bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of Current and Remitted Cannabis Use Disorder With Health-related Quality of Life and Employment Among US Adults
Authors: Rhee Taeho Greg , Rosenheck Robert A.
Published: June 2021

Background

The associations of current and remitted cannabis use disorder (CUD) with health-related quality of life (HRQOL) and employment have not been studied, and we aim to address these gaps.

Methods

The 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized civilian US adults (≥18 years) (n = 36,309 unweighted). Using DSM-5 criteria, adults with current CUD were compared with those with CUD in remission and no history of CUD on standard measures of the mental and physical component scores of HRQOL and of quality-adjusted life years (QALYs) along with employment in the past 12 months. Multivariable-adjusted regression analyses were used to adjust for and examine the role of covariates.

Results

Overall, 2.5% of the study sample, representing 6.0 million adults nationwide, met criteria for current CUD, and 3.7%, representing 8.8 million adults, met the criteria for CUD in remission. Adults with current or past CUD had lower mental HRQOL and QALYs, as compared to adults who never had CUD. However, these differences were no longer significant when adjusted for behavioral co-morbidities and personal histories. Current CUD was associated with lower odds of being employed (Adjusted odds ratio AOR = 0.76; 95% confidence intervals [CI], 0.60–0.96), but CUD in remission with a greater likelihood of employment (Adjusted odds ratio = 1.53; 95% CI, 1.23–1.91), both as compared to those never experiencing CUD.

Conclusions

Both current CUD and past CUD are adversely associated with HRQOL and current CUD with not being employed; Since CUD associations are not independent of comorbidities, treatment must take a wide-ranging approach.
Mitigation of Triceps Avulsion Fracture After Proximal Ulna Plate Fixation
Authors: Orbay Jorge , Vernon Lauren , Gibson Keegan , Lacau Gustavo , Mercer Deana , Hoekzema Nathan
Published: June 2021

Objectives:

Triceps avulsion fractures have become an increasingly common postoperative complication of olecranon fracture repair with proximal ulna plate (PUP) fixation. The purpose of this study is to create an efficient, reproducible mechanism to mitigate this issue.

Methods:

Ten matched pair cadaveric specimens underwent a complete transverse osteotomy to simulate an olecranon fracture, followed by fracture reduction with a PUP. One arm from each pair underwent an additional augmented suture repair, where the triceps tendon was sutured directly to the plate. A custom jig was used to hold the specimen in position and apply a tensile force on the triceps until mechanical failure.

Results:

All control specimens (without augmented suture repair) failed through a full-thickness triceps avulsion fracture at an average force of 967.7 N. The augmented suture-repaired specimens failed at an average force of 1204.3 N through partial avulsion fractures, widening of the osteotomy site, and triceps ruptures.

Conclusions:

Our study demonstrated that an augmented suture repair of PUP fixation for olecranon fractures is a simple and effective way to significantly increase fixation strength and change the potential failure mechanism.
Clinical Outcomes and Surgical Complications Among Patients with Bleeding Disorders After Acute Hip Fracture Surgery
Authors: Darbandi Aria D. , Saadat Ghulam H. , Butler Bennet A. , Bokhari Faran
Published: June 2021

Objective:

To compare short-term (≤30 days) outcomes of hip fracture between patients with and without bleeding disorders.

Design:

Retrospective database review.

Setting:

The study setting included hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database.

Patients:

Patients with acute hip fractures were identified from the National Surgical Quality Improvement Program database between 2016 and 2019.

Intervention:

Open reduction internal fixation or hemiarthroplasty.

Main Outcome Measurements:

Mortality, readmission, reoperation, length of stay, and complication were main outcome measurements.

Results:

There were 63,718 patients undergoing hip surgery, and 16.0% had a bleeding disorder. After adjusting for confounders, multivariable regression models showed that cases with bleeding disorders were associated with higher rates of transfusion [odds ratio (OR) 1.404; confidence interval (CI), 1.335–1.479], myocardial infarction (OR 1.367; CI, 1.190–1.572), pneumonia (OR 1.193; CI, 1.078–1.321), renal failure (OR 1.843; CI, 1.363–2.491), surgical site infections (OR 1.429; CI, 1.185–1.175), sepsis (OR 1.25; CI, 1.034–1.511), and readmission (OR 1.314; CI, 1.224–1.408). However, bleeding disorders were not associated with mortality (OR 0.947; CI, 0.866–1.036) or reoperation (OR 1.061; CI, 0.925–1.220).

Conclusions:

Hip fracture surgery in patients with bleeding disorders is not associated with higher risks of short-term mortality or reoperation. However, special consideration should be taken when calculating preoperative risks of complications among bleeding disorder patients.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Treatment of Posttraumatic Tibial Diaphyseal Bone Defects: A Systematic Review and Meta-Analysis
Authors: Klifto Kevin M. , Azoury Saïd C. , Klifto Christopher S. , Mehta Samir , Levin L. Scott , Kovach Stephen J.
Published: June 2021

Objective:

To describe evidenced-based treatment options for patients who sustained trauma and/or posttraumatic osteomyelitis of the tibia resulting in diaphyseal bone defects and to compare outcomes between patients treated with nonvascularized bone grafts (NBGs), bone transport (BT), or vascularized bone grafts (VBGs).

Data Source:

The Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data and Cochrane guidelines were followed. PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and CINAHL were searched from inception to June 2020.

Study Selection:

Patients who were ≥18 years, had sustained trauma to the tibia resulting in fracture and/or osteomyelitis with measurable diaphyseal bone defects, and were treated by interventions such as NBGs, BT, or VBGs were eligible. Excluded studies were non-English, reviews, nonreviewed literature, cadavers, animals, unavailable full texts, nondiaphyseal defects, atrophic nonunions, malignancy, and replantations.

Data Extraction:

A total of 108 studies were included with 826 patients. Two reviewers systematically/independently screened titles/abstracts, followed by full texts to ensure quality, accuracy, and consensus among authors for inclusion/exclusion of studies. A third reviewer addressed disagreements if investigators were unable to reach a consensus. Studies were quality assessed using “Methodological Quality and Synthesis of Case Series and Case Reports”.

Data Synthesis:

Analyses were performed with IBM SPSS version 25.0 (IBM Corporation, Armonk, NY) and G*Power3.1.9.2.

Conclusions:

NBGs may be considered first line for trauma defect sizes ≤ 10 cm or posttraumatic osteomyelitis defect sizes <5 cm. BT may be considered first line for posttraumatic osteomyelitis defect sizes <5 cm. VBGs may be considered first line for trauma and posttraumatic osteomyelitis defect sizes ≥5 cm.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Pancytopenia after administration of hyperthermic intraperitoneal chemotherapy with mitomycin-C: local therapy and systemic toxicity
Authors: Wu Vernon , Shen Janice , Chung Su Yun , Saif Muhammad Wasif
Published: June 2021

Cytoreductive surgery (CRS) coupled with hyperthermic intraperitoneal chemotherapy (HIPEC) has become the standard of treatment for many cancers with peritoneal metastasis. Mitomycin-C (MMC), the most common chemotherapy utilized with HIPEC, is associated with neutropenia but the degree of hematologic toxicity is unclear when splenectomy is included as part of CRS with MMC. We present an interesting case of pancytopenia following treatment with HIPEC using MMC and comment on the possible role of splenectomy in exacerbating its cytotoxic effects. Our unique case highlights potential hematologic toxicity following MMC-HIPEC and splenectomy. It suggests that spleen removal may enhance toxicity profiles of chemotherapy such as MMC. Because MMC is the preferred agent of choice used in CRS-HIPEC, future studies should investigate optimal MMC dosing and patient selection when splenectomy is performed to balance survival benefit with hematologic toxicities.
Repurposing calcium channel blockers: may be sensible combination with erlotinib for non-small cell lung cancer
Authors: Alandağ Celal , Merev Elif , Özdemir Feyyaz
Published: June 2021

Erlotinib is a tyrosine kinase inhibitor that inhibits epidermal growth factor receptor. It is being used for metastatic non-small cell lung cancer patients (NSCLC). Repurposing noncancer drugs for cancer treatment is a current issue and it has many advantages. We planned to reveal the effects of noncancer drugs [calcium channel blockers (CCBs) and others] on erlotinib. We scanned the files of NSCLC patients retrospectively who were applied to Karadeniz Technical University between January 2013 and April 2019 and used erlotinib. There were 63 patients, 9 of them were taking CCB simultaneously for arterial hypertension. We analyzed some parameters of these patients and their effects on overall survival (OS) and progression-free survival (PFS). A χ
2 or Fisher’s exact test, Kaplan–Meier and Cox regressions were used in the statistical analysis. 12-month OS rates of CCB user and nonuser were 78.3 and 39.7%, respectively, [odds ratio (OR),0.14; 95% confidence interval (CI), 0.27–0.75; P = 0.023]. 24-month PFS rates of CCB user and nonuser were 44.4 and 8.3%, respectively (OR,0.11; 95% CI, 0.02–0.60; P = 0.016). There was 12-month OS and 24-month PFS advantage with simultaneously taking CCBs and erlotinib, they have an additive effect for NSCLC. This study will be inspiring future prospective studies.
The efficacy and safety of low-dose Apatinib in the management of stage IV luminal-type breast cancer: a case report and literature review
Authors: Lv Xingxing , Chen Juan , Yi Tingwu , Lu Hong , Liu Juan , Yu Danfei
Published: June 2021

Advanced breast cancer (ABC) is incurable. Previous studies have shown that vascular endothelial growth factor (VEGF) inhibitors play a significant role in the angiogenesis of breast carcinoma. Apatinib, a highly selective orally administered small-molecule tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor-2 (VEGFR2) has successfully been used as a second- and third-line agent in the management of ABC. There are also multiple reported cases where Apatinib was miraculously effective in the management of triple-negative and HER2-positive tumors. However, case reports of its effectiveness against luminal-type tumors are rare. Here, we report the case of a 34-year-old woman with hormone receptor-positive and HER2-negative ABC who was successfully treated with low-dose Apatinib. Owing to necrosis of the center of the tumor due to the effective anticancer effect of Apatinib, a large cavity formed rapidly in the primary lesion; thus, the quality of life of the patient was seriously affected. This report aims to caution physicians about this unique phenomenon when using Apatinib in clinical practice.
Successful nelarabine and venetoclax treatment of a relapsed/refractory mediastinal myeloid sarcoma with clonal TCR rearrangement
Authors: Contejean Adrien , Palmic Patricia , Kosmider Olivier , Belhadj Maya , Willems Lise , Lengliné Etienne , Suarez Felipe , Damotte Diane , Cottereau Anne-Ségolène , Asnafi Vahid , Bouscary Didier , Burroni Barbara
Published: June 2021

Myeloid sarcomas represent a heterogeneous group of diseases with a tumoral presentation of acute myeloid leukemia. The clinical presentation of these hematologic cancers is typically aggressive and thus rapidly fatal in the absence of treatment, which relies on intensive chemotherapy that is sometimes followed by allogeneic hematopoietic stem-cell transplant (AHSCT). However, the global treatment strategy for these lesions is currently not well established. We report the case of a patient presenting with a highly refractory mediastinal myeloid sarcoma with uncommon morphologic and phenotypic characteristics and a clonal TCR rearrangement. The patient’s disease was progressive despite multiple courses of intensive chemotherapy and a combination of nelarabine and venetoclax finally led to a complete metabolic response consolidated by an AHSCT. This treatment regimen, which has never been reported before, was very well tolerated especially on the neurologic and hematologic levels. This case underlines the clinical, histologic and molecular heterogeneity of what is called myeloid sarcoma and the importance of next-generation sequencing analysis of the tumor mass with both myeloid and lymphoid panels to better classify this rare entity and identify therapeutic targets.
IL-12 inhibits postoperative residual tumor growth in murine models of sarcoma and renal carcinoma
Authors: Ding Huiqin , Yuan Shoujun , Wang Jiangang , Qin Huan , Han Yantao
Published: June 2021

Surgical tumor removing is the most common procedure after a confirmed cancer diagnosis with no detected metastasis. Surgery can reduce tumor burden and address pathologic changes caused by local compression of tissues by the tumor. This lowers the chances of tumor cell spreading and creates more favorable conditions for further treatment. However, not all tumor cells can be eliminated through surgery. Even in the early stages of the disease, tumor cells often metastasize and cannot be identified by current detection methods. These tiny, disseminated tumors are often the cause of tumor recurrence. There is currently a lack of effective treatment options that can completely prevent tumor recurrence after surgery. To simulate the actual clinical situation, we selected murine-derived tumor cell lines S180 and Kcc853 to establish a post-transplantation residual tumor model in mice. Surgery was performed on mice inoculated with tumors. Tumor tissue was partially excised to set up the postsurgical residual tumor models. The model simulated the clinical situation where tumor cells were not completely eliminated or there were small tumors that had metastasized before surgery. IL-12 was injected to observe its effect on residual tumors or metastatic microtumors. The administration of IL-12 after surgery can significantly inhibit the growth of residual tumors and metastasis, improve the postoperative tumor-free rate and address the problem of tumor recurrence caused by the growth of residual tumors and micro-metastasis. Therefore, the use of IL-12 antitumor cytokine combined with surgery can effectively inhibit tumor recurrence. Low-dose IL-12 (1–10 ng/kg in humans) can inhibit residual tumor growth.
Quality of Online Information Regarding High-Risk Pregnancies
Authors: Lee Shin-Young , Lee Seonah
Published: June 2021

Health information on the Internet can have a direct effect on healthcare decision-making. However, the quality of information online has seldom been evaluated. This study aimed to assess the quality of online information on high-risk pregnancies provided by English and Korean Web sites. Through a Google search, 30 English and 30 Korean Web sites were selected on January 2 and 3, 2020, respectively, and assessed using DISCERN, a Journal of the American Medical Association, and Health On the Net Foundation code questionnaires. The data assessed were analyzed using descriptive and nonparametric statistical tests. Overall, the information provided by the English Web sites presented higher-quality information than the Korean Web sites. Most Web sites did not provide the sources of the information presented on their Web sites, meet the Journal of the American Medical Association criteria, or provide information on complementarity. Based on our results, nurses need to be competent in assessing the quality of Web sites and the health information presented there, and nursing students need to be prepared to do so as well. Nurses are responsible for educating their patients about the possibility of incorrect information provided by Internet Web sites and informing their patients about reliable Web sites, thus assisting them to make informed decisions regarding their health.
Reducing Hospital Visit Rates in Hospice Patients Using Telemedicine
Authors: Teter Clara Michelle , Whitted Kelli , Vardaman Shellye A.
Published: June 2021

The purpose of this project was to examine the impact of accessibility to a provider via telemedicine on emergency department visit rates in adults, 35 years and older, on home hospice and palliative care. Utilizing a quasi-experimental design, 44 adults 35 years and older were educated on Doxy.me telemedicine usage as an intervention. Measures included gender, diagnosis, age, the reason for contact, and outcome (intervention group only); the number of emergency department visits, the number of 911 calls, and the number of discharges/transfers (control and intervention) in the 8 weeks after the evidence-based telemedicine intervention. Statistical analyses were performed to examine the number of emergency department visits and 911 calls preintervention and postintervention among all participants. A total of eight teletechnology calls were documented from a patient or patient caregiver. Among the intervention group, the number of emergency department visits and the number of 911 calls decreased from 12 (54.5%) to one (4.5%) postintervention. Paired-samples t tests show there were statistically significant differences in the number of emergency department visits and 911 calls between the two points in time. In conclusion, a telemedicine hospice care application may benefit a palliative and hospice organization by enhancing patient clinical outcomes and decreasing emergency department visit rates.
Feasibility, Acceptability, and Preliminary Impact of Asdzáán Be'eená
Authors: Chambers Rachel A. , Patel Hima , Richards Jennifer , Begay Jaime , Littlepage Shea , Begay Marissa , Sheppard Laurelle , Nelson Danielle , Masten Kristin , Mitchell Kristin , Kee Crystal , Barlow Allison , Tingey Lauren
Published: June 2021

Native American youth endure a complex interplay of factors that portend greater risk-taking behaviors and contribute to marked health disparities experienced in adolescence. The Asdzáán Be'eená (“Female Pathways” in Navajo) program was developed as a primary prevention program to prevent substance use and teen pregnancy among Navajo girls. The Asdzáán Be'eená program consists of 11 lessons delivered to dyads of girls ages 8 to 11 years and their female caregivers. Feasibility, acceptability, and preliminary impact on risk and protective factors were assessed through a pre-/post study design. Data were collected from girls and their female caregivers at baseline, immediate, and 3 months postprogram completion. Forty-seven dyads enrolled in the study, and 36 completed the 3-month evaluation. At 3 months postprogram, girls reported significant increases in self-esteem, self-efficacy, parent-child relationship, social support, cultural, and sexual health knowledge. Caregivers reported increased family engagement in Navajo culture and parent-child communication and improved child functioning (fewer internalizing and externalizing behaviors). Findings suggest Asdzáán Be'eená has potential to break the cycle of substance use and teen pregnancy in Native communities by improving protective and reducing risk factors associated with these adverse health outcomes. Additional rigorous efficacy trials are necessary to establish program effectiveness.
Unemployment Status Is Associated With Greater Cognitive Intraindividual Variability in Veterans With a History of Remote Mild TBI
Authors: Sakamoto McKenna S. , Delano-Wood Lisa , Sorg Scott F. , Schiehser Dawn M. , Merritt Victoria C.
Published: June 2021

Objective:

To examine the association between employment status and neuropsychological functioning in veterans with a history of remote mild traumatic brain injury (mTBI) using 2 approaches to assess cognitive performance: (a) standard, traditional mean cognitive performance; and (b) across-test intraindividual variability (IIV).

Setting:

Outpatient Veterans Affairs (VA) hospital.

Participants:

Eligibility criteria included veterans with a history of mTBI who performed adequately on performance validity tests. Participants (N = 75; 37 employed, 38 unemployed) were evaluated, on average, about 5.5 years after their most recent mTBI.

Design:

Observational cohort study; all participants completed a clinical interview and a comprehensive neuropsychological assessment.

Main Measures:

Primary outcomes of interest included mean cognitive composite test scores and IIV scores on tasks of memory, attention/processing speed, and executive functioning.

Results:

Logistic regression models showed that mean cognitive performance was not predictive of employment status; however, IIV indices were (

= 7.88, P = .048) and accounted for 13% of the variance. Greater memory-IIV was significantly associated with being unemployed (β = −.16, SE = .07, P = .020, Exp(B) = 0.85; 95% CI, 0.74-0.98).

Conclusion:

These findings build upon prior work showing that IIV, or cognitive dispersion, is associated with important functional outcomes following mTBI, including employment status. Future studies are needed to verify these findings, but the present study suggests that IIV indices offer a clinically meaningful marker of cognitive functioning and should be considered when evaluating functional outcomes following head trauma.
Impact of Prior Brain Injury on Concussion Recovery in Military Personnel: Evaluation of Timing Between Concussions
Authors: Remigio-Baker Rosemay A. , Babakhanyan Ida , Gregory Emma , Cole Wesley R. , Ettenhofer Mark L. , West Therese , Qashu Felicia , Mullins Lynita , Bailie Jason M.
Published: June 2021

Objective:

To evaluate the potential impact of timing between the current and the most recent previous concussions on symptom severity among acutely concussed active duty military Service members (SMs).

Setting:

Three military installations.

Participants:

Eighty-four SMs aged 18 to 44 years who sustained a concussion within 72 hours of enrollment. No previous concussion within 1 year preenrollment.

Design:

Longitudinal study with enrollment within 72 hours of injury, and follow-up at 1 week and 1 month postinjury.

Main Measures:

Lifetime concussion history (yes/no) and recency of the latest concussion (no history, relatively more recent [1 to <6 years ago], and more remote [6+ years ago]) from the current concussion using the Ohio State University Traumatic Brain Injury Identification Method–Interview Form. Symptom severity (total and by categories: cognitive, affective, somatosensory, vestibular) at all time points using the Neurobehavioral Symptoms Inventory.

Results:

Concussion history assessed as having any previous concussion was not found significantly related to symptom severity (total or by categories) following a current concussion. However, when timing between concussion was taken into account, time since previous concussion was significantly related to symptomatology, whereby those with relatively more recent previous concussion had greater total symptoms within 72 hours of injury and at 1 week postinjury (though not at 1 month) than those with more remote previous concussion (≤72 hours: difference = 15.4, 95% CI = 1.8 to 29.1; 1 week: difference = 15.2, 95% CI = 1.2 to 29.2) or no history (≤72 hours: difference = 11.6, 95% CI = 0.4 to 22.8; 1 week: difference = 13.9, 95% CI = 2.4 to 25.4). When evaluated by symptom category, this relationship was particularly important on affective and somatosensory symptoms.

Conclusion:

In recently concussed active duty SMs, the timing between the current and previous concussions may be an important factor in determining prognosis. Clinical assessment of concussion history that accounts for the timing of the most recent event may be necessary to identify patients who may require a more conservative plan of care and more gradual return to activity in the acute recovery stage.
Critical Elements of Return to Learn for Students With Concussion: A Scoping Review
Authors: Kemp Amy M. , O'Brien Katy H.
Published: June 2021

Objective:

To identify critical elements of return to learn (RTL) for students with concussion and examine the state of the peer-reviewed published literature through a scoping review.

Methods:

Three electronic databases were systematically searched, and reference lists screened for articles addressing components of RTL protocols and accommodations for students with concussion. In total, 100 articles met inclusion criteria, including 56 empirical studies and 44 expert articles.

Results:

Four key components to RTL protocols were identified: RTL teams, management approaches, outcome measurement, and accommodations. Both bodies of literature agree on the importance of RTL teams, but evidence for specific monitoring tools and management approaches is less robust. Accommodations have been better addressed by experts than empirical evaluation. Empirical studies are largely cross-sectional, and many are survey based. Just 24 include student perspectives. Publication of expert literature has declined in frequency, as empirical studies have become more common.

Conclusion:

This scoping review describes the current landscape of RTL and provides guidance toward expanding the empirical literature to systematically determine best practices to serve students with concussion.
Cognitive Reserve in Individuals Aging With Traumatic Brain Injury: Independent and Interactive Effects on Cognitive Functioning
Authors: Venkatesan Umesh M. , Rabinowitz Amanda R. , Bernier Rachel A. , Hillary Frank G.
Published: June 2021

Objective:

To examine the influence of 2 temporal factors—age and injury chronicity—on the relationship between cognitive reserve (CR) and cognitive functioning in older adults with chronic traumatic brain injury (TBI).

Setting:

Outpatient research laboratory.

Participants:

Adults, 50 years or older, with a 1- to 45-year history of moderate or severe TBI (N = 108).

Design:

Cross-sectional observational study.

Main Measures:

CR was estimated using demographically corrected performance on a word-reading test (an approximation of premorbid IQ). Injury chronicity was operationalized as number of years since the date of injury. Composite cognitive scores were computed from performances on neuropsychological tests of processing speed, executive functioning, and memory.

Results:

CR was positively and significantly related to all cognitive performances independent of age, injury chronicity, and injury severity. Greater injury chronicity significantly attenuated the effect of CR on processing speed such that individuals more distal from their injury date evidenced a weaker positive relationship between CR and performance.

Conclusion:

Temporal factors may modify associations between CR and cognition. Findings suggest that the protective effects of CR are temporally delimited, potentially contending with declines in brain reserve. The prognostic value of traditional outcome determinants should be considered in the context of injury chronicity.
Readmission Following Hospitalization for Traumatic Brain Injury: A Nationwide Study
Authors: Kelly Dayton J. , Thibault Dylan , Tam Derrick , Liu Lisa J. W. , Cragg Jacquelyn J. , Willis Allison W. , Crispo James A. G.
Published: June 2021

Objective:

To determine whether sociodemographic and clinical factors were associated with nonelective readmission within 30 days of hospitalization for traumatic brain injury (TBI). Secondary objectives were to examine the effects of TBI severity on readmission and characterize primary reasons for readmission.

Setting:

Hospitalized patients in the United States, using the 2014 Nationwide Readmission Database.

Participants:

All patients hospitalized with a primary diagnosis of TBI between January 1, 2014, and November 30, 2014. We excluded patients (1) with a missing or invalid length of stay or admission date, (2) who were nonresidents, and 3) who died during their index hospitalization.

Design:

Observational study; cohort study.

Main Measures:

Survey weighting was used to compute national estimates of TBI hospitalization and nonelective 30-day readmission. Associations between sociodemographic and clinical factors with readmission were assessed using unconditional logistic regression with and without adjustment for suspected confounders.

Results:

There were 135 542 individuals who were hospitalized for TBI; 8.9% of patients were readmitted within 30 days of discharge. Age (strongest association for 65-74 years vs 18-24 years: adjusted odds ratio [AOR], 2.57; 95% CI: 2.02-3.27), documentation of a fall (AOR, 1.24; 95% CI: 1.13-1.35), and intentional self-injury (AOR, 3.13; 95% CI: 1.88-5.21) at the index admission were positively associated with readmission. Conversely, history of a motor vehicle (AOR, 0.69; 95% CI: 0.62-0.78) or cycling (AOR, 0.56; 95% CI: 0.40-0.77) accident was negatively associated with readmission. Females were also less likely to be readmitted following hospitalization for a TBI (AOR, 0.87; 95% CI: 0.82-0.92).

Conclusions:

Many sociodemographic and clinical factors were found to be associated with acute readmission following hospitalizations for TBI. Future studies are needed to determine the extent to which readmissions following TBI hospitalizations are preventable.
The Boston Assessment of Traumatic Brain Injury-Lifetime Semistructured Interview for Assessment of TBI and Subconcussive Injury Among Female Survivors of Intimate Partner Violence: Evidence of Research Utility and Validity
Authors: Fortier Catherine B. , Beck Brigitta M. , Werner Kimberly B. , Iverson Katherine M. , Kim Sahra , Currao Alyssa , Fonda Jennifer R. , Galovski Tara E.
Published: June 2021

Objective:

To adapt the Boston Assessment of TBI-Lifetime (BAT-L) interview specifically for female survivors of intimate partner violence (IPV), validate the adapted BAT-L/IPV, and report the prevalence of head injury.

Setting:

The BAT-L is the first validated instrument to diagnose traumatic brain injuries (TBIs) throughout the life span for post-9/11 veterans. The BAT-L/IPV was adapted to target diagnostic issues belonging exclusively to IPV while maintaining its life span approach.

Participants:

Community-dwelling convenience sample of 51 female survivors of IPV with subthreshold (n = 10) or full diagnostic criteria (n = 41) of posttraumatic stress disorder.

Design:

Standard TBI criteria were evaluated using a semistructured clinical interview.

Main Measures:

The BAT-L/IPV is compared with the Ohio State University TBI Identification Method (OSU-TBI-ID) scoring approach as the criterion standard.

Results:

Correspondence between the BAT-L/IPV and the OSU-TBI-ID score was excellent (Cohen κ = 0.86; Kendall τ-b = 0.89). Sensitivity = 89.3% (95% CI, 81.2-97.4); specificity = 98.3% (95% CI, 95.0-100); positive predictive value = 98.0% (95% CI, 94.2-100); and negative predictive value = 90.6% (95% CI, 83.5-97.7). On the BAT-L/IPV, more than one-third (35.3%) of IPV survivors reported TBI secondary to an IPV-related assault, 76.5% reported IPV subconcussive head injury, 31.4% reported attempted strangulation, and 37.3% reported non-IPV TBI.

Conclusions:

The BAT-L/IPV performed well in diagnosing TBI in female IPV survivors as compared with the criterion standard. The prevalence of TBI was frequent; subconcussive head injury was pervasive. Greater awareness for head injury risk and increased diagnostic specificity of TBI in IPV survivors is needed.
Should We Lose Sleep Over Sleep Disturbances After Sports-Related Concussion? A Scoping Review of the Literature
Authors: Stevens David J. , Alghwiri Alia , Appleton Sarah L. , Rogers Jeffrey M. , Plummer Stephanie L. , Grant Catharina , Bickley Kelsey , Alvaro Pasquale K. , Kennett Stephen , Adams Robert , Holtzhausen Louis
Published: June 2021

Objective:

A single, severe traumatic brain injury can result in chronic sleep disturbances that can persist several years after the incident. In contrast, it is unclear whether there are sleep disturbances after a sports-related concussion (SRC). Considering growing evidence of links between sleep disturbance and neurodegeneration, this review examined the potential links between diagnosed SRCs and sleep disturbances to provide guidance for future studies.

Methods:

The scoping review undertook a systematic search of key online databases (Scopus, MEDLINE, SportDiscus, and Web of Science) using predetermined search terms for any articles that examined sleep after concussion. A screening criterion using agreed inclusion and exclusion criteria was utilized to ensure inclusion of relevant articles.

Design:

This scoping review is guided by the PRSIMA Scoping Review report.

Results:

Ten studies met the inclusion criteria, reporting on 896 adults who had experienced an SRC. Comparison with 1327 non-SRC adults occurred in 8 studies. Nine studies subjectively examined sleep, of which all but one study reported sleep disturbances after an SRC. Three studies objectively measured sleep, with 2 studies indicating large coefficients of variation of sleep duration, suggesting a range of sleep responses after an SRC. The only study to examine overnight polysomnography showed no differences in sleep metrics between those with and without an SRC. No studies examined interventions to improve sleep outcomes in people with concussion.

Conclusions:

This scoping review indicates preliminary evidence of sleep disturbances following an SRC. The heterogeneity of methodology used in the included studies makes consensus on the results difficult. Given the mediating role of sleep in neurodegenerative disorders, further research is needed to identify physiological correlates and pathological mechanisms of sleep disturbances in SRC-related neurodegeneration and whether interventions for sleep problems improve recovery from concussion and reduce the risk of SRC-related neurodegeneration.
Preinjury Health Status of Adults With Traumatic Brain Injury: A Preliminary Matched Case-Control Study
Authors: Bulas Ashlyn M. , Li Lihua , Kumar Raj G. , Mazumdar Madhu , Rosso Andrea L. , Youk Ada O. , Dams-O'Connor Kristen
Published: June 2021

Objective:

To discern whether there is evidence that individuals who sustained a traumatic brain injury (TBI) had the greater odds of preexisting health conditions and/or poorer health behaviors than matched controls without TBI.

Setting:

Brain Injury Inpatient Rehabilitation Unit at Mount Sinai Hospital. Midlife in the United States (MIDUS) control data were collected via random-digit-dialing phone survey.

Participants:

TBI cases were enrolled in the TBI Health Study and met at least 1 of the following 4 injury severity criteria: abnormal computed tomography scan; Glasgow Coma Scale score between 3 and 12; loss of consciousness greater than 30 minutes; or post-TBI amnesia longer than 24 hours. Sixty-two TBI cases and 171 matched MIDUS controls were included in the analyses; controls were excluded if they reported having a history of head injury.

Design:

Matched case-control study.

Main Measures:

Self-reported measures of depression symptoms, chronic pain, health status, alcohol use, smoking status, abuse of controlled substances, physical activity, physical health composite score, and behavioral health composite score.

Results:

Pre–index injury depression was nearly 4 times higher in TBI cases than in matched controls (OR= 3.98, 95% CI, 1.71-9.27; P = .001). We found no significant differences in the odds of self-reporting 3 or more medical health conditions in year prior to index injury (OR = 1.52; 95% CI, 0.82-2.81; P = .183) or reporting more risky health behaviors (OR = 1.48; 95% CI; 0.75-2.91; P = .254]) in individuals with TBI than in controls.

Conclusion:

These preliminary findings suggest that the odds of depression in the year prior to index injury far exceed those reported in matched controls. Further study in larger samples is required to better understand the relative odds of prior health problems in those who sustain a TBI, with a goal of elucidating the implications of preinjury health on post-TBI disease burden.
Alcohol, coffee consumption, and smoking in relation to migraine: a bidirectional Mendelian randomization study
Authors: Yuan Shuai , Daghlas Iyas , Larsson Susanna C.
Published: June 2021

We conducted a Mendelian randomization study to assess whether alcohol and coffee consumption and smoking are causally associated with risk of developing migraine. Independent single-nucleotide polymorphisms associated with the potential risk factors at P < 5 × 10−8 in large-scale genome-wide association studies were selected as instrumental variables. Summary-level data for the associations of the selected single-nucleotide polymorphisms with migraine were obtained from the FinnGen consortium comprising 6687 cases and 144,780 noncases and the UK Biobank study comprising 1072 cases and 360,122 noncases. Estimates derived from the FinnGen and UK Biobank cohorts were combined using fixed-effects meta-analysis. We found evidence for associations of genetically predicted alcohol consumption (odds ratio [OR] 0.54 per SD increase in log-transformed alcoholic drinks per week, 95% confidence interval [CI], 0.35-0.82; P = 0.004), coffee consumption (OR 0.56 per 50% increase in coffee consumption, 95% CI, 0.45-0.70; P < 0.001), and smoking initiation (OR 1.15 for one SD increase in the prevalence of smoking initiation, 95% CI, 1.01-1.31; P = 0.038). These associations persisted in sensitivity analyses, including mutual adjustment in multivariable Mendelian randomization analyses. In reverse Mendelian randomization analyses, genetic liability to migraine was inversely associated with alcohol consumption but was not associated with coffee consumption or smoking initiation. This study provides genetic evidence in support of a protective role of moderate coffee consumption and a detrimental role of cigarette smoking in the etiology of migraine. The inverse association between alcohol consumption and migraine risk may be attributable to reverse causality.
At my own pace, space, and place: a systematic review of qualitative studies of enablers and barriers to telehealth interventions for people with chronic pain
Authors: Fernandes Lívia G. , Devan Hemakumar , Fioratti Iuri , Kamper Steven J. , Williams Christopher M. , Saragiotto Bruno T.
Published: June 2021

Telehealth is a promising approach to support self-management with the potential to overcome geographical barriers. Understanding patient perspectives will identify practical challenges to delivering self-management strategies by telehealth. The aim of this study was to synthesize the perceptions of people with chronic musculoskeletal pain for engaging in interventions delivered using telehealth. We searched MEDLINE, Embase, CINAHL, LILACS, and PsycINFO databases. We included qualitative studies that explored perceptions or experiences or attitudes of people with chronic musculoskeletal pain engaging with telehealth. We assessed the methodological quality using the Critical Appraisal Skills Programme checklist. Meta-synthesis was guided by a thematic synthesis approach. The level of confidence of review findings was assessed using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). Twenty-one studies were included (n = 429). Telehealth comprised web-based, videoconference-based, telephone-based, video-based, and smartphone app–based programs delivered solely or combined. Chronic musculoskeletal conditions included people with knee or hip osteoarthritis, chronic low back pain, persistent pain (chronic joint pain or nonspecific chronic musculoskeletal pain), rheumatoid arthritis, and functional fatigue syndrome. The enablers for engaging in telehealth interventions were as follows: (1) “at my own pace, space, and place” and (2) empowered patient. Barriers to engaging in telehealth interventions were as follows: (1) impersonal, (2) technological challenges, (3) irrelevant content, and (4) limited digital (health) literacy. Telehealth interventions with well-designed interactive platforms, flexibility to fit patients' routine, and the broad availability of material may favor better engagement. Encouragement of self-efficacy is linked to successful telehealth-delivered self-management programs.
Different routes of administration in chronic migraine prevention lead to different placebo responses: a meta-analysis
Authors: Swerts Diego Belandrino , Benedetti Fabrizio , Peres Mario Fernando Prieto
Published: June 2021

Placebo response is a powerful determinant of health outcomes in several disorders. Meta-analysis of clinical trials in pain conditions shows that it can contribute up to 75% of the overall treatment effect. Placebo response deriving from different routes of administration is poorly understood in primary headaches' pharmacological prevention. Thus, this meta-analysis aims to analyze how different routes of administration affect the placebo response in chronic migraine (CM). We conducted a meta-analysis with 7 randomized, double-blind, placebo-controlled clinical trials, with 5672 patients older than 18 years who suffer from CM without associated comorbidities. We compared those who received a placebo-administered agent for the preventive treatment of CM subcutaneous, endovenous, or oral against those who received multiple head injections. The primary outcome was reduction in the number of days with migraine in the month assessed at 12, 16, and 24 weeks of treatment compared with baseline. Our study shows that placebo responses were greater when botulinum toxin was applied to the head, followed by intravenous injection of the anti-calcitonin gene-related peptide monoclonal antibody eptinezumab. Oral topiramate and subcutaneous monoclonal showed no difference, being inferior to head injection. Administration route affects placebo responses in CM preventive treatment. Elucidating the underlying mechanisms that mediate a placebo response in migraine treatment is beneficial to clinical practice and drug development, especially when comparing drugs with different routes of administration, with the effect of application to the head being superior to the other routes in this study. In our study the placebo response accounted for approximately 75% of the therapeutic gain in the treatment of CM.
Perceived discrimination, health, and well-being among adults with and without pain: a prospective study
Authors: Scott Whitney , Jackson Sarah E. , Hackett Ruth A.
Published: June 2021

Discrimination negatively influences health and well-being in the general population, but its impact on people with pain is unclear. This study assessed discrimination, health, and well-being in people with and without pain. Data were from 5871 participants from the English Longitudinal Study of Ageing. Experiences of discrimination were reported in 2010 to 2011. Pain, self-rated health, depressive symptoms, quality of life, life satisfaction, and loneliness were assessed in 2010 to 2011 and 2016 to 2017. A quarter (26%, n = 1524) of the sample reported pain at baseline. Participants with pain were more likely to report discrimination than those without pain (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.13-1.46). Cross-sectionally, those with pain who perceived discrimination had poorer self-rated health (OR = 1.28, 95% CI 1.02-1.61), greater depressive symptoms (OR = 1.90, 95% CI 1.48-2.45), were more likely to be lonely (β = 0.21, 95% CI 0.15-0.26), and had lower quality of life (β = −4.01, 95% CI −4.88 to −3.14), and life satisfaction (β = −1.75, 95% CI −2.45 to −1.06) than those with pain who did not perceive discrimination. Prospectively, discrimination in those with pain was associated with greater depression (OR = 1.67, 95% CI 1.19-2.34) and loneliness (β = 0.11, 95% CI 0.05-0.17), adjusting for baseline values. In those without pain in 2010 to 2011, discrimination predicted pain in 2016 to 2017, controlling for covariates (OR = 1.29, 95% CI 1.06-1.56). People with pain are more likely to report discrimination than those without pain, and this experience is associated with increased depression and loneliness. Discrimination was predictive of incident pain in pain-free adults. These findings highlight the need to tackle discrimination to improve well-being in those with pain and to potentially reduce the risk of pain onset.
Enhanced mindfulness-based stress reduction in episodic migraine—effects on sleep quality, anxiety, stress, and depression: a secondary analysis of a randomized clinical trial
Authors: Burrowes Shana A.B. , Goloubeva Olga , Stafford Kristen , McArdle Patrick F. , Goyal Madhav , Peterlin B. Lee , Haythornthwaite Jennifer A. , Seminowicz David A.
Published: June 2021

Patients with migraine suffer from high morbidity related to the repeated headache attacks, characteristic of the disorder, poor sleep, and a high prevalence of comorbid psychosocial disorders. Current pharmacological therapies do not address these aspects of migraine, but nonpharmacological treatments such as mindfulness-based stress reduction (MBSR) have been shown to improve both pain and psychological well-being. In this secondary analysis, we examined the change over time in sleep quality and psychosocial outcomes from the magnetic resonance imaging outcomes for mindfulness meditation clinical trial and assessed how these mediated treatment response (50% reduction in headache frequency postintervention). We also examined the relationship between baseline values and treatment response. The trial (primary outcomes previously reported) included 98 patients with episodic migraine randomized to either enhanced MBSR (MBSR+) or stress management for headache. They completed psychosocial questionnaires and headache diaries at baseline (preintervention), midintervention (10 weeks after baseline), and postintervention (20 weeks after baseline). There was a significant improvement in sleep quality from baseline to postintervention (P = 0.0025) in both groups. There were no significant changes from baseline or between groups in anxiety, depression, and stress. There was also no significant association between baseline scores and treatment response. Mediation analysis showed a significant indirect effect of 6% for sleep: In other words, small improvements in sleep may have contributed to the efficacy of MBSR+.

Trial registration: NCT02133209.