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Miller RM, Dunn JA, O'Beirne GA, Whitney SL, Snell DL. Relationships between vestibular issues, noise sensitivity, anxiety and prolonged recovery from mild traumatic brain injury among adults: a scoping review. Brain Inj 2024; 38:607-619. [PMID: 38597651 DOI: 10.1080/02699052.2024.2337905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND We investigated the extent of literature and findings on relationships between vestibular issues, noise sensitivity (NS), and anxiety. We were interested in how relationships among these factors impacted adults' recovery three months or more after mild traumatic brain injury (mTBI). METHODS We conducted a scoping review to evaluate the extent of evidence linking relationships between vestibular issues, NS and anxiety with recovery after mTBI. Data relating to study characteristics and key findings were extracted and used to inform a critical narrative synthesis of findings. RESULTS After screening and full-text review, we included two studies. Both studies considered the combination of vestibular issues, NS and anxiety and mTBI recovery. Vestibular issues, NS and anxiety were all significantly associated with one another and their presence was the strongest indicator that symptoms would extend beyond three-months after mTBI. CONCLUSION Few studies have focused on the relationships that vestibular issues, NS and anxiety have with one another and recovery after mTBI. Given the apparent strong relationships between these factors and prolonged recovery, we highlight this as an area warranting further investigation.
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Affiliation(s)
- Rebekah M Miller
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Greg A O'Beirne
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, Univeristy of Auckland, Auckland, New Zealand
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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MacGregor AJ, Dougherty AL, Crouch DJ, Dye JL. Sex Differences in Screening Positive for Post-Traumatic Stress Disorder After Combat Injury. Mil Med 2024:usae050. [PMID: 38771005 DOI: 10.1093/milmed/usae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/08/2023] [Accepted: 02/21/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION U.S. military women were at risk of combat exposure and injury from asymmetric warfare during the conflicts in Iraq and Afghanistan. Previous research has yielded mixed results when examining sex differences in PTSD following operational deployment. To date, no study has explored sex differences in PTSD after combat injury. MATERIALS AND METHODS This retrospective study included U.S. military service men and women who experienced a combat injury in Iraq or Afghanistan (March 2003 to March 2013) and completed a Post-Deployment Health Assessment (PDHA) within 1 year of injury. The PDHA is administered at the end of deployment and includes the 4-item Primary Care PTSD Screen. The prevalence of screening positive for PTSD was evaluated by sex using a chi-square test. Multivariable logistic regression was used to assess the association between sex and PTSD while adjusting for covariates. RESULTS The study sample included 16,215 injured military personnel (666 women and 15,549 men). The average time between injury and PDHA was 132 days (SD = 91.0). Overall, women had a higher prevalence of screening positive for PTSD than men (48.3% vs. 40.9%, P < .001). In multivariable regression, women had higher odds than men of screening positive for PTSD (odds ratio, 1.34; 95% confidence interval, 1.14-1.57). Psychiatric history was the strongest predictor of screening positive for PTSD regardless of sex (odds ratio, 1.59; 95% confidence interval, 1.45-1.74). CONCLUSIONS In this novel study of military service members, women were more likely to screen positive for PTSD than men after combat injury. Strategies to mitigate PTSD, enhance resiliency, and incorporate psychological care into injury rehabilitation programs for women may be needed for future U.S. military conflicts where they will play a larger role in combat operations.
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Affiliation(s)
- Andrew J MacGregor
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
| | - Amber L Dougherty
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
| | - Daniel J Crouch
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
| | - Judy L Dye
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
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D'Souza EW, MacGregor AJ, Markwald RR, Elkins TA, Zouris JM. Investigating insomnia in United States deployed military forces: A topic modeling approach. Sleep Health 2024; 10:75-82. [PMID: 38071173 DOI: 10.1016/j.sleh.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 03/01/2024]
Abstract
STUDY OBJECTIVES This retrospective study analyzed free-text clinical notes from medical encounters for insomnia among a sample of deployed US military personnel. Topic modeling, a natural language processing technique, was used to identify thematic patterns in the clinical notes that were potentially related to insomnia diagnosis. METHODS Clinical notes of patient clinical encounters coded for insomnia from the US Department of Defense Military Health System Theater Medical Data Store were analyzed. Following preprocessing of the free text in the clinical notes, topic modeling was employed to identify relevant underlying topics or themes in 32,864 unique patients. The machine-learned topics were validated using human-coded potential insomnia etiological issues. RESULTS A 12-topic model was selected based on quantitative metrics, interpretability, and coherence of terms comprising topics. The topics were assigned the following labels: personal/family history, stimulants, stress, family/relationships, other sleep disorders, depression, schedule/environment, anxiety, other medication, headache/concussion, pain, and medication refill. Validation of these topics (excluding the two medication topics) against their corresponding human-coded potential etiological issues showed strong agreement for the assessed topics. CONCLUSIONS Analysis of free-text clinical notes using topic modeling resulted in the identification of thematic patterns that largely mirrored known correlates of insomnia. These findings reveal multiple potential etiologies for deployment-related insomnia. The identified topics may augment electronic health record diagnostic codes and provide valuable information for sleep researchers and providers. As both civilian and military healthcare systems implement electronic health records, topic modeling may be a valuable tool for analyzing free-text data to investigate health outcomes.
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Affiliation(s)
- Edwin W D'Souza
- Leidos, Inc., San Diego, California, USA; Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA.
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, California, USA
| | - Trevor A Elkins
- Leidos, Inc., San Diego, California, USA; Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - James M Zouris
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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Bunt SC, LoBue C, Hynan LS, Didehbani N, Stokes M, Miller SM, Bell K, Cullum CM. Early vs. delayed evaluation and persisting concussion symptoms during recovery in adults. Clin Neuropsychol 2023; 37:1410-1427. [PMID: 36083237 DOI: 10.1080/13854046.2022.2119165] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
Objective: Persisting concussion symptoms may adversely affect return to work and functioning in daily activities. This study compared adults who were initially evaluated < 30 days versus those evaluated ≥ 30 days following a concussion at a specialty concussion clinic to determine if delayed initial evaluation is associated with persisting symptoms during recovery. Method: Participants (N = 205) 18 years of age and older who sustained a concussion and presented to a North Texas Concussion Registry (ConTex) clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Participants provided medical history, injury related information, and completed the Sport Concussion Assessment Tool-5 Symptom Evaluation, Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire (PHQ-8). Participants were divided into two groups: early and delayed evaluation (±30 days post injury). Results: Number and severity of concussion symptoms were similar between both groups at their initial clinical visit. However, linear regression models showed that a delayed clinical evaluation was associated with a greater number and severity of concussion symptoms along with greater aggravation of symptoms from physical and cognitive activity at three-month follow-up. Conclusions: Individuals who sought care at specialty concussion clinics regardless of previous care 30 or more days following their injury reported more serious persisting concussion symptoms at three month follow-up than those who sought care sooner. Education to improve adults' recognition of concussions when they occur and obtaining earlier clinical evaluation may represent important opportunities in promoting better recovery and reducing persisting concussion symptoms.
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Affiliation(s)
- Stephen C Bunt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Stokes
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shane M Miller
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Sports Medicine, Scottish Rite for Children, Dallas, TX, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center Dallas, TX, USA
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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Babov KD, Zabolotna IB, Plakida AL, Volyanska VS, Babova IK, Gushcha SG, Kolker IA. The effectiveness of high-tone therapy in the complex rehabilitation of servicemen with post-traumatic stress disorder complicated by traumatic brain injury. Neurol Sci 2023; 44:1039-1048. [PMID: 36417014 DOI: 10.1007/s10072-022-06510-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As a result of local military conflicts that have become more frequent over the past decades, the number of military personnel subjected to combat stress has sharply increased. More than 50% of them suffer from combat posttraumatic stress disorder. The most common comorbidity in this category of patients is a traumatic brain injury. Due to the undesirability of the long-term use of pharmacological agents, for rehabilitation, preference should be given to physiotherapeutic procedures. OBJECTS AND METHODS We examined 50 patients with post-traumatic stress disorder in combination with a closed craniocerebral injury. Group 1-25 patients received standard complex treatment at the sanatoriumresort rehabilitation stage (diet therapy, climatotherapy, balneotherapy, exercise therapy, psychotherapy). Group 2-25 patients, in addition to the standard complex treatment, received a course of high-tone therapy. RESULTS Complex rehabilitation of patients with the use of high-tone therapy contributes to a significant decrease in astheno-neurotic (p < 0.05) and asthenic depressive (p < 0.01) syndromes and has a psycho-relaxing effect on anxiety syndrome (p < 0.01). There was also a decrease in the severity of pyramidal symptoms and regression of the vestibulo-atactic syndrome (p < 0.05). The course application of hightone therapy was accompanied by a significant restoration of the elastotonic properties of the vascular wall and an improvement in cerebral perfusion (p < 0.05). Positive dynamics of electrophysiological indicators were noted: a decrease in the intensity of slow rhythms against the background of an increase in the frequency and intensity of the alpha rhythm in both hemispheres (p < 0.05), which indicates the harmonization of the bioelectrical activity of the brain.
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Affiliation(s)
- Kostyantyn D Babov
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna B Zabolotna
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Alexander L Plakida
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine.
| | | | - Iryna K Babova
- State Institution "South Ukrainian National Pedagogical University Named After K.D. Ushynsky", Odessa, 65020, Ukraine
| | - Sergey G Gushcha
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna A Kolker
- Odessa National Medical University, Odessa, 65000, Ukraine
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