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Laaksonen J, Ponkilainen V, Kuitunen I, Möttönen J, Mattila VM. Association between pediatric traumatic brain injury and epilepsy at later ages in Finland: A nationwide register-based cohort study. Epilepsia 2023; 64:3257-3265. [PMID: 37867469 DOI: 10.1111/epi.17805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE This study was undertaken to examine how pediatric traumatic brain injury (pTBI) correlates with incidence of epilepsy at later ages in Finland. METHODS This nationwide retrospective register-based cohort study extended from 1998 to 2018. The study group consisted of 71 969 pediatric (<18 years old) patients hospitalized with TBI and a control group consisting of 64 856 pediatric patients with distal extremity fracture. Epilepsy diagnoses were gathered from the Finnish Social Insurance Institution. Kaplan-Meier and multivariable Cox regression models were conducted to analyze the probability of epilepsy with 95% confidence intervals (CIs). RESULTS Cumulative incidence rates (CIRs) for the first 2 years were .5% in the pTBI group and .1% in the control group. The corresponding rates after 15 years of follow-up were 1.5% in the pTBI group and .7% in the control group. Due to proportional hazard violations, the study population was split to the first 2 years and in subgroup analysis 4 years. During the first 2 years of surveillance, the hazard ratio (HR) for the pTBI group was 4.38 (95% CI = 3.39-5.66). However, between years 2 and 20, the HR for the pTBI group was 2.02 (95% CI = 1.71-2.38). A total of 337 patients (.47%) underwent neurosurgery, and 36 (10.7%) patients subsequently developed epilepsy. The CIR for the first year after TBI was 4.5% (95% CI = 2.3-6.7) in operatively managed patients and .3% (95% CI = .3-.4) in nonoperatively managed patients. Corresponding figures after 15 years were 12.0% (95% CI = 8.2-15.8) and 1.5% (95% CI = 1.4-1.6). During the first 4 years of surveillance, the HR for the operative pTBI group was 14.37 (95% CI = 9.29-20.80) and 3.67 (95% CI = 1.63-8.22) between years 4 and 20. SIGNIFICANCE pTBI exposes patients to a higher risk for posttraumatic epilepsy for many years after initial trauma. Children who undergo operative management for TBI have a high risk for epilepsy, and this risk was highest during the first 4 years after injury.
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Affiliation(s)
- Juho Laaksonen
- School of Medicine, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Ilari Kuitunen
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Julius Möttönen
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Ville M Mattila
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
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Rosen JE, Chang SSE, Williams S, Lee JS, Han D, Agrawal N, Joo JH, Hsieh G, Reinecke K, Liao JM. Association between Risk Communication Format and Perceived Risk of Adverse Events after COVID-19 Vaccination among US Adults. Healthcare (Basel) 2023; 11:healthcare11030380. [PMID: 36766956 PMCID: PMC9914684 DOI: 10.3390/healthcare11030380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The format used to communicate probability-verbal versus numerical descriptors-can impact risk perceptions and behaviors. This issue is salient for the Coronavirus disease 2019 (COVID-19), where concerns about vaccine-related risks may reduce uptake and verbal descriptors have been widely used by public health, news organizations and on social media, to convey risk. Because the effect of risk-communication format on perceived COVID-19 vaccine-related risks remains unknown, we conducted an online randomized survey among 939 US adults. Participants were given risk information, using verbal or numerical descriptors and were asked to report their perceived risk of experiencing headache, fever, fatigue or myocarditis from COVID-19 vaccine. Associations between risk communication format and perceived risk were assessed using multivariable regression. Compared to numerical estimates, verbal descriptors were associated with higher perceived risk of headache (β = 5.0 percentage points, 95% CI = 2.0-8.1), fever (β = 27 percentage points, 95% CI = 23-30), fatigue (β = 4.9 percentage points, 95% = CI 1.8-8.0) and myocarditis (β = 4.6 percentage points, 95% CI = 2.1-7.2), as well as greater variability in risk perceptions. Social media influence was associated with differences in risk perceptions for myocarditis, but not side effects. Verbal descriptors may lead to greater, more inaccurate and variable vaccine-related risk perceptions compared to numerical descriptors.
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Affiliation(s)
- Joshua E. Rosen
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA 98195, USA
- Correspondence: ; Tel.: +1-206-598-3300
| | | | - Spencer Williams
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Joy S. Lee
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Value and Systems Science Lab, Seattle, WA 98195, USA
| | - DaHee Han
- Desautels Faculty of Management, McGill University, Montreal, QC H3A 1G5, Canada
| | - Nidhi Agrawal
- Foster School of Business, University of Washington, Seattle, WA 98195, USA
| | - Joseph H. Joo
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Value and Systems Science Lab, Seattle, WA 98195, USA
| | - Gary Hsieh
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Katharina Reinecke
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Joshua M. Liao
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Value and Systems Science Lab, Seattle, WA 98195, USA
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Randomized Pilot Test of a Decision Support Tool for Acute Appendicitis: Decisional Conflict and Acceptability in a Healthy Population. ANNALS OF SURGERY OPEN 2022; 3:e213. [PMID: 36590895 PMCID: PMC9780038 DOI: 10.1097/as9.0000000000000213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 01/03/2023] Open
Abstract
To test the effect of a new decision support tool for acute appendicitis and assess its efficacy and acceptability. Background Mounting evidence from randomized controlled trials have shown that antibiotics can be a safe and effective treatment for appendicitis. Patients and surgeons must work together to choose the optimal treatment approach for each patient based on their own preferences and values. We developed a decision support tool to facilitate shared decision-making for appendicitis and its effect on decisional outcomes remains unknown. Methods We conducted an online randomized field test in at-risk individuals comparing the decision support tool to a standard infographic. Individuals were randomized 3:1 to view the decision support tool or infographic. The primary outcome was the total decisional conflict scale (DCS) score measured before and after exposure to the decision support tool. Secondary outcomes included between-group DCS scores, and between-group comparisons of the acceptability. Results One hundred eighty individuals were included in the study. Total DCS scores decreased significantly after viewing the decision support tool (59 [95% confidence interval (CI): 55-63] to 15 [95% CI: 12-17], P < 0.001) representing movement from a state of high to low decisional conflict. Individuals exposed to the decision support tool reported higher acceptability ratings (3.7 [95% CI: 3.6-3.8] vs 3.3 [95% CI: 3.2-3.5] out of 4) and demonstrated increased willingness to consider both treatment options. Conclusions These data support the further use and testing of this novel decision support tool in patients with acute appendicitis.
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Effects of opioid addiction risk information on Americans’ agreement with postoperative opioid minimization and perceptions of quality. Healthcare (Basel) 2022; 10:100629. [DOI: 10.1016/j.hjdsi.2022.100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022] Open
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Rosen JE, Agrawal N, Flum DR, Liao JM. Unrealistic optimism about treatment risks for acute appendicitis. Br J Surg 2022; 109:405-407. [PMID: 35136965 PMCID: PMC9565953 DOI: 10.1093/bjs/znac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022]
Abstract
Unrealistic optimism is a cognitive bias that causes people to think they are at lower risk of a negative outcome than they actually are. This study identified significant unrealistic optimism towards the risks of appendicitis treatment complications.
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Affiliation(s)
- Joshua E Rosen
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington, USA
- Decision Science Group, Seattle, Washington, USA
| | - Nidhi Agrawal
- Decision Science Group, Seattle, Washington, USA
- Foster School of Business, University of Washington, Seattle, Washington, USA
| | - David R Flum
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Washington, USA
- Decision Science Group, Seattle, Washington, USA
| | - Joshua M Liao
- Decision Science Group, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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