Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury

<p>Abstract</p> <p>Background</p> <p>The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning.</p> <p>Methods</p> <p>This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis.</p> <p>Results</p> <p>Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning.</p> <p>Conclusion</p> <p>This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.</p

Innovations in coastline management with natural and nature-based features (NNBF): lessons learned from three case studies

Coastal communities around the world are facing increased coastal flooding and shoreline erosion from factors such as sea-level rise and unsustainable development practices. Coastal engineers and managers often rely on gray infrastructure such as seawalls, levees and breakwaters, but are increasingly seeking to incorporate more sustainable natural and nature-based features (NNBF). While coastal restoration projects have been happening for decades, NNBF projects go above and beyond coastal restoration. They seek to provide communities with coastal protection from storms, erosion, and/or flooding while also providing some of the other natural benefits that restored habitats provide. Yet there remain many unknowns about how to design and implement these projects. This study examines three innovative coastal resilience projects that use NNBF approaches to improve coastal community resilience to flooding while providing a host of other benefits: 1) Living Breakwaters in New York Harbor; 2) the Coastal Texas Protection and Restoration Study; and 3) the South Bay Salt Pond Restoration Project in San Francisco Bay. We synthesize findings from these case studies to report areas of progress and illustrate remaining challenges. All three case studies began with innovative project funding and framing that enabled expansion beyond a sole focus on flood risk reduction to include multiple functions and benefits. Each project involved stakeholder engagement and incorporated feedback into the design process. In the Texas case study this dramatically shifted one part of the project design from a more traditional, gray approach to a more natural hybrid solution. We also identified common challenges related to permitting and funding, which often arise as a consequence of uncertainties in performance and long-term sustainability for diverse NNBF approaches. The Living Breakwaters project is helping to address these uncertainties by using detailed computational and physical modeling and a variety of experimental morphologies to help facilitate learning while monitoring future performance. This paper informs and improves future sustainable coastal resilience projects by learning from these past innovations, highlighting the need for integrated and robust monitoring plans for projects after implementation, and emphasizing the critical role of stakeholder engagement.Environmental Biolog

The relationship between mood and sleep in different female reproductive states

Peer reviewe

Psychometric Characteristics of the Insomnia Severity Index in Veterans With History of Traumatic Brain Injury

Objective/backgroundThe Insomnia Severity Index (ISI) is a widely used self-report measure of insomnia symptoms. However, to date this measure has not been validated or well-characterized in veterans who have experienced traumatic brain injury (TBI). This study assessed the psychometric properties and convergent, divergent, construct, and discriminate validity of the ISI in veterans with a history of TBI.ParticipantsEighty-three veterans with history of TBI were seen in the VA San Diego Healthcare System as part of a research protocol.MethodsMeasures included the ISI, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Neurobehavioral Symptom Inventory, Beck Depression Inventory-II, Beck Anxiety Inventory, and PTSD Checklist-Military Version.ResultsThe ISI demonstrated moderate to strong or excellent convergent and divergent validity. A principal component analysis indicated a single construct with excellent internal consistency (Cronbach's alpha = 0.92). In exploratory analyses, the ISI discriminated well between those with (73%) and without (27%) sleep disturbance based on the PSQI.ConclusionsResults from this study indicate validity of the ISI in assessing insomnia in veterans with history of TBI and suggest a cutoff score not dissimilar from non-TBI populations. Findings from this study can help inform clinical applicability of the ISI, as well as future studies of insomnia in TBI

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury.

A comprehensive evaluation, including the assessment of neurobehavioral symptoms, has been instituted at the Department of Veterans Affairs (VA) healthcare system to address the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans returning with mild traumatic brain injuries (mTBIs). The Validity-10 is measure of symptom overreporting embedded within the Neurobehavioral Symptom Inventory, a component of the comprehensive evaluation that assesses postconcussive symptom severity. The Validity-10 is composed of 10 unlikely/low-frequency items and a validated cutoff score to identify postconcussive symptom overreporting. We examined the items and cutoff used in the initial development and validation study of the Validity-10 through retrospective chart reviews of 331 treatment-seeking Veterans who sustained an mTBI. The Validity-10 exhibited significant relationships with psychiatric variables, VA service connection, and neuropsychological performance validity (all p &lt; 0.01), but nonsignificant relationships with demographic and injury variables (all p &gt; 0.05). Furthermore, the Validity-10 modestly predicted neuropsychological performance validity test failure over and above psychiatric comorbidities and VA service connection. The present study supports the use of the Validity-10 to assess symptom validity in treatment-seeking OIF/OEF Veterans with a history of mTBI

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury.

A comprehensive evaluation, including the assessment of neurobehavioral symptoms, has been instituted at the Department of Veterans Affairs (VA) healthcare system to address the large number of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans returning with mild traumatic brain injuries (mTBIs). The Validity-10 is measure of symptom overreporting embedded within the Neurobehavioral Symptom Inventory, a component of the comprehensive evaluation that assesses postconcussive symptom severity. The Validity-10 is composed of 10 unlikely/low-frequency items and a validated cutoff score to identify postconcussive symptom overreporting. We examined the items and cutoff used in the initial development and validation study of the Validity-10 through retrospective chart reviews of 331 treatment-seeking Veterans who sustained an mTBI. The Validity-10 exhibited significant relationships with psychiatric variables, VA service connection, and neuropsychological performance validity (all p &lt; 0.01), but nonsignificant relationships with demographic and injury variables (all p &gt; 0.05). Furthermore, the Validity-10 modestly predicted neuropsychological performance validity test failure over and above psychiatric comorbidities and VA service connection. The present study supports the use of the Validity-10 to assess symptom validity in treatment-seeking OIF/OEF Veterans with a history of mTBI