Traumatic brain injury related hospitalization and mortality in California.

ObjectiveThe aim of this study is to describe the traumatic brain injury (TBI) population and causes and identify factors associated with TBI hospitalizations and mortality in California.MethodsThis is a cross-sectional study of 61,188 patients with TBI from the California Hospital Discharge Data 2001 to 2009. We used descriptive, bivariate, and multivariate analyses in SAS version 9.3.ResultsTBI-related hospitalizations decreased by 14% and mortality increased by 19% from 2001 to 2009. The highest percentages of TBI hospitalizations were due to other causes (38.4%), falls (31.2%), being of age ≥75 years old (37.2%), being a males (58.9%), and being of Medicare patients (44%). TBIs due to falls were found in those age ≤4 years old (53.5%), ≥75 years old (44.0%), and females (37.2%). TBIs due to assaults were more frequent in Blacks (29.0%). TBIs due to motor vehicle accidents were more frequent in 15-19 and 20-24 age groups (48.7% and 48.6%, resp.) and among Hispanics (27.8%). Higher odds of mortality were found among motor vehicle accident category (adjusted odds ratio (AOR): 1.27, 95% CI: 1.14-1.41); males (AOR: 1.36, 95% CI: 1.27-1.46); and the ≥75-year-old group (AOR: 6.4, 95% CI: 4.9-8.4).ConclusionsOur findings suggest a decrease in TBI-related hospitalizations but an increase in TBI-related mortality during the study period. The majority of TBI-related hospitalizations was due to other causes and falls and was more frequent in the older, male, and Medicare populations. The higher likelihood of TBI-related mortalities was found among elderly male ≥75 years old who had motor vehicle accidents. Our data can inform practitioners, prevention planners, educators, service sectors, and policy makers who aim to reduce the burden of TBI in the community. Implications for interventions are discussed

The Prevalence of Occult Celiac Disease among Patients with Functional Dyspepsia: A Study from the Western Region of Iran

Objective. The prevalence of Celiac Disease (CD) is high in Iran, and evaluation of CD is not part of the routine screening procedure for dyspeptic patients; therefore, cases of occult CD may be missed. This study aimed to investigate the prevalence of occult CD among dyspeptic patients who presented at a gastroenterology clinic in the Western region of Iran. Methods. In this descriptive, cross-sectional prospective study, patients who had a history of at least 12 weeks of upper abdominal discomfort were eligible to participate in the study during a 14-month recruitment period. Patients with a clinical or paraclinical data in favor of organic causes were excluded from the study. Enrolled patients were screened for IgA antiendomysium antibody (EMA) and IgA antitissue transglutaminase antibody (tTG). Those who screened positive for EMA/tTG received a confirmatory diagnostic biopsy for Marsh classification of CD. Results. From 225 potential participants with dyspepsia, 55 patients were excluded due to having explainable organic causes. The study sample included 170 patients with “functional dyspepsia.” Mean age of participants was 31 years and 55.8% were female. Twelve patients (7%) had positive tests (EMA/tTG), of which 10 were female (83.4%). According to Rome II criteria, all twelve patients with positive tests had “dysmotility type dyspepsia.” Based on Marsh classification, six patients were consistent with “Marsh I,” four with “Marsh II,” and two with the “Marsh III” classification. Conclusions. In this study, the prevalence of CD in dyspeptic patients was high. As a result, this study suggests that screening by serology tests (EMA/tTG) is justifiable for the detection of CD among functional dyspeptic patients in the tertiary centers in our country

Depression Symptoms , Acculturation, Needing Care, and Receiving Care: A Study of Adolescents Living in California

Background: The objectives of this study are 1) to depict the prevalence of moderate depressive symptoms (MDS) in adolescents living in California, 2) to examine the role of acculturation in reported MDS, and 3) to identify any relationship between acculturation, “needing emotional help,” and “receiving psychological or emotional counseling,” as reported by adolescents with MDS. Methods: We analyzed data from a cross-sectional population-based telephone survey for adolescents who completed the California Health Interview Survey (CHIS) in 2007, 2009, and 2011-2012. The primary predictor variable was level of acculturation. Outcome variables were 1) the presence of MDS, 2) whether participants needed help with emotional problems, and 3) whether they had received psychological or emotional counseling. Results: Of the sample (n = 9816), 6.0% had MDS; 50% of these reported needing help for emotional problems, and 30% reported receiving psychological/emotional counseling. Multivariate analysis that included the interaction effects of race/ethnicity and acculturation showed that the latter was not associated with any of the outcome variables. However, Latino adolescent with MDS and moderate acculturation were less likely to report needing help for psychological/emotional problems, compared to their White counterparts with higher acculturation. Conclusion: Our findings suggest disparities in reporting depression symptoms and receiving psychological/emotional help are not driven by adolescents’ acculturation levels. However, more studies are needed to clarify what cultural factors facilitate or inhibit moderately acculturated Latino adolescents from reporting needing help for psychological/emotional problems

The Knowledge, Attitudes and Usage of Complementary and Alternative Medicine of Medical Students

The increasing use of CAM by patients has led to an increase in teaching about CAM in medical school in the US. In preparation for initiation of a new curriculum in Integrative Medicine at the David Geffen School of Medicine at UCLA a cross sectional survey was used to assess medical students': (i) familiarity, (ii) opinions, (iii) personal use and (iv) willingness to recommend specific CAM modalities, using a five point Likert scale of an established measure. A total of 263 first, second and third year medical students at UCLA completed surveys. Third year students reported less personal use of CAM and less favorable attitudes towards CAM than first year students. Since this was a cross-sectional rather than longitudinal study this may be a cohort effect. However, it may reflect the increased curricular emphasis on evidenced-based medicine, and subsequent student dependence on randomized clinical trials to influence and guide practice. This will need to be addressed in curricular efforts to incorporate Integrative Medicine

Psychometric properties of the 12-item WHODAS applied through phone survey: an experience in PERSIAN Traffic Cohort

Background Due to limited capability to function in post-injury daily life injury, survivors need to be reliably assessed without need to commute more than necessary. The key action is to determine the level of functioning difficulties. Having the opportunity of conducting a national post-crash traffic safety and health cohort study, we aimed to translate into Persian and assess the psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) through phone surveys six month post injury. Methods First, having World Health Organization permission, we tested the translation validity by forward translation, expert panel evaluation, back-translation, pre-testing and cognitive interviewing, and finalizing the Persian WHODAS. Then, through a psychometric study within a national cohort platform, the validity, reliability and applicability of the 12-item WHODAS was assessed through phone surveys. We included data of 255 road traffic injury patients enrolled from the cohort at six-month follow-up. The psychometric assessment (internal consistency reliability and stability reliability) was conducted on test-retest data of 50 patients with an average 7-day time span. An exploratory factor analysis tested the construct validity using extraction method of principal component factor and oblique rotation on data from 255 patients. Regarding the multiple criteria including an eigenvalue > 0.9, Cattell's scree test, cumulative variance, and the theoretical basis, the minimum number of factors were retained. Data were analyzed using STATA statistical software package. Results The respondents were mostly male (81%), employed (71%), educated (87%), and with a mean age of 37.7(14.9). The Persian version had high internal consistency reliability (Cronbach's alpha = 0.93) and excellent stability reliability (ICC = 0.97, 95% CI: 0.92-0.98). An exploratory factor analysis retained four factors defining 86% of all the variance. Factors of Self-care, Mobility, and Cognition were completely retained. Conclusions The brief Pesrian WHODAS 2.0 was highly reliable and valid to be applied through phone interviews post injury

Traumatic injuries in pregnant women: a case of motor vehicle accident for “Ground Round” discussion

The main objective for introducing this case study is to create a platform from which the importance of road traffic related injuries and traumas can be emphasized and discussed within and across various fields of investigation. The long term goal is to entice public campaign around unmet needs for higher road safety measures to reduce primary, secondary, and tertiary risks of injuries and traumas

Use and outcomes of antihypertensive medication treatment in the US hypertensive population: A gender comparison

Background: Although effective antihypertensive medications have existed for decades, only about half of the hypertensive individuals are considered to have controlled blood pressure. Limited research studies have investigated gender disparity in the utilization and effectiveness of antihypertensive medications treatment. To examine the gender difference in antihypertensive medications’ use and the effect of using antihypertensive medication treatment on blood pressure control among the U.S. adult with hypertension. Methods: Analysis of National Health and Nutrition Examination Survey (NHANES) data from (1999-2012) including individuals≥18 years old with hypertension. Study variables included gender, age, race/ethnicity, obesity, smoking, comorbidities, treatment medication type, and continuity of care. We used multivariate logistic regression in STATA V14. The data is presented as adjusted odds ratios (ORs) and 95% confidence interval (CI). Results: Of the 15719 participants, 52% were female. 49% of the antihypertensive medication users had their blood pressure under control (95% CI). In the adjusted logistic regression analysis, use of antihypertensive medications was found to be 12% greater in females as compared to males (OR=1.12; CI=1.02-1.22; P<0.05). No association between gender and blood pressure control was found. Blood pressure control was less likely achieved among 50 years or younger individuals, Blacks and Hispanics, obese, and those taking calcium channel blocker (CCB). Conclusion: Hypertensive females are more likely than males to use antihypertensive medications. The effectiveness of treatment to control blood pressure is equal across males and females. Our findings have implications for practitioners to account gender-specific approaches when discussing adherence to hypertension medication treatment with their patients

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran

Objectives Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. Methods The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. Results Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. Conclusions The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs

Functional Consequences of Road Traffic Injuries: Preliminary Results from PERSIAN Traffic Cohort (PTC)

Introduction: Traffic injuries are one of the main causes of death worldwide. After decreasing mortality rates and improving the recovery of injured patients, long-term functional consequences need to be addressed. The purpose of this study was to assess the functional outcomes of road traffic injuries and their predictors six months after hospital discharge, based on the preliminary results from PTC.Methods: A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled-in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients were hospitalized after road accidents at two referral trauma centers, (from 23 September 2018 to 20 March 2019).Results: The majority of participants were men (82.7%), (Mean age =38.8). The mean score of WHODAS 2.0 was 17.8) SD=9.1). The highest score was estimated for the self-care dimension 3.3 (SD=1.8), and the lowest score for getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05).Conclusion: The current study identified some functional disabilities among patients sustaining road traffic injuries. It is evident from the results that a proportion of patients do not recover six months after the injury and suffer a disability, especially in self-care, mobility, and life activities, which potentially prevent them from returning to normalcy. In addition, age, gender, physiotherapy, injury localization was related to WHODAS 2.0 score