Plein ciel journal / Paul Louis Weiller, directeur

septembre 19381938/09 (N62,A11)-1938/10

Derivation of study cohort of Iraq and Afghanistan veterans with zolpidem exposure in fiscal year 2014.

<p>Derivation of study cohort of Iraq and Afghanistan veterans with zolpidem exposure in fiscal year 2014.</p

Table_1_Comorbidity and polypharmacy impact neurobehavioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury.DOCX

ObjectiveThe study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) with reported neurobehavioral symptoms and symptom validity screening among post-9/11 veterans with a history of mild traumatic brain injury (mTBI).SettingAdministrative medical record data from the Department of Veterans Affairs (VA) were used in the study.ParticipantsPost-9/11 veterans with mTBI and at least 2 years of VA care between 2001 and 2019 who had completed the comprehensive traumatic brain injury evaluation (CTBIE) were included in the study.DesignRetrospective cross-sectional design was used in the study.Main measuresNeurobehavioral Symptom Inventory (NSI), International Classification of Diseases, Ninth Revision, and Clinical Modification diagnosis codes were included in the study.ResultsOf the 92,495 veterans with a history of TBI, 90% had diagnoses of at least one identified comorbidity (PTSD, depression, and/or headache) and 28% had evidence of CNS polypharmacy. Neurobehavioral symptom reporting and symptom validity failure was associated with comorbidity burden and polypharmacy after adjusting for sociodemographic characteristics. Veterans with concurrent diagnoses of PTSD, depression, and headache were more than six times more likely [Adjusted odds ratio = 6.55 (99% CI: 5.41, 7.92)]. to fail the embedded symptom validity measure (Validity-10) in the NSI.ConclusionTBI-related multimorbidity and CNS polypharmacy had the strongest association with neurobehavioral symptom distress, even after accounting for injury and sociodemographic characteristics. Given the regular use of the NSI in clinical and research settings, these findings emphasize the need for comprehensive neuropsychological evaluation for individuals who screen positively for potential symptom overreporting, the importance of multidisciplinary rehabilitation to restore functioning following mTBI, and the conscientious utilization of symptom validity measures in research efforts.</p

Is balance performance reduced after mild traumatic brain injury?: Interim analysis from chronic effects of neurotrauma consortium (CENC) multi-centre study

<p><b>Objectives</b>: Determine if mild traumatic brain injury (mTBI) history is associated with balance disturbances.</p> <p><b>Setting</b>: Chronic Effects of Neurotrauma Consortium (CENC) centres.</p> <p><b>Participants</b>: The CENC multi-centre study enrols post-9/11 era Service Members and Veterans with combat exposure. This sample (<i>n</i> = 322) consisted of enrolees completing initial evaluation by September 2016 at the three sites conducting computerized dynamic post-urography (CDP) testing.</p> <p><b>Design</b>: Observational study with cross-sectional analyses using structural equation modelling.</p> <p><b>Main Measures</b>: Comprehensive structured interviews were used to diagnose all lifetime mild traumatic brain injuries (mTBIs). The outcome, Sensory Organization Test (SOT), was measured on CDP dual-plate force platform. Other studied variables were measured by structured interviews, record review and questionnaires.</p> <p><b>Results</b>: The overall positive/negative mTBI classification did not have a significant effect on the composite equilibrium score. However, the repetitive mTBI classification showed lower scores for participants with ≥ 3 mTBI versus 1–2 lifetime mTBIs. For repetitive mTBI, pain interference acted as a mediator for the indirect effect, and a direct effect was evident on some sensory condition equilibrium scores.</p> <p><b>Conclusion</b>: These findings show that repeated mTBI, partially mediated by pain, may lead to later balance disturbances among military combatants. Further study of CDP outcomes within this accruing cohort is warranted.</p