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Mauck MC, Zhao Y, Goetzinger AM, Tungate AS, Spencer AB, Lal A, Barton CE, Beaudoin F, McLean SA. Incidence of persistent opioid use following traumatic injury. Reg Anesth Pain Med 2024; 49:79-86. [PMID: 37364919 DOI: 10.1136/rapm-2022-103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Major traumatic injuries are a known risk factor for persistent opioid use, but data describing the relationship between specific traumatic injuries and opioid use is lacking. METHODS We used insurance claims data from January 1, 2001 to December 31, 2020 to estimate the incidence of new persistent opioid use in three hospitalized trauma populations: individuals hospitalized after burn injury (3809, 1504 of whom required tissue grafting), individuals hospitalized after motor vehicle collision (MVC; 9041), and individuals hospitalized after orthopedic injury (47, 637). New persistent opioid use was defined as receipt of ≥1 opioid prescriptions 90-180 days following injury in an individual with no opioid prescriptions during the year prior to injury. RESULTS New persistent opioid use was observed in 12% (267/2305) of individuals hospitalized after burn injury with no grafting, and 12% (176/1504) of burn injury patients requiring tissue grafting. In addition, new persistent opioid use was observed in 16% (1454/9041) of individuals hospitalized after MVC, and 20% (9455/47, 637) of individuals hospitalized after orthopedic trauma. In comparison, rates of persistent opioid use in all trauma cohorts (19%, 11, 352/60, 487) were greater than the rates of persistent opioid use in both non-traumatic major surgery (13%) and non-traumatic minor surgery (9%). CONCLUSIONS These data demonstrate that new persistent opioid use frequently occurs in these common hospitalized trauma populations. Improved interventions to reduce persistent pain and opioid use in patients hospitalized after these and other traumas are needed.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ying Zhao
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amy M Goetzinger
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew S Tungate
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alex B Spencer
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Asim Lal
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Chloe E Barton
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Emergency Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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2
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Kim R, Lin T, Pang G, Liu Y, Tungate AS, Hendry PL, Kurz MC, Peak DA, Jones J, Rathlev NK, Swor RA, Domeier R, Velilla MA, Lewandowski C, Datner E, Pearson C, Lee D, Mitchell PM, McLean SA, Linnstaedt SD. Derivation and validation of risk prediction for posttraumatic stress symptoms following trauma exposure. Psychol Med 2023; 53:4952-4961. [PMID: 35775366 DOI: 10.1017/s003329172200191x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS. METHODS Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale - Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample). RESULTS Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms. CONCLUSIONS These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.
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Affiliation(s)
- Raphael Kim
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA
| | - Tina Lin
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Gehao Pang
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yufeng Liu
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, Carolina Center for Genome Sciences, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama, Birmingham, AL, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey Jones
- Department of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, Baystate State Health System, Springfield, MA, USA
| | - Robert A Swor
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Robert Domeier
- Department of Emergency Medicine, St Joseph Mercy Health System, Ann Arbor, MI, USA
| | | | | | - Elizabeth Datner
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Detroit Receiving, Detroit, MI, USA
| | - David Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Patricia M Mitchell
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
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3
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Himmelberger ZM, Faught GG, Tungate AS, Conners FA, Merrill EC. Personality traits predict attitudes toward individuals with intellectual disability. Int J Dev Disabil 2022; 69:906-914. [PMID: 37885845 PMCID: PMC10599174 DOI: 10.1080/20473869.2022.2044594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/14/2022] [Indexed: 10/28/2023]
Abstract
Background: Explaining individual differences in people's attitudes toward individuals with intellectual disability (ID) is important for increasing social inclusion of people with ID. The aim of the current study was to replicate and extend past research by formulating a single model of attitudes toward individuals with ID with several predictors: personality traits, quality and quantity of contact, perceived knowledge of ID, social desirability, and demographics. Methods: A sample of 221 undergraduate students in the United States completed several surveys in a lab setting: the Mental Retardation Attitude Inventory-Revised, the Big Five Inventory, McManus et al.'s measures of contact with and perceived knowledge of ID, and the Marlowe-Crowne Social Desirability Scale. Results: Results replicated previous findings by showing quality of contact was the strongest predictor of attitudes. Additionally, we found openness to experience and agreeableness remained significant predictors after holding all other variables constant. A follow-up mediation analysis demonstrated that quality of contact mediated the relations from openness and agreeableness to attitudes. Conclusions: Findings suggest personality factors can influence attitudes toward individuals with ID, and further emphasize the importance of quality of contact. Implications for the social inclusion of individuals with ID are discussed.
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Affiliation(s)
- Zachary M. Himmelberger
- Behavioral Sciences Division, Maryville College, Maryville, TN, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Gayle G. Faught
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Andrew S. Tungate
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Frances A. Conners
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Edward C. Merrill
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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4
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Short NA, Tungate AS, Bollen KA, Sullivan J, D'Anza T, Lechner M, Bell K, Black J, Buchanan J, Reese R, Ho JD, Reed GD, Platt MA, Riviello RJ, Rossi CH, Martin SL, Liberzon I, Rauch SAM, Kessler RC, Nugent N, McLean SA. Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain 2022; 163:e121-e128. [PMID: 34224498 DOI: 10.1097/j.pain.0000000000002329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Kenneth A Bollen
- Psychology and Neuroscience, and Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jenyth Sullivan
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Teresa D'Anza
- Albuquerque SANE Collaborative, Albuquerque, NM, United States
| | - Megan Lechner
- Emergency Deprtment, UC Health Memorial Hospital, Colorado Springs, CO, United States
| | - Kathy Bell
- Tulsa Forensic Nursing Services, Tulsa, OK, United States
| | | | - Jennie Buchanan
- Department of Emergency Medicine, Denver Health, Denver, CO, United States
| | - Rhiannon Reese
- Crisis Center of Birmingham, Birmingham, AL, United States
| | - Jeffrey D Ho
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Gordon D Reed
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States
| | - Melissa A Platt
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health San Antonio, TX, United States
| | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, Bryan, TX, United States
| | - Sheila A M Rauch
- Department of Psychiatry, Emory University, Atlanta, GA, VA Atlanta Healthcare System, Atlanta, GA, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine, Brown University, Providence, RI, United States
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
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5
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Linnstaedt SD, Mauck MC, Son EY, Tungate AS, Pan Y, Rueckeis C, Yu S, Lechner M, Datner E, Cairns BA, Danza T, Velilla MA, Pearson C, Shupp JW, Smith DJ, McLean SA. Peritraumatic 17β-estradiol levels influence chronic posttraumatic pain outcomes. Pain 2021; 162:2909-2916. [PMID: 34028234 PMCID: PMC8464624 DOI: 10.1097/j.pain.0000000000002282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
ABSTRACT Biologic factors that predict risk for and mediate the development of common outcomes of trauma exposure such as chronic posttraumatic pain (CPTP) are poorly understood. In the current study, we examined whether peritraumatic circulating 17β-estradiol (E2) levels influence CPTP trajectories. 17β-estradiol levels were measured in plasma samples (n = 254) collected in the immediate aftermath of trauma exposure from 3 multiethnic longitudinal cohorts of men and women trauma survivors. Chronic posttraumatic pain severity was evaluated 6 weeks, 6 months, and 1 year after traumatic stress exposure. Repeated measures mixed models were used to test the relationship between peritraumatic E2 levels and prospective CPTP. Secondary analyses in a nested cohort assessed the influence of participant body mass index on the E2-CPTP relationship. In women, a statistically significant inverse relationship between peritraumatic E2 and CPTP was observed (β = -0.280, P = 0.043) such that higher E2 levels predicted lower CPTP severity over time. Secondary analyses identified an E2 * body mass index interaction in men from the motor vehicle collision cohort such that obese men with higher E2 levels were at greater risk of developing CPTP. In nonobese men from the motor vehicle collision cohort and in men from the major thermal burn injury cohort, no statistically significant relationship was identified. In conclusion, peritraumatic circulating E2 levels predict CPTP vulnerability in women trauma survivors. In addition, these data suggest that peritraumatic administration of E2 might improve CPTP outcomes for women; further research is needed to test this possibility.
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Affiliation(s)
- Sarah D. Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew C. Mauck
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Esther YeEun Son
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew S. Tungate
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yue Pan
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Cathleen Rueckeis
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Shan Yu
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Megan Lechner
- Forensic Nursing Program, Memorial Health System, Colorado Springs, CO, USA
| | - Elizabeth Datner
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Bruce A. Cairns
- Jaycee Burn Center, University of North Carolina, Chapel Hill, NC, USA
| | - Teresa Danza
- Forensic Nursing Program, Albuquerque SANE Collaborative, Albuquerque, NM, USA
| | | | - Claire Pearson
- Department of Emergency Medicine, Detroit Receiving, Detroit, MI, USA
| | | | - David J. Smith
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Samuel A. McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
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6
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Buchbinder M, Brassfield ER, Tungate AS, Witkemper KD, D'Anza T, Lechner M, Bell K, Black J, Buchanan J, Reese R, Ho J, Reed G, Platt M, Riviello R, Rossi C, Nouhan P, Phillips CA, Martin SL, Liberzon I, Rauch SA, Bollen K, McLean SA. "I still feel so lost": experiences of women receiving SANE care during the year after sexual assault. J Am Coll Emerg Physicians Open 2021; 2:e12464. [PMID: 34263245 PMCID: PMC8254598 DOI: 10.1002/emp2.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Emergency caregivers provide initial care to women sexual assault (SA) survivors. An improved understanding of the issues facing this population can aide emergency care practitioners in providing high quality care. The goal of this study was to share the experiences of women SA survivors with the emergency care practitioners that care for them. METHODS English-speaking adult women (n = 706) who received SA Nurse Examiner (SANE) evaluation within 72 hours of SA at 1 of 13 geographically distributed sites were enrolled in a prospective, longitudinal multi-site observational study. We qualitatively analyzed responses to the open-ended question: "What do you think is most important for researchers to understand about your experience since the assault?" asked 1 week, 6 weeks, 6 months, and 1 year after enrollment. RESULTS Themes from responses (n = 1434) from 590 women (84% of study sample) fell into 12 broad categories: daily life, justice, medical, and social services, mental health, physical health, prior trauma, recovery, romantic relationships, safety, self, shame, and social interactions. Responses demonstrated that the assault permeates many aspects of assault survivors' daily lives. CONCLUSIONS Qualitative analyses of open-ended responses from a large cohort of women SA survivors receiving SANE care highlight the challenges for survivors and can increase understanding among the emergency care practitioners who care for them. The authors propose a brief acronym to help emergency care practitioners recall important messages for SA survivors.
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Affiliation(s)
- Mara Buchbinder
- Department of Social MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Elizabeth R. Brassfield
- Department of Social MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Andrew S. Tungate
- Institute for Trauma RecoveryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Departments of Emergency Medicine and AnesthesiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kristen D. Witkemper
- Institute for Trauma RecoveryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Departments of Emergency Medicine and AnesthesiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Teresa D'Anza
- Albuquerque SANE CollaborativeAlbuquerqueNew MexicoUSA
| | - Megan Lechner
- UC Health Memorial HospitalColorado SpringsColoradoUSA
| | - Kathy Bell
- Tulsa Forensic NursingTulsa Police DepartmentTulsaOklahomaUSA
| | | | - Jennie Buchanan
- Department of Emergency MedicineDenver HealthDenverColoradoUSA
| | | | - Jeffrey Ho
- Department of Emergency MedicineHennepin HealthcareMinneapolisMinnesotaUSA
| | - Gordon Reed
- Department of Emergency MedicineChristianaCareNewarkDelawareUSA
| | - Melissa Platt
- SAFE ServicesUniversity of LouisvilleLouisvilleKentuckyUSA
| | | | | | - Patricia Nouhan
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
| | | | - Sandra L. Martin
- Department of Maternal and Child HealthGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Sheila A.M. Rauch
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgiaUSA
- Veterans Affairs Atlanta Healthcare SystemAtlantaGeorgiaUSA
| | - Kenneth Bollen
- Department of Psychology and Neuroscience and Department of SociologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Samuel A. McLean
- Institute for Trauma RecoveryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Departments of Emergency Medicine and AnesthesiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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7
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Mauck MC, Barton CE, Tungate AS, Shupp JW, Karlnoski R, Smith DJ, Williams FN, Jones SW, Sefton C, McGrath K, Cairns BA, McLean SA. Peritraumatic plasma Omega-3 fatty acid concentration predicts chronic pain severity following thermal burn injury. J Burn Care Res 2021; 43:109-114. [PMID: 33895836 DOI: 10.1093/jbcr/irab071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic pain is a significant co-morbidity of burn injury affecting up to 60% of survivors. Currently, no treatments are available to prevent chronic pain after burn injury. Accumulating evidence suggests that omega-3 fatty acids (O3FA) improve symptoms across a range of painful conditions. In this study, we evaluated whether low peritraumatic levels of O3FA predicts greater pain severity during the year after burn injury. Burn survivors undergoing skin autograft were recruited from three participating burn centers. Plasma O3FA (n=77) levels were assessed in the early aftermath of burn injury using liquid chromatography/mass spectrometry and pain severity was assessed via the 0-10 numeric rating scale for 1 year following burn injury. Repeated-measures linear regression analyses were used to evaluate the association between peritraumatic O3FA concentrations and pain severity during the year following burn injury. Peritraumatic O3FA concentration and chronic pain severity were inversely related; lower levels of peritraumatic O3FA predicted worse pain outcomes (β=-.002, p=.020). Future studies are needed to evaluate biological mechanisms mediating this association and to assess the ability of O3FA to prevent chronic pain following burn injury.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Chloe E Barton
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Andrew S Tungate
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Department of Surgery, Georgetown University, Washington, DC
| | | | - David J Smith
- Department of Surgery, University of South Florida, Tampa, FL
| | | | - Samuel W Jones
- Jaycee Burn Center, University of North Carolina Chapel Hill, NC
| | - Christopher Sefton
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Kyle McGrath
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Bruce A Cairns
- Jaycee Burn Center, University of North Carolina Chapel Hill, NC
| | - Samuel A McLean
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC.,Emergency Medicine, University of North Carolina, Chapel Hill, NC
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8
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Khoury S, Wang QP, Parisien M, Gris P, Bortsov AV, Linnstaedt SD, McLean SA, Tungate AS, Sofer T, Lee J, Louie T, Redline S, Kaunisto MA, Kalso EA, Munter HM, Nackley AG, Slade GD, Smith SB, Zaykin DV, Fillingim RB, Ohrbach R, Greenspan JD, Maixner W, Neely GG, Diatchenko L. Multi-ethnic GWAS and meta-analysis of sleep quality identify MPP6 as a novel gene that functions in sleep center neurons. Sleep 2021; 44:zsaa211. [PMID: 33034629 PMCID: PMC7953222 DOI: 10.1093/sleep/zsaa211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/28/2020] [Indexed: 11/14/2022] Open
Abstract
Poor sleep quality can have harmful health consequences. Although many aspects of sleep are heritable, the understandings of genetic factors involved in its physiology remain limited. Here, we performed a genome-wide association study (GWAS) using the Pittsburgh Sleep Quality Index (PSQI) in a multi-ethnic discovery cohort (n = 2868) and found two novel genome-wide loci on chromosomes 2 and 7 associated with global sleep quality. A meta-analysis in 12 independent cohorts (100 000 individuals) replicated the association on chromosome 7 between NPY and MPP6. While NPY is an important sleep gene, we tested for an independent functional role of MPP6. Expression data showed an association of this locus with both NPY and MPP6 mRNA levels in brain tissues. Moreover, knockdown of an orthologue of MPP6 in Drosophila melanogaster sleep center neurons resulted in decreased sleep duration. With convergent evidence, we describe a new locus impacting human variability in sleep quality through known NPY and novel MPP6 sleep genes.
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Affiliation(s)
- Samar Khoury
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Qiao-Ping Wang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-Sen University, Guangzhou, China
| | - Marc Parisien
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Pavel Gris
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
| | - Andrey V Bortsov
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery and Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Samuel A McLean
- Institute for Trauma Recovery and Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew S Tungate
- Institute for Trauma Recovery and Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tamar Sofer
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jiwon Lee
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Tin Louie
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Susan Redline
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Mari Anneli Kaunisto
- Department of Diagnostics and Therapeutics, University of Helsinki, Helsinki, Finland
| | - Eija A Kalso
- Department of Diagnostics and Therapeutics, University of Helsinki, Helsinki, Finland
| | | | - Andrea G Nackley
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Gary D Slade
- School of dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Shad B Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Dmitri V Zaykin
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | | | - Richard Ohrbach
- Department of Oral Diagnostic Services, University at Buffalo, Buffalo, NY
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, Brotman Facial Pain Clinic, School of Dentistry and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, MD
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - G Gregory Neely
- The Dr. John and Anne Chong Laboratory for Functional Genomics, Charles Perkins Centre and School of Life & Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Luda Diatchenko
- The Alan Edwards Centre for Research on Pain, McGill University, Montréal, QC, Canada
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9
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Faught GG, Himmelberger ZM, Tungate AS, Conners FA. Sustained attention to response task performance trajectories in Down syndrome. J Intellect Disabil Res 2021; 65:230-235. [PMID: 33368698 DOI: 10.1111/jir.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sustained attention (SA) has been reported to be a unitary construct in youth with Down syndrome (DS), but additional analyses of how auditory and visual SA change over task presentation time are warranted. METHOD The current study was a secondary data analysis employing multilevel modeling. Specifically, we compared auditory and visual sustained attention to response task (SART) performance trajectories within a group of 42 youth with DS aged 10 to 22 years. RESULTS We found that auditory omission errors increased at a faster rate than visual omission errors over increasing SART block presentations in youth with DS. CONCLUSIONS Youth with DS experience more SA lapses over time in the auditory than visual modality. Results have implications for academic instruction and assessment.
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Affiliation(s)
- G G Faught
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Z M Himmelberger
- Behavioral Sciences Division, Maryville College, Maryville, TN, USA
| | - A S Tungate
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - F A Conners
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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10
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Tungate AS, Conners FA. Executive function in Down syndrome: A meta-analysis. Res Dev Disabil 2021; 108:103802. [PMID: 33341075 DOI: 10.1016/j.ridd.2020.103802] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Executive function (EF) refers to a set of cognitive processes involved in goal-oriented behavior-especially inhibition, attention shifting, and working memory. EF has been identified as a probable area of difficulty in Down syndrome (DS), but the exact nature of the difficulty has not been well-established. AIMS The meta-analysis sought to confirm or disconfirm EF as an area of difficulty in DS and elucidate an EF profile. METHODS AND PROCEDURES A random-effects meta-analysis was conducted on 57 studies that compared a group with DS to a typically developing (TD) mental age matched group on one or more executive function tasks. Heterogeneity was examined and moderators analyzed. OUTCOMES AND RESULTS The overall mean weighted effect size was large (d = -0.87), indicating poorer EF in groups with DS vs TD groups. Heterogeneity was significant, and moderator analysis revealed an EF profile with a very large effect for verbal WM/STM, a large effect for shifting, and moderate effects for inhibition and nonverbal WM/STM. Skewness analysis suggested that mean effect sizes might have been dampened, especially for WM/STM and shifting. CONCLUSIONS AND IMPLICATIONS Individuals with DS display a pronounced difficulty in EFs; implications for interventions and future research are discussed.
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Affiliation(s)
- Andrew S Tungate
- The University of Alabama, Department of Psychology, Box 870348, Tuscaloosa, AL, 35487-0348, USA.
| | - Frances A Conners
- The University of Alabama, Department of Psychology, Box 870348, Tuscaloosa, AL, 35487-0348, USA
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11
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Conners FA, Tungate AS, Abbeduto L, Merrill EC, Faught GG. Growth and Decline in Language and Phonological Memory Over Two Years Among Adolescents With Down Syndrome. Am J Intellect Dev Disabil 2018; 123:103-118. [PMID: 29480772 PMCID: PMC5858704 DOI: 10.1352/1944-7558-123.2.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Forty-two adolescents with Down syndrome (DS) ages 10 to 21 years completed a battery of language and phonological memory measures twice, 2 years apart. Individual differences were highly stable across two years. Receptive vocabulary scores improved, there was no change in receptive or expressive grammar scores, and nonword repetition scores declined. Digit memory and expressive vocabulary scores improved among younger adolescents, but generally held steady among older adolescents. These patterns may reveal key points in development at which interventions may be best applied. Further research is needed to understand specific processes in tasks that appear to be slowing or declining during adolescence. They may be important for understanding early aging and dementia in DS.
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Affiliation(s)
- Frances A Conners
- Frances A. Conners and Andrew S. Tungate, Department of Psychology, The University of Alabama
| | - Andrew S Tungate
- Frances A. Conners and Andrew S. Tungate, Department of Psychology, The University of Alabama
| | - Leonard Abbeduto
- Leonard Abbeduto, MIND Institute, and Department of Psychiatry and Behavioral Sciences, The University of California, Davis
| | - Edward C Merrill
- Edward C. Merrill and Gayle G. Faught, Department of Psychology, The University of Alabama
| | - Gayle G Faught
- Edward C. Merrill and Gayle G. Faught, Department of Psychology, The University of Alabama
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12
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Linnstaedt SD, Pan Y, Mauck MC, Sullivan J, Zhou CY, Jung L, Rueckeis CA, Blount JD, Carson MS, Tungate AS, Kurz MC, Hendry PL, Lewandowski C, D'Anza T, Datner E, Bell K, Lechner M, Shupp JW, Cairns BA, McLean SA. Evaluation of the Association Between Genetic Variants in Circadian Rhythm Genes and Posttraumatic Stress Symptoms Identifies a Potential Functional Allele in the Transcription Factor TEF. Front Psychiatry 2018; 9:597. [PMID: 30498461 PMCID: PMC6249322 DOI: 10.3389/fpsyt.2018.00597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
Previous studies suggest that genetic variants within genes affecting the circadian rhythm influence the development of posttraumatic stress symptoms (PTSS). In the present study, we used data from three emergency care-based cohorts to search genetic variants in circadian pathway genes previously associated with neuropsychiatric disorders for variants that influence PTSS severity. The three cohorts used included a discovery cohort of African American men and women enrolled following motor vehicle collision (n = 907) and two replication cohorts: one of multi-ethnic women enrolled following sexual assault (n = 274) and one of multi-ethnic men and women enrolled following major thermal burn injury (n = 68). DNA and RNA were collected from trauma survivors at the time of initial assessment. Validated questionnaires were used to assess peritraumatic distress severity and to assess PTSS severity 6 weeks, 6 months, and 1 year following trauma exposure. Thirty-one genetic variants from circadian rhythm genes were selected for analyses, and main effect and potential gene*stress and gene*sex interactions were evaluated. Secondary analyses assessed whether associated genetic variants affected mRNA expression levels. We found that six genetic variants across five circadian rhythm-associated genes predicted PTSS outcomes following motor vehicle collision (p < 0.05), but only two of these variants survived adjustment for multiple comparisons (False Discovery Rate < 5%). The strongest of these associations, an interaction between the PAR-zip transcription factor, thyrotroph embryonic factor (TEF) variant rs5758324 and peritraumatic distress, predicted PTSS development in all three cohorts. Further analysis of genetic variants in the genetic region surrounding TEFrs5758324 (±125,000 nucleotides) indicated that this allele showed the strongest association. Further, TEF RNA expression levels (determined via RNA-seq) were positively associated with PTSS severity in distressed individuals with at least one copy of the TEFrs5758324 minor allele. These results suggest that rs5758324 genetic variant in TEF, a regulator of clock-controlled genes and key mediator of the core circadian rhythm, influence PTSS severity in a stress-dependent manner.
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Affiliation(s)
- Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States.,Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, United States
| | - Yue Pan
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States.,Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Matthew C Mauck
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States.,Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, United States
| | - Jenyth Sullivan
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States
| | - Christine Y Zhou
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States
| | - Lindsey Jung
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Cathleen A Rueckeis
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States
| | - Jameson D Blount
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States
| | - Matthew S Carson
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, United States
| | | | - Teresa D'Anza
- Albuquerque Sexual Assault Nurse Examiner Collaborative, Albuquerque, NM, United States
| | - Elizabeth Datner
- Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States
| | - Kathy Bell
- Forensic Nursing Program, Tulsa Police Department, Tulsa, OK, United States
| | - Megan Lechner
- Forensic Nursing Program, Memorial Health System, Colorado Springs, CO, United States
| | - Jeffrey W Shupp
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, United States
| | - Bruce A Cairns
- Jaycee Burn Center, University of North Carolina, Chapel Hill, NC, United States
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, United States.,Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, United States.,Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, United States
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13
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Loveall SJ, Conners FA, Tungate AS, Hahn LJ, Osso TD. A cross-sectional analysis of executive function in Down syndrome from 2 to 35 years. J Intellect Disabil Res 2017; 61:877-887. [PMID: 28726285 PMCID: PMC5573132 DOI: 10.1111/jir.12396] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 04/25/2017] [Accepted: 06/14/2017] [Indexed: 05/31/2023]
Abstract
BACKGROUND Previous research has indicated a unique profile of executive function (EF) in children and adolescents with Down syndrome (DS). However, there is a paucity of research on EF in adults with DS. This study aimed to gain a broader understanding of strengths and weaknesses in EF in DS from 2 to 35 years. METHOD Parents of 112 individuals with DS between 2 and 35 years participated in this study. Parents either completed the Behaviour Rating Inventory of Executive Function - for individuals 6+ years - or the Behaviour Rating Inventory of Executive Function Preschool Version - for children 2-5 years. RESULTS Results suggest not only overall difficulties but also patterns of strength and weakness within EF for individuals with DS. For the 2 to 5-year-old group, emotional control and shift were relative strengths, planning/organisation and inhibit were intermediate skills, and working memory was a relative weakness. For the 6 to 18-year-old group, emotional control and organisation of materials were relative strengths, inhibit and initiate were intermediate skills, and working memory, monitor, planning/organisation, and shift were relative weaknesses. Most abilities were consistent from 2 to 18 years, except shift, which decreased in preadolescence before beginning to recover in adolescence. Across the full age range (2-35 years), composite scores indicated quadratic trends in inhibit, working memory, and planning/organisation, and a cubic trend in shift, with EF abilities generally declining in middle childhood before recovering in adulthood. CONCLUSIONS This study extends previous research on EF in DS by providing an initial description of EF profiles across the lifespan. More longitudinal and behavioural research is needed to further characterise the development of EF in DS.
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Affiliation(s)
- S J Loveall
- Department of Communication Sciences and Disorders, University of Mississippi, Oxford, MS, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
- Life Span Institute, University of Kansas, Lawrence, KS, USA
| | - F A Conners
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - A S Tungate
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - L J Hahn
- Life Span Institute, University of Kansas, Lawrence, KS, USA
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - T D Osso
- Department of Communication Sciences and Disorders, University of Mississippi, Oxford, MS, USA
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