Factors associated with remission of post-traumatic brain injury fatigue in the years following traumatic brain injury (TBI): a TBI model systems module study

Post-traumatic brain injury fatigue (PTBIF) is a major problem in the years after traumatic brain injury (TBI), yet little is known about its persistence and resolution. The objective of the study was to identify factors related to PTBIF remission and resolution. TBI Model System registrants at five centres participated in interviews at either one and two years post-injury (Y1-2 Cohort), or two and five years post-injury (Y2-5 Cohort). Characteristics of participants with PTBIF remission were compared to those with PTBIF persistence. Variables studied included the presence of and changes in disability, sleep dysfunction, mood, and community participation. The Functional Independence Measure did not differ significantly between groups or over time. In the Y1-2 Cohort the Fatigue Resolved group scored significantly better on the Disability Rating Scale and Pittsburgh Sleep Quality Index. In the Y2-5 Cohort the Fatigue Resolved group scored significantly higher on a measure of community participation. It was concluded that fewer than half of the sample in each cohort experienced a remission of PTBIF between time points. Persistence of PTBIF 1–2 years post-injury is associated with disability, sleep disturbance, and depression while persistence of fatigue beyond 2 years post-injury appears to be related to participation level, underscoring the potential impact of effective surveillance, assessment, and treatment of this condition in optimising life after TBI. Differences in fatigue progression may point to the presence of different types of PTBIF

Relationship Between Hispanic Nativity, Residential Environment, and Productive Activity Among Individuals With Traumatic Brain Injury: A TBI Model Systems Study

Objective: To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI). Setting: Acute rehabilitation facilities and community follow-up. Participants: A total of 706 Hispanic individuals in the TBI Model Systems National Database. Design: Secondary data analysis from a multicenter longitudinal cohort study. Main Measures: Nativity (foreign born or US native), productive activity derived from interview questions regarding employment status, and other demographic information. Census data were extracted by zip code to represent residential characteristics of aggregate household income and proportion of foreign language speakers (FLS). Results: Among foreign-born individuals with TBI, those living in an area with a higher proportion of FLS were 2.8 times more likely to be productive than those living in areas with a lower proportion of FLS. Among individuals living in an area with a lower proportion of FLS, US-born Hispanics were 2.7 times more likely to be productive compared with Hispanic immigrants. Conclusion: The relationship between nativity and productive activity at 1 year post-TBI was moderated by the residential proportion of FLS. Findings underscore the importance of considering environmental factors when designing vocational rehabilitation interventions for Hispanics after TBI

Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan

<p>Abstract</p> <p>Background</p> <p>Relatively little empirical attention has focused on the association between social participation and depressive symptoms amongst older adults in Asian nations, where persons over the age of 65 represent a rapidly growing segment of the population. This study explores the dynamic relationship between participation in social activities and trajectories of depressive symptomatology among older Taiwanese adults surveyed over 18 years.</p> <p>Methods</p> <p>Data are from a nationally representative sample of 1,388 adults aged 60-64 first surveyed in 1989 and followed over an 18-year time period for a total of six waves. Individual involvement in social activities was categorized into continuous participation, ceased participation before age 70, initiating participation in older adulthood, never participated, and dropped out before age 70. Two domains of depressive symptoms--negative affect and lack of positive affect--were measured using a 10-item version of the Center for Epidemiologic Studies-Depression Scale.</p> <p>Results</p> <p>Analyses using growth curve modeling showed that continuously participating or initiating participation in social activities later life is significantly associated with fewer depressive symptoms among older Taiwanese adults, even after controlling for the confounding effects of aging, individual demographic differences, and health status.</p> <p>Conclusions</p> <p>These findings suggest that maintaining or initiating social participation in later life benefits the mental health of older adults. Facilitating social activities among older adults is a promising direction for programs intended to promote mental health and successful aging among older adults in Taiwan.</p

Variations in social capital among vocational rehabilitation applicants

BACKGROUND: In general, people with disabilities have lower levels of social capital, a measure of the quality of social relations, than people without disabilities. People with disabilities who participate in the labor force, however, have been found to have higher levels of social capital than their peers who do not participate in the labor force. OBJECTIVE: Using newly available data from the Survey of Disability and Employment (SDE), this study examined perceived social capital as it relates to supporting employment among applicants for state vocational rehabilitation (VR) services in three states: Mississippi, New Jersey, and Ohio. METHODS: We used multivariate analysis to compare differences in levels of perceived (i.e. cognitive) social capital between applicants who were employed and applicants who were not employed, by disability severity, age at disability onset, health status, and individual characteristics. RESULTS: VR applicants were more likely to benefit from social capital in their working lives if they reported currently working, less severe disability, and better perceived health. CONCLUSIONS: VR counselors must recognize that persons applying for VR services vary greatly in their access to the social supports that are closely associated with employment

A multilevel analysis of ethnic variation in depressive symptoms among adolescents in the United States

This study examines linkages between ethnicity and symptoms of depression among adolescents, with a specific focus on the intersection of individual- and contextual-level risk factors. Data are from the National Longitudinal Study of Adolescent Health (Add Health), a panel survey of a nationally representative United States sample (analytic N=18,473) of students in the 7th through 12th grades. Depressive symptoms are measured with a 16-item subscale of the Center for Epidemiologic Studies-Depression Scale. Hierarchical linear modeling is used to estimate the simultaneous effects of individual-level ethnicity, sex, age, family structure, and socioeconomic status (SES), and community-level ethnic composition and SES, operationalized by collapsing United States Census tract data to the school sampling area. There is significant variation in depressive symptoms among sampling areas and both individual- and contextual-level characteristics exert effects on depressive symptomatology. The impact of individual-level ethnicity on depressive symptoms depends upon characteristics of the sampling area, in that African American teens living within predominantly Non-Hispanic White areas are at especially high risk for frequent depressive symptoms. The findings demonstrate that the emotional consequences of membership in an ethnic group are in some instances contingent upon social context.Ethnicity Adolescent Depressive symptoms Multilevel USA

Benefits and barriers to return to education and relationship to quality of life for people living with spinal cord injury: Results of a mixed methods study

There is limited research on return to education (RTE) after spinal cord injury (SCI). As a result, few programs exist to help people achieve this goal. The primary objective was to investigate the barriers and facilitators to RTE, and the relationship between RTE and quality of life (QOL). The secondary objective was to examine the role of a Vocational Resource Facilitation (VRF) program on RTE. A mixed methods approach with a semi-structured interview and online survey was used. Participants included 15 people with SCI with RTE goals who received VRF services at an acute inpatient rehabilitation hospital. Qualitative responses on the barriers, facilitators and perceived benefits of RTE were analyzed using a grounded theory strategy. Barriers to RTE included physical and mental health, transportation, time, environmental barriers, finances, lack of knowledge about available resources, and discrimination. Facilitators to RTE included the VRF program, social support, financial support, virtual learning, organizational support, and policy constructs. People who RTE after SCI reported better QOL, less depressed mood than those who did not, and were more likely to have returned to work. This study highlighted common barriers and facilitators to RTE, and potential areas of intervention. VRF is a potentially efficacious early intervention vocational rehabilitation approach that improves participation in education and employment for people with SCI. People who received VRF and achieved RTE may have better QOL outcomes and improved employability.</p