dimpling at posterolateral wall of trachea, which was the opening of communication between the trachea and infected paratracheal air cyst. Both patients received antibiotic treatment. After medical treatment, the patients' symptoms were improved. Follow-up chest CT scans showed air-filled paratracheal air cysts without internal fluid or rim enhancement. A physician should pay attention to paratracheal air cyst in patients with respiratory symptoms when their lungs are clear on CT scan.

Celiac disease symptoms in a female collegiate tennis player: a case report.

PubMed

Leone, James E; Gray, Kimberly A; Massie, John E; Rossi, Jennifer M

2005-01-01

To present the case of a collegiate tennis player with celiac disease symptoms. Celiac disease is a common intestinal disorder that is often confused with other conditions. It causes severe intestinal damage manifested by several uncomfortable signs and symptoms. Failure by the sports medicine staff to recognize symptoms consistent with celiac disease and treat them appropriately can have deleterious consequences for the athlete. Irritable bowel syndrome, Crohn disease, Addison disease, lupus erythematosus, juvenile rheumatoid arthritis, lactose intolerance, herpes zoster, psychogenic disorder (depression), fibromyalgia, complex regional pain syndrome, hyperthyroidism, anemia, type I diabetes. The athlete underwent a series of blood and allergen tests to confirm or refute a diagnosis of celiac disease. When celiac disease was suspected, dietary modifications were made to eliminate all wheat-based and gluten-based products from the athlete's diet. The athlete was able to fully compete in a competitive National Collegiate Athletic Association Division I tennis program while experiencing the debilitating effects associated with celiac disease. The immediacy of symptom onset was notable because the athlete had no history of similar complaints. Celiac disease is a potentially life-threatening condition that affects more people than reported. A properly educated sports medicine staff can help to identify symptoms consistent with celiac disease early, so damage to the intestine is minimized. Prompt recognition and appropriate management allow the athlete to adjust the diet accordingly, compete at a high-caliber level, and enjoy a healthier quality of life.

Dose-Volume Effects on Patient-Reported Acute Gastrointestinal Symptoms During Chemoradiation Therapy for Rectal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Ronald C.; Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

2012-07-15

Purpose: Research on patient-reported outcomes (PROs) in rectal cancer is limited. We examined whether dose-volume parameters of the small bowel and large bowel were associated with patient-reported gastrointestinal (GI) symptoms during 5-fluorouracil (5-FU)-based chemoradiation treatment for rectal cancer. Methods and Materials: 66 patients treated at the Brigham and Women's Hospital or Massachusetts General Hospital between 2006 and 2008 were included. Weekly during treatment, patients completed a questionnaire assessing severity of diarrhea, urgency, pain, cramping, mucus, and tenesmus. The association between dosimetric parameters and changes in overall GI symptoms from baseline through treatment was examined by using Spearman's correlation. Potential associationsmore » between these parameters and individual GI symptoms were also explored. Results: The amount of small bowel receiving at least 15 Gy (V15) was significantly associated with acute symptoms (p = 0.01), and other dosimetric parameters ranging from V5 to V45 also trended toward association. For the large bowel, correlations between dosimetric parameters and overall GI symptoms at the higher dose levels from V25 to V45 did not reach statistical significance (p = 0.1), and a significant association was seen with rectal pain from V15 to V45 (p < 0.01). Other individual symptoms did not correlate with small bowel or large bowel dosimetric parameters. Conclusions: The results of this study using PROs are consistent with prior studies with physician-assessed acute toxicity, and they identify small bowel V15 as an important predictor of acute GI symptoms during 5-FU-based chemoradiation treatment. A better understanding of the relationship between radiation dosimetric parameters and PROs may allow physicians to improve radiation planning to optimize patient outcomes.« less

How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes

PubMed Central

Bannaga, Ayman; Kelman, Lawrence; O'Connor, Michelle; Pitchford, Claire; Walters, Julian R F; Arasaradnam, Ramesh P

2017-01-01

Objectives Bile acid diarrhoea (BAD) is an underdiagnosed condition producing diarrhoea, urgency and fear of faecal incontinence. How patients experience these symptoms has not previously been studied. Bile Acid Malabsorption (BAM) Support UK was established in 2015 as a national charity with objectives including to provide details regarding how BAD affects patients, to improve earlier recognition and clinical management. Design, setting and main outcome A questionnaire was collected anonymously by BAM Support UK and the Bile Salt Malabsorption Facebook group over 4 weeks at the end of 2015. It comprised 56 questions and aimed to inform patients and clinicians about how BAD affects the respondents. Results The first 100 responses were analysed. 91% of the respondents reported a diagnosis of BAD. 58% of total respondents diagnosed following a Selenium-homocholic acid taurine scan, 69% were diagnosed by a gastroenterologist, with type 2 and 3 BAD comprising 38% and 37%, respectively, of total respondents. Symptoms had been experienced for more than 5 years before diagnosis in 44% of respondents. Following treatment, usually with bile acid sequestrants, 60% of participants reported improvement of diarrhoea and most reported their mental health has been positively impacted. Just over half of the cohort felt as though their symptoms had been dismissed during clinical consultations and 28% felt their GPs were unaware of BAD. Conclusions BAD requires more recognition by clinicians to address the current delays in diagnosis. Treatment improves physical and mental symptoms in the majority of participants. PMID:28123771

How bad is bile acid diarrhoea: an online survey of patient-reported symptoms and outcomes.

PubMed

Bannaga, Ayman; Kelman, Lawrence; O'Connor, Michelle; Pitchford, Claire; Walters, Julian R F; Arasaradnam, Ramesh P

2017-01-01

Bile acid diarrhoea (BAD) is an underdiagnosed condition producing diarrhoea, urgency and fear of faecal incontinence. How patients experience these symptoms has not previously been studied. Bile Acid Malabsorption (BAM) Support UK was established in 2015 as a national charity with objectives including to provide details regarding how BAD affects patients, to improve earlier recognition and clinical management. A questionnaire was collected anonymously by BAM Support UK and the Bile Salt Malabsorption Facebook group over 4 weeks at the end of 2015. It comprised 56 questions and aimed to inform patients and clinicians about how BAD affects the respondents. The first 100 responses were analysed. 91% of the respondents reported a diagnosis of BAD. 58% of total respondents diagnosed following a Selenium-homocholic acid taurine scan, 69% were diagnosed by a gastroenterologist, with type 2 and 3 BAD comprising 38% and 37%, respectively, of total respondents. Symptoms had been experienced for more than 5 years before diagnosis in 44% of respondents. Following treatment, usually with bile acid sequestrants, 60% of participants reported improvement of diarrhoea and most reported their mental health has been positively impacted. Just over half of the cohort felt as though their symptoms had been dismissed during clinical consultations and 28% felt their GPs were unaware of BAD. BAD requires more recognition by clinicians to address the current delays in diagnosis. Treatment improves physical and mental symptoms in the majority of participants.

Motivation and Pleasure Scale-Self-Report (MAP-SR): Validation of the German version of a self-report measure for screening negative symptoms in schizophrenia.

PubMed

Engel, Maike; Lincoln, Tania Marie

2016-02-01

Validated self-report instruments could provide a time efficient screening method for negative symptoms in people with schizophrenia. The aim of this study was to examine the psychometric properties of a German version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) which is based on the Clinical Assessment Interview for Negative Symptoms (CAINS). In- and outpatients (N=50) with schizophrenia or schizoaffective disorder were assessed with standardized interviews and questionnaires on negative and positive symptoms and general psychopathology in schizophrenia, depression, and global functioning. The German version of the MAP-SR showed high internal consistency. Convergent validity was supported by significant correlations between the MAP-SR with the experience sub-scale of the CAINS and the negative symptom sub-scale of the Positive and Negative Syndrome Scale. The MAP-SR also exhibited discriminant validity indicated by its non-significant correlations with positive symptoms and general psychopathology, which is in line with the findings for the original version of the MAP-SR. However, the MAP-SR correlated moderately with depression. The German MAP-SR appears to be a valid and suitable diagnostic tool for the identification of negative symptoms in schizophrenia. Copyright © 2015 Elsevier Inc. All rights reserved.

High usability of a smartphone application for reporting symptoms in adults with cystic fibrosis.

PubMed

Wood, Jamie; Jenkins, Sue; Putrino, David; Mulrennan, Siobhain; Morey, Sue; Cecins, Nola; Hill, Kylie

2017-01-01

Introduction In cystic fibrosis, exacerbations impair lung function and health-related quality of life, increase healthcare costs and reduce survival. Delayed reporting of worsening symptoms can result in more severe exacerbations and worse clinical outcomes; therefore there is a need for a novel approach to facilitate the early identification and treatment of exacerbations in this population. This study investigated the usability of a smartphone application to report symptoms in adults with cystic fibrosis, and the observer agreement in clinical decision-making between senior clinicians interpreting smartphone application responses. Methods Adults with cystic fibrosis used the smartphone application weekly for four weeks. The application comprised 10 yes/no questions regarding respiratory symptoms and two regarding emotional well-being. Usability was measured with the System Usability Scale; Observer agreement was tested by providing a cystic fibrosis physician and a nurse practitioner with 45 clinical scenarios. For each scenario the clinicians, who were blinded to each other's responses, were asked to indicate whether or not they would: (i) initiate telephone contact, and/or (ii) request a clinic visit for the individual. Results Ten participants (five female), aged mean (SD) 33 (11) years, FEV1 49 (27)% predicted completed the study. The mean (SD) System Usability Scale score was 94 (6). There was perfect agreement between clinicians for initiating contact with the participant ( κ = 1.0, p < 0.001), and near-perfect for requesting a clinic visit ( κ = 0.86, p < 0.001). Discussion The use of a smartphone application for reporting symptoms in adults with cystic fibrosis has excellent usability and near-perfect agreement between senior clinicians when interpreting the application responses.

Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss

PubMed Central

Basaria, Shehzad; Jasuja, Ravi; Huang, Grace; Wharton, Whitney; Pan, Hong; Pencina, Karol; Li, Zhuoying; Travison, Thomas G.; Bhawan, Jag; Gonthier, Renaud; Labrie, Fernand; Dury, Alain Y.; Serra, Carlo; Papazian, Allen; O'Leary, Michael; Amr, Sami; Storer, Thomas W.; Stern, Emily

2016-01-01

Context: Some men who use finasteride for hair loss report persistent sexual and other symptoms after discontinuing finasteride therapy. Objective: To determine whether these persistent symptoms after discontinuation of finasteride use are due to androgen deficiency, decreased peripheral androgen action, or persistent inhibition of steroid 5α-reductase (SRD5A) enzymes. Participants: Finasteride users, who reported persistent sexual symptoms after discontinuing finasteride (group 1); age-matched finasteride users who did not report sexual symptoms (group 2); and healthy men who had never used finasteride (group 3). Outcomes: Sexual function, mood, affect, cognition, hormone levels, body composition, functional magnetic resonance imaging (fMRI) response to sexually and affectively valenced stimuli, nucleotide sequences of androgen receptor (AR), SRD5A1, and SRD5A2; expression levels of androgen-dependent genes in skin. Setting: Academic medical center. Results: Symptomatic finasteride users were similar in body composition, strength, and nucleotide sequences of AR, SRD5A1, and SRD5A2 genes to asymptomatic finasteride users and nonusers. Symptomatic finasteride users had impaired sexual function, higher depression scores, a more negative affectivity balance, and more cognitive complaints than men in groups 2 and 3 but had normal objectively assessed cognitive function. Testosterone, dihydrotestosterone, 5α-androstane-3α,17β-diol-glucuronide, testosterone to dihydrotestosterone and androsterone glucuronide to etiocholanolone glucuronide ratios, and markers of peripheral androgen action and expression levels of AR-dependent genes in skin did not differ among groups. fMRI blood oxygen level-dependent responses to erotic and nonerotic stimuli revealed abnormal function in brain circuitry linked to sexual arousal and major depression. Conclusions: We found no evidence of androgen deficiency, decreased peripheral androgen action, or persistent peripheral inhibition of

MATERNAL SELF-REPORTED DEPRESSIVE SYMPTOMS AND MATERNAL CORTISOL LEVELS INTERACT TO PREDICT INFANT CORTISOL LEVELS.

PubMed

Khoury, Jennifer E; Gonzalez, Andrea; Levitan, Robert; Masellis, Mario; Basile, Vincenzo; Atkinson, Leslie

2016-01-01

Three basic findings have emerged from research on maternal depressive symptoms and offspring hypothalamic-pituitary-adrenal functioning: (a) Mothers' depressive symptoms are positively associated with their offsprings' cortisol stress response, (b) numerous individual and interpersonal maternal characteristics moderate this association, and (c) maternal and infant cortisol levels are highly correlated. In combination, these findings have suggested that maternal cortisol levels may moderate the relation between maternal depressive symptoms and infant cortisol responsivity; the current study assessed this hypothesis. Participants were 297 mother-infant dyads who were recruited from the community. Maternal depressive symptoms were assessed via self-report. Dyads participated in two differentially stressful infant challenges when infants were 16 and 17 months old. Mother and infant salivary cortisol was collected before and after challenges. Results indicate that maternal cortisol levels moderated associations between maternal depressive symptoms and infant cortisol levels across both challenges. Infants showed higher cortisol levels if their mothers had both higher depressive symptoms and higher cortisol levels, as compared to infants of mothers with higher depressive symptoms and lower cortisol, and to infants of mothers with lower depressive symptoms and either higher or lower cortisol levels. We discuss findings in relation to environmental and biological factors that may contribute to the intergenerational transmission of depressive symptoms. © 2016 Michigan Association for Infant Mental Health.

[Neuropsychiatric symptoms in Sotos syndrome. Case report and review of the literature].