Investigating metacognition,cognition, and behavioral deficits of college students with acute traumatic brain injuries

ABSTRACT

Objective: Executive dysfunction in college students who have had an acute traumatic brain injury (TBI) was investigated. The cognitive, behavioral, and metacognitive effects on college students who endorsed experiencing a brain injury were specifically explored. Participants: Participants were 121 college students who endorsed a mild TBI, and 121 college students with no history of a TBI were matched on sex and ethnicity to examine potential differences between groups. Methods: Participants completed the Dysexecutive Questionnaire (DEX). Results: A Rasch analysis indicated that the TBI group had significantly higher total scores on the DEX than the control group. Moreover, when compared with the control group, the students with a TBI had higher scores on all 3 subcomponents of the DEX. Conclusion: These findings suggest that students who endorse brain injuries may experience more difficulty with specific facets of college. Thus, the importance of academic and personal resources available for students with a TBI is discussed.     

Risk factors and physical signs of child abuse in hospitalized children in Taiwan

PurposeThis study used the Criteria for Distinguishing Abuse from Accidents Chinese version (CDAA-C) to determine cases of child abuse, undetermined intent, and unintentional injury, and compared risk factors and injury profiles among hospitalized children in Taiwan.DesignA retrospective chart review study.MethodsWe selected children aged 0–3 who were hospitalized with a discharge diagnosis of injury or child maltreatment in a medical center in southern Taiwan between 2007 and 2009. The CDAA-C was used to collect children's demographics and injury types and to determine the intent of injury. Children's charts with records and notes of admission, surgery and emergency care were reviewed and analyzed.ResultsAmong 157 eligible cases, the CDAA-C identified 13 child abuse cases including additional 8 victims who were not previously coded in ICD-9-CM. Most abused children suffered from brain injuries, had ≥ 2 in jury incidents, and had a misdiagnosis in the previous visit. Abused children were younger and more likely to be born premature.ConclusionsThis study highlighted the under-diagnosis of child abuse in Taiwan. An easy-to-use standardized screening tool for child abuse in Taiwan is needed.     

Evaluation of the relationship between compliance with the follow-up and treatment protocol and health literacy in bladder tumor patients

Abstract

Objective: To investigate the relationship between the compliance of bladder cancer patients with cystoscopic follow-up and the treatment protocol, and their health literacy.

Methods: Patients who underwent transurethral resection surgery for bladder tumor were found to have non-muscular invasive bladder carcinoma on pathology examination and then underwent cystoscopic follow-up for 1?year or more were included in the study. Cystoscopic follow-up was recommended to the low- and high-risk groups in terms of progression and recurrence. The patients were evaluated with the Health Literacy Survey-European Union scale.

Results: The mean age of the patients was 67.13?±?10.77 years. The treatment continuity rate was 80.50% (n?=?33) in the adequate health literacy group (n?=?41) and significantly higher than the 56.50% (n?=?48) rate in the inadequate health literacy group (n?=?85) (p?=?.008). The health literacy results revealed that the health promotion and general index score was higher in the group of patients under the age of 65.

Conclusions: Adequate health literacy in bladder cancer patients is associated with better compliance with the treatment protocol. Young patients show better compliance with the follow-up protocol recommended by the physician. Increasing the follow-up protocol compliance of elderly patients with inadequate health literacy is necessary.     

US campus fraternities and sororities and the young adult injury burden

Objective: To investigate whether the presence of fraternities and sororities was associated with a higher local injury rate among undergraduate-age youth. Methods: In 2016 we compared the rate of 2010–2013 youth (18–24 years) emergency department (ED) visits for injuries in Hospital Service Areas (HSA) with and without fraternities and sororities. ED visits were identified in the State Emergency Department Database (n=1,560 hospitals, 1,080 HSAs, 16 states). US Census Bureau and National Center for Education Statistics sources identified HSA population and campus (n=659) characteristics. A proprietary database identified campuses with fraternities and sororities (n=287). ED visits explicitly linked to fraternities and sororities in the National Electronic Injury Surveillance System–All Injury Program were used to identify injury causes for sub-group analysis. Results: HSAs serving campuses with fraternities and sororities had lower age 18–24 injury rates for all causes except firearm injuries (no difference). Conclusions: Fraternities and sororities were not associated with a higher injury rate at the population level among undergraduate-age youth. A major limitation is not being able to observe campus health services utilization.     

Transurethral resection of the prostate achieves favorable outcomes in stroke patients with symptomatic benign prostate hyperplasia

Objectives: To evaluate the surgical outcomes of stroke patients with symptomatic benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP) and compare the clinical outcomes between patients with stroke and those without stroke receiving this procedure.

Methods: This retrospective cohort study analyzed claims data collected during the period of 1997–2012 from Taiwan National Health Insurance Research Database. We enrolled 6625 patients who had persistent lower urinary tract symptoms and underwent TURP for BPH. They were categorized into a stroke (n?=?577) and nonstroke (n?=?6048) group. Patient characteristics, postoperative clinical outcomes, medication records, and medical expenses were compared.

Results: Compared with the stroke group patients, those in the nonstroke group were younger, had fewer comorbidities, and more favorable postoperative clinical outcomes. Nevertheless, TURP achieved favorable outcomes in stroke patients with symptomatic BPH. In the stroke group, the rate of urinary tract infection (UTI) decreased from 34.7% during 1 year preoperatively to 29.8% during 1 year postoperatively (p?=?.05). The rate of urinary retention (UR) also decreased from 55.5% during 1 year preoperatively to 22.5% during 1 year postoperatively (p?=?.05). TURP reduced the overall medical expenses of patients with stroke. Annual patient medical expense during 1 year preoperatively, 1 year postoperatively, 2 years postoperatively, and 3 years postoperatively was NT$659,000, NT$646,000, NT$560,000, and NT$599,000, respectively.

Conclusions: In patients with stroke, TURP reduces the risks of UTI and UR and annual total medical expense.     

Cognitive functions and health-related quality of life in men with benign prostatic hyperplasia and symptoms of overactive bladder when treated with a combination of tamsulosin and solifenacin in a higher dosage

Aim: To study the cognitive functions and health-related quality of life (HRQoL) in individuals taking a combination of tamsulosin and solifenacin in a higher dosage.

Methods: All patients (n?=?262) were assigned to group A (N?=?93, tamsulosin 0.4?mg?+?solifenacin 10?mg per day), group B (N?=?83, tamsulosin 0.4?mg?+?solifenacin 20?mg), and control group C (N?=?86; tamsulosin 0.4?mg?+?placebo). The lower urinary tract (LUT) condition was assessed on the scales International Prostate Symptom Score, Over Active Bladder Awareness Tool and uroflowmetry. The state of cognitive status was assessed on the scales Mini-mental State Examination, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler III, Color Trails Test, California Verbal Learning Test.

Results: The values of cognitive function indicators in the individuals from all groups after treatment did not significantly differ from the respective values at the baseline (p?>?.05). The values of most HRQoL parameters of the functional state of the LUT significantly improved in groups A and B. A significant correlation between the state of cognitive status and HRQoL, as well as LUT was absent (r?<0.3).

Conclusion: The combination of solifenacin in a double dosage along with tamsulosin can be recommended for elderly benign prostatic hyperplasia patients with overactive bladder symptoms.     

Lifetime exposure to abuse,current stressors,and health in federally qualified health center patients

ABSTRACT

Purpose: The purpose of this study was to examine the impacts of lifetime exposure to abuse and current stressors on health, an integrative concept of physical, mental and social health, among patients of a Federally Qualified Health Center.

Method: The sample included 1,055 patients (male: N = 346; female: N = 709) who were at least 18 years of age and completed an assessment on their first visit between January 2015 and March 2017 at a Federally Qualified Health Center. The assessment contained subscales of the DUKE Health Profile measuring physical, mental, and social health; four questions assessing lifetime exposure to abuse; and a relational and socioeconomic stressor checklist.

Results: Results from structural equation modeling analyses showed that for both male and female groups, lifetime exposure to abuse, relational stressors and socioeconomic-related stressors were strongly associated with health. In the male group, socioeconomic-related stressors were the strongest predictor of health, while in the female group, lifetime exposure to abuse was the strongest predictor of health.

Conclusions: Understanding the relationships between health and the combined factors of a lifetime exposure to abuse, relational stressors, and socioeconomic stressors can provide insight to patient care professionals who treat patients in lower income, underserved communities. Ecological Systems Theory provides a framework to plan interventions or to prevent potential negative outcomes associated with these stressors.     

Comparison of the effectiveness of IPSS and VPSS without any help in LUTS patients: a prospective study

Aim: To compare the correlation of visual prostate symptom score (VPSS) and international prostate symptom score (IPSS). To investigate the effect of educational level and age in the responses to VPSS and IPSS.

Method: Three hundred and nine patients who gave consent and applied via LUTS to our institution were included in this study. They were requested to fill IPSS and VPSS. The patients were divided into two groups as middle-aged and elderly with a cutoff point of 65?years. They were divided into six groups based on educational level. SPSS was used for the statistical evaluation.

Results: The mean age of the patients was 61.5?±?8.9?years. The correlation was found between IPSS and VPSS (p?p?=?.332 and .138, respectively). No difference was found between the middle-aged and elderly groups in terms of the rates of inability to answer IPSS and VPSS (p?=?.177 and .681, respectively).

Conclusions: There is a correlation between VPSS and IPSS. VPSS can be used as an auxiliary or alternative tool instead of IPSS in evaluating LUTS; however, has no superiority to IPSS in elderly group. Currently, the best option to exclude bias in illiterate group is VPSS.     

Radical prostatectomy for clinically localized prostate cancer in patients aged 75 years or older: comparison with primary androgen deprivation therapy

Objective: To determine whether radical prostatetomy (RP) is suitable for prostate cancer patients with age ≥75 years in comparison to primary androgen deprivation therapy (PADT).

Patients and methods: A cohort study was conducted in clinically localized prostate cancer patients with ≥75 years of age who underwent RP or PADT at six institutions from 2005 to 2013. Patients who had less than 12 months of follow-up, or received neoadjuvant or adjuvant therapy were excluded. We compared clinical characteristics, cancer-specific and overall survivals, and post-treatment complication rates between two groups.

Results: We included 92 and 99 patients in the RP and PADT groups, respectively. In survival analyses, there were no significant differences in cancer-specific and overall survivals (p?=?.302 and .995, respectively). The incidence of serious adverse events (cardio- or cerebrovascular event, or bone fracture) was higher in the PADT group (p?=?.001). Multivariable analysis showed that PADT had a worse effect on the serious adverse events (OR 10.12, p?=?.038).

Conclusions: In selected elderly patients, RP was safe and effective for treatment of localized prostate cancer, as compared to PADT. Surgical treatment options should be considered in elderly patients with respect to life expectancy, rather than chronological age.     

Prevalence of Sufficient Physical Activity Among Parents Attending a University

Objective: The benefits of regular physical activity are well documented. However, approximately half of all university students are insufficiently active, and no research to date exists on the activity behavior of university students who are also parents. Participants and Methods: Using an adapted version of the Godin Leisure Time Exercise Questionnaire (ie, the Physical Activity Prevalence Questionnaire), the authors examined the prevalence of sufficient physical activity among 245 parent students from 6 faculties and 12 programs. Results: Half (49.5%) of the students who were not parents (n = 90) were sufficiently physically active, compared with 16% of students who were parents (n = 3, p < .002). The authors found that 33.3% of parents and 13% of nonparents limited their activity level as a result of illness or injury (p < .05). Conclusions: Most parent students in this study were insufficiently active and at potential risk for the negative health consequences of inactivity. This is a grossly understudied population, and researchers must conduct further studies to understand what can be done to facilitate physical activity among this potentially vulnerable group of students.     

From Hospital to Home with NDIS Funded Support: Examining Participant Pathway Timeframes Against Discharge Expectations

ABSTRACT

For patients with disability who require funded supports to leave hospital, the introduction of the National Disability Insurance Scheme (NDIS) represents opportunity and challenges. At a time of major reform, timely and supported discharge is reliant on overcoming interface complexities. The purpose of this study was to examine the NDIS participant pathway timeframes against discharge expectations for hospitalised adults with spinal cord injury (SCI) or acquired brain injury (ABI) and interrogate delays for the two groups. Administrative data on 54 participants (ABI?=?18 and SCI?=?36) were analysed. Both groups experienced delays to discharge and significant variability in timeframes between NDIS pathway processes and extent of delays. Group differences were identified regarding inefficiencies across the continuum, with type of support a factor to investigate further. This study has uncovered critical points in the NDIS pathway that could impact discharge of participants and where collaboration and adaptive strategies could be targeted to improve processes.

IMPLICATIONS

• Ensuring the National Disability Insurance Scheme (NDIS) pathway operates effectively in the hospital setting is critical to the timely discharge of people with complex needs who require funded supports.

• Monitoring implementation of the NDIS in the health setting is important to avert interface problems that impede timely discharge and access.

     

Evaluation of the relationship between microalbuminuria and 25-(OH) vitamin D levels in patients with type 2 diabetes mellitus

Background: 25-(OH) vitamin D (VD) deficiency has been described as potential risk factor for the development of diabetes in many epidemiological studies. 25-(OH) VD deficiency and insulin resistance associated with this deficiency are common findings in patients with type 2 diabetes mellitus. The objective of this study is to evaluate the relationship between 25-(OH) VD levels and microalbuminuria.

Methods: The patients with type 2 diabetes mellitus aged between 40 and 65 years, who were admitted to the diabetes outpatient clinics of our hospital, were evaluated in two different groups. The first group consisted of 119 patients with insufficient 25-(OH) VD levels (10–30?ng/mL) and the second group consisted of 121 patients with 25-(OH) VD deficiency (≤10?ng/mL). The relationship between 25-(OH) VD levels and the level of microalbuminuria was evaluated in the two groups.

Results: The mean 25-(OH) VD level was 11.5?ng/mL and the mean HbA1c level was 9.1%. When the patient groups were evaluated according to 25-(OH) VD levels, HbA1c values were significantly higher in patients with a 25-(OH) VD level of 10?ng/mL or lower (p?=?.039). 25-(OH) VD levels were not significantly different between patients with different stages of renal failure (p?=?.119), whereas the level of microalbuminuria was significantly different (p?=?.030).

Conclusions: This study found that the level of microalbuminuria was significantly higher in patients with 25-(OH) vitamin D deficiency compared to patients with 25-(OH) VD insufficiency.     

Managing Employee Absence

ABSTRACT

Employee absences represent a major concern for employers due to financial losses, both direct and indirect. Absences occur for several reasons; however, perhaps the most significant loss of work time is attributed to work related injuries. This paper addresses losses due to injury and proposes a plan of action for effective cost containment involving rehabilitation case management and early return to work.     

Psychosocial experiences of concussed collegiate athletes: The role of emotional support in the recovery process

Abstract

Objective: Understand from whom concussed football players seek and receive emotional support, and whether this support is associated with injury perceptions. Participants: Football players (N?=?26) from three NCAA Division I programs. Methods: With approval from the head athletic trainer, concussed athletes (2017 season) completed short surveys within 4–6?days of diagnosis and when cleared to return. Results: Concussed athletes perceived their injury as a normal consequence of playing football, not serious, and reported little, if any, depression and anxiety. Athletes reported the most support from athletic trainers; the least from coaches and teammates. Emotional support was associated with fewer adverse psychosocial reactions, more sport-injury related growth, and greater intentions to report future concussion symptoms. Conclusion: Results from this pilot study suggest that emotional support during the concussion recovery process should be understood and fostered by university officials charged with the health and well-being of collegiate football players.     

Effectiveness of the Brief Alcohol and Screening Intervention for College Students (BASICS) Program With a Mandated Population

Abstract

Objective: This study evaluated the effectiveness of a large-scale intervention designed to reduce alcohol abuse among adjudicated college students. Participants: Participants were college students mandated to attend a Brief Alcohol Screening and Intervention for College Students (BASICS) program and a randomly selected comparison group of high-risk drinkers. Methods: Data were collected from January 2006 through December 2008. A total of 1,390 (67%) students in the intervention group and 508 (61%) students in the comparison group completed baseline and 6-month follow-up surveys. Results: Male students in the intervention group significantly decreased their drinking at follow-up, whereas those in the comparison group increased their drinking. Women in both the intervention and comparison groups decreased their drinking at 6 months. Conclusions: When implemented with fidelity, BASICS is a generally effective intervention, especially for male adjudicated college students. The intervention was most effective for moderate- and high-risk drinkers.     

Spinal Cord Injury

ABSTRACT

This article provides an overview of spinal cord injury (SCI) that is useful and informative for social workers and other health care professionals who work with this population. Social workers new to the specialty of spinal cord injury must expand their knowledge base of this chronic injury. Social workers contribute to the rehabilitation process through assessment, education, and discharge planning. This article also may be used to inform persons with spinal cord injury and their families and to encourage them to engage in dialogue about SCI in the earliest stages of treatment and rehabilitation.     

Brachial Plexus Stretch Injury

Abstract

Upper trunk brachial plexopathy is a significant injury. Five percent to ten percent of “burners” result in a neurologic deficit which may take several weeks for full recovery. Anatomy, pathophysiology, physical examination, criteria for return to play, and therapy are reviewed.     

Safety of a meningococcal group B vaccine used in response to two university outbreaks

Objective: To assess the safety of meningococcal group B (MenB)-4C vaccine. Participants: Undergraduates, dormitory residents, and persons with high-risk medical conditions received the MenB-4C vaccine two-dose series during mass vaccination clinics from 12/2013 through 11/2014. Methods: Adverse events (AEs) were identified by 15 minutes of observation postvaccination, spontaneous reports, surveys, and hospital surveillance. Causality was assessed for serious adverse events (SAEs). Results: 16,974 persons received 31,313 MenB-4C doses. The incidence of syncope during the 15-minutes post-dose 1 was 0.88/1000 persons. 2% of participants spontaneously reported an AE (most common were arm pain and fever). 3 SAEs were suspected of being caused by the vaccine, including one case of anaphylaxis. Conclusions: Most AEs reported were nonserious and consistent with previous clinical trial findings. Measures to prevent injury from syncope and to treat anaphylaxis should be available wherever vaccines are administered. Our safety evaluation supports the use of MenB-4C in response to outbreaks.     

Gonococcal Perihepatitis: Diagnosis and Management in a College Population

Abstract

Although gonococcal perihepatitis is not a common clinical problem, it should be in the differential diagnosis of patients who present with right upper quadrant pain and a subsequent positive gonorrhea culture. With the increasing incidence of venereal disease, more cases of gonococcal perihepatitis are anticipated, and an awareness of its protean manifestations should be known and considered by all health care providers. This is especially true for physicians treating college students, as the sequelae of pelvic infection can be severe tissue injury to the reproductive organs with resultant involuntary infertility.

This paper presents three cases of diagnosed gonococcal perihepatitis in a college population with a complete literature review of this disease entity.     

Elder care as "frustrating" and "boring": Understanding the persistence of negative attitudes toward older patients among physicians-in-training

ObjectivesThis study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.MethodsThis study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.ResultsWe found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called “hidden” curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a “problem” of inevitable biological decay and an opportunity for medical intervention.DiscussionEfforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled “frustrating” or “boring”.