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2 Examining the Role of Symptom Attribution on Neurobehavioral and Neurocognitive Outcomes in Treatment-Seeking Veterans with Remote History of Traumatic Brain Injury
- Victoria C Merritt, McKenna S Sakamoto, Laura D Crocker, Amy J Jak
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 667-668
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Objective:
Illness perception, or the ways in which individuals understand and cope with injury, has been extensively studied in the broader medical literature and has been found to have important associations with clinical outcomes across a wide range of medical conditions. However, there is a dearth of knowledge regarding how perceptions of traumatic brain injury (TBI) influence outcome and recovery following injury, especially in military populations. The purpose of this study was to examine relationships between illness perception, as measured via symptom attribution, and neurobehavioral and neurocognitive outcomes in Veterans with TBI history.
Participants and Methods:This cross-sectional study included 44 treatment-seeking Veterans (86.4% male, 65.9% white) with remote history of TBI (75.0% mild TBI). All Veterans were referred to the TBI Cognitive Rehabilitation Clinic at VA San Diego and completed a clinical interview, self-report questionnaires, and a neuropsychological assessment. A modified version of the Neurobehavioral Symptom Inventory (NSI) was administered to assess neurobehavioral symptom endorsement and symptom attribution. Symptom attribution was assessed by having participants rate whether they believe each NSI item was caused by TBI. A total symptom attribution score was computed, as well as the standard NSI total and symptom cluster scores (i.e., vestibular, somatic, cognitive, and affective symptom domains). Three cognitive composite scores (representing mean performance) were also computed, including memory, attention/processing speed, and executive functioning. Participants were excluded if they did not complete the NSI attribution questions or they failed performance validity testing.
Results:Results showed that the symptoms most frequently attributed to TBI included forgetfulness (82%), poor concentration (80%), and slowed thinking (77%). There was a significant positive association between symptom attribution and the NSI total score (r = 0.62, p < .001), meaning that greater attribution of symptoms to TBI was significantly associated with greater symptom endorsement overall.
Symptom attribution was also significantly associated with all four NSI symptom domains (r’s = 0.47-0.66; all p’s < .001), with the strongest relationship emerging between symptom attribution and vestibular symptoms. Finally, linear regressions demonstrated that symptom attribution but not symptom endorsement was significantly associated with objective cognitive functioning. Specifically, greater attribution of symptoms to TBI was associated with worse memory (ß = -0.33, p = .035) and attention/processing speed (ß = -0.40, p = .013) performance.
Conclusions:Results showed significant associations between symptom attribution and (1) symptom endorsement and (2) objective cognitive performance in Veterans with a remote history of TBI. Taken together, findings suggest that Veterans who attribute neurobehavioral symptoms to their TBI are at greater risk of experiencing poor long-term outcomes. Although more research is needed to understand how illness perception influences outcomes in this population, results highlight the importance of early psychoeducation regarding the anticipated course of recovery following TBI.
A Tailored Habits-based Dietary Intervention Combined With Oral Rehabilitation on Partially Dentate Older Adults: Nutritional Impact
- Leigh-Ann McCrum, Gerry Mckenna, Jayne Woodside, Laura McGowan, Sinead Watson
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E148
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Introduction
Replacing missing teeth alone is not enough to engender dietary behaviour change amongst older adults. Whilst there is a body of evidence to support oral rehabilitation in conjunction with dietary advice, this is currently limited to edentate patients even though the majority of older adults are now partially dentate. One approach proven to change long-term food behaviours but is novel in this population is habit-formation. Consequently, this study developed and tested a habit-based tailored dietary intervention, in conjunction with oral rehabilitation amongst partially dentate older adults.
Materials and methodsA pilot randomised control trial was conducted on 57 partially dentate older patients. Participants were randomised to an intervention group (habits-based dietary intervention) or a control group and followed up for 8 months. The intervention group attended four meetings with a trained researcher to target habit-formation around 3 dietary domains (fruit/vegetables, wholegrains, healthy proteins). The primary outcome measure was self-reported automaticity for developing healthy habits and habit formation was assessed using the Self-Report Behavioural Automaticity Index (SRBAI). Preliminary analysis was conducted on n = 36 participants between baseline and 8 month follow up.
ResultsPreliminary results showed that SRBAI scores and self-reported frequency of days doing habits in the intervention group for all tailored dietary habits was significant between baseline and follow up visits (p < 0.001). There were moderate positive correlations between automaticity and habit adherence (Fruit/vegetables rho = 0.43, p = 0.09: Wholegrains rho = 0.44, p = 0.08: Healthy Proteins rho = 0.52, p = 0.03) for the intervention group. Automaticity trends were increased in the intervention group for all 3 dietary habits compared to the control group but, other than wholegrain (p = 0.005), between group differences were non-significant (p > 0.05). BMI decreased in the intervention group (29.6 to 28.7 kg/m2) compared to a non-significant increase in the control group (27.7 to 27.8 kg/m2) (p = 0.08). There were slight increases in Mini Nutritional Assessment mean change scores (0.19 intervention: 0.32 control) for both groups, however between-group differences were not statistically significant (p = 0.9). Greater improvements in food intake around dietary habits were observed in the intervention group (Fruit/vegetables:108 g Fibre 4g: Protein 11g) compared to the control group (Fruit/vegetables -17g: Fibre 2g: Protein -4g).
DiscussionPreliminary results demonstrate the success of a habit-based dietary intervention coupled with oral rehabilitation in positively influencing dietary behaviours and other nutritional outcomes in partially dentate older adults.
11 - Thought-Leader Perspectives on Risks in Precision Medicine Research
- from Part IV - Protecting Health Privacy in the World of Big Data
- Edited by I. Glenn Cohen, Harvard Law School, Massachusetts, Holly Fernandez Lynch, Harvard Law School, Massachusetts, Effy Vayena, Swiss Federal University (ETH), Zürich, Urs Gasser
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- Book:
- Big Data, Health Law, and Bioethics
- Published online:
- 26 February 2018
- Print publication:
- 08 March 2018, pp 161-174
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Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Treatment of early onset bipolar disorder, NOS with low dose Carbamazepine
- Fiona McNicholas, Laura McKenna
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- Journal:
- Irish Journal of Psychological Medicine / Volume 20 / Issue 2 / June 2003
- Published online by Cambridge University Press:
- 13 June 2014, pp. 69-71
- Print publication:
- June 2003
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This report describes the presentation, monitoring and successful treatment of an eight year old girl with bipolar disorder, NOS (not otherwise specified), with low dose carbamazepine. The difficulties of diagnosing and managing bipolar disorder in prepubertal children are discussed.