Health Care Costs 1 Year After Pediatric Traumatic Brain Injury

Objectives. This study sought to estimate total health care costs for mild, moderate, and severe pediatric traumatic brain injury (TBI) and to compare individual- and population-level costs across levels of TBI severity.Methods. Using 2007 to 2010 MarketScan Commercial Claims and Encounters data, we estimated total quarterly health care costs 1 year after TBI among enrollees (aged < 18 years). We compared costs across levels of TBI severity using generalized linear models.Results. Mild TBI accounted for 96.6% of the 319 103 enrollees with TBI; moderate and severe TBI accounted for 1.7% and 1.6%, respectively. Adjusted individual health care costs for moderate and severe TBI were significantly higher than mild TBI in the year after injury (P < .01). At the population level, moderate and severe TBI costs were 88% and 75% less than mild TBI, respectively.Conclusions. Individually, moderate and severe TBI initially generated costs that were markedly higher than those of mild TBI. At the population level, costs following mild TBI far exceeded those of more severe cases, a result of the extremely high population burden of mild TBI.More than 600 000 children visit US emergency departments each year for traumatic brain injuries (TBIs).1 Several recent studies have described the costs associated with pediatric TBI2–7; however, many focused on acute inpatient treatment and used emergency department or hospital data only.2,3,5–7 These studies captured costs of moderate and severe TBIs, injuries that often involve poor verbal and motor responses, seizures, intracranial hypertension, and posttraumatic amnesia. Mild TBIs, such as concussions, may be evaluated solely in office settings and were not included in studies using emergency department or hospital data. Indeed, pediatric TBI cost analyses should include any rehabilitation, long-term care, and clinical evaluation for months after the injury, care that may be received in multiple clinical settings. Moderate and severe TBIs are associated with long-term physical and psychological impacts that require ongoing care, and recent research described disability from mild TBIs as well.8–11 Studies that estimated long-term costs years after injury were limited in geographic scope4 or population size.12An analysis of the 1997 to 2000 Medical Expenditure Panel Survey (MEPS) estimated that total annual expenditures for services for nonhospitalized children with TBIs averaged $77.9 million in the United States, with per capita costs estimated at $1044.13 Although this study captured costs for mild and moderate TBIs that are often not reported in the scientific literature, the analysis was limited in MEPS by self-reported conditions.13Given that mild TBI constitutes 75% of all TBIs in the United States,14 it is reasonable to expect that the population-level costs for mild TBI may exceed those of moderate or severe TBI, even though more severe injuries may cost considerably more per person. This would be important to payers who contemplate priorities for strategies to reduce costs after TBI. Moreover, although Medicaid patients are disproportionately affected by severe TBI, the diagnosis of mild TBI in particular may be more prevalent among commercially insured children.The purpose of this study was to use a large, commercial claims database to provide a comprehensive estimate of total health care costs for pediatric TBI and to explore the differences between individual- and population-level costs for mild, moderate, and severe TBI.     

Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury

The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.     

Preface to the Special Issue on Sexuality Education and Traumatic Brain Injury

Sexuality and Disability -     

Incidence of Disability Among Children 12 Months After Traumatic Brain Injury

Objectives. We examined the burden of disability resulting from traumatic brain injuries (TBIs) among children younger than 18 years.Methods. We derived our data from a cohort study of children residing in King County, Washington, who were treated in an emergency department for a TBI or for an arm injury during 2007–2008. Disabilities 12 months after injury were assessed according to need for specialized educational and community-based services and scores on standardized measures of adaptive functioning and social–community participation.Results. The incidence of children receiving new services at 12 months was about 10-fold higher among those with a mild TBI than among those with a moderate or severe TBI. The population incidence of disability (defined according to scores below the norm means on the outcome measures included) was also consistently much larger (2.8-fold to 28-fold) for mild TBIs than for severe TBIs.Conclusions. The burden of disability caused by TBIs among children is primarily accounted for by mild injuries. Efforts to prevent these injuries as well as to decrease levels of disability following TBIs are warranted.Traumatic brain injuries (TBIs) are the most common cause of death from trauma among children and adolescents1 and one of the most common causes of acquired disability.2 TBI surveillance systems have provided important aggregate information on the incidence of these injuries.3 Studies conducted in hospitals and rehabilitation centers have provided information on medical care4 and rehabilitation of patients with TBIs and their resultant impairments, focusing on those with more severe TBIs.5 However, population-based estimates of subsequent disability after pediatric TBIs are lacking. This population-based information is important to guide TBI prevention efforts and to ensure appropriate planning and delivery of services to children with TBIs who have special needs.Although much of the focus in the literature has been on severe TBIs, concerns about the consequences of concussions and mild TBIs have recently increased in both the medical literature and the lay press.6 Available data indicate that mild TBIs are much more common than moderate or severe TBIs,7,8 and thus even if the consequences for most injured individuals are much less serious, mild TBIs have the potential to contribute a large share to the overall population TBI burden. In this study, we examined the burden of disability resulting from TBIs occurring among children younger than 18 years.     

Theoretical Applications of Positive Psychology to Vocational Rehabilitation After Traumatic Brain Injury

Purpose Traumatic brain injury (TBI) produces broad-reaching and often persistent challenges that impact an individual’s ability to engage in vocational productivity. Return to work (RTW) rates after TBI are markedly poor and the efficacy of current TBI vocational rehabilitation (VR) practices is unclear. Positive psychology, the practice of fostering positive emotions and traits, offers novel approaches that might enhance the effectiveness of existing TBI VR practices. This article assesses the potential relevance of positive psychology principles and practices to VR for clients recovering from TBI. Methods A literature search was conducted using the database resources of a large university hospital, including PubMed, ProQuest, PsycINFO, and Web of Science. Content from this search was reviewed and synthesized, including literature on VR for TBI, vocational applications of positive psychology, and general rehabilitation applications of positive psychology. Results Ten guiding principles for positively-informed TBI VR are proposed. Specific positive psychology measures and interventions for improving emotional, social, and cognitive functioning are identified and discussed as they might be applied to TBI VR. Conclusions Theoretically, positive psychology principles and practices appear to be well suited to improving VR outcomes for individuals with TBI. In addition to examining the feasibility of incorporating positive psychology techniques, future research should examine the impact of positive psychology interventions on RTW rates, job satisfaction, job stability, and other vocational outcomes. With additional investigation, positive psychology measures and interventions may prove to be a beneficial compliment to existing VR practices.     

Rates and Predictors of Suicidal Ideation During the First Year After Traumatic Brain Injury

Objectives. We examined rates of suicidal ideation (SI) after traumatic brain injury (TBI) and investigated whether demographic characteristics, preinjury psychiatric history, or injury-related factors predicted SI during the first year after injury.Methods. We followed a cohort of 559 adult patients who were admitted to Harborview Medical Center in Seattle, Washington, with a complicated mild to severe TBI between June 2001 and March 2005. Participants completed structured telephone interviews during months 1 through 6, 8, 10, and 12 after injury. We assessed SI using item 9 of the Patient Health Questionnaire (PHQ-9).Results. Twenty-five percent of the sample reported SI during 1 or more assessment points. The strongest predictor of SI was the first PHQ-8 score (i.e., PHQ-9 with item 9 excluded) after injury. Other significant multivariate predictors included a history of a prior suicide attempt, a history of bipolar disorder, and having less than a high school education.Conclusions. Rates of SI among individuals who have sustained a TBI exceed those found among the general population. Increased knowledge of risk factors for SI may assist health care providers in identifying patients who may be vulnerable to SI after TBI.Suicide is a major public health problem among the 1.7 million people who sustain traumatic brain injury (TBI) each year in the United States.1 People with a history of TBI in both civilian and military populations are 1.55 to 4.05 times more likely to die by suicide than the general population.2–5 In a study of Australian outpatients with a history of TBI, the majority of whom had no preinjury history of suicide attempts, suicide attempts were reported by 17.4% (30 of 172) of the sample over a 5-year period.6 Nearly half of the individuals who attempted suicide had made multiple attempts.6,7 The Centers for Disease Control and Prevention recently called for investigations of individual-level risk and protective factors for self-directed violence among people with TBI as an important component of improving long-term outcomes.8Rates of suicidal ideation (SI) after TBI have been found to exceed 20% in some studies6,9–14; however, in a recent systematic review of SI and behavior after TBI, Bahraini et al. highlighted the paucity of research in this area.15 They concluded that additional research is needed to determine the prevalence of SI and behavior after brain injury, as well as to ascertain patient-level factors that may be associated with increased suicide risk. Studies examining whether injury severity predicts post-TBI suicidality have yielded inconclusive findings.6,13,16,17 In perhaps the most thorough study on this topic to date, Tsaousides et al.12 surveyed 356 community-dwelling adults with a self-reported history of TBI and found that preinjury substance abuse was the only correlate of current SI. Risk factors for SI after TBI have been underinvestigated. Research in this area has been limited by reliance on retrospective reporting and self-reported history of TBI,12,18–20 with only a few studies including objective indicators of TBI severity.6 Most studies have involved cross-sectional designs and have included participants whose time since injury varied from several months to many years.12,21 Finally, because most existing studies have included relatively small, potentially biased samples21 recruited from outpatient clinics or TBI survivor programs,6,7,12 they may not be representative of the population of people who sustain TBI.Given these gaps in the existing literature, our objectives were (1) to investigate rates of SI during the first year after complicated mild to severe TBI in a representative sample of adults who had been admitted to a level I trauma center and (2) to investigate whether demographic characteristics, preinjury psychiatric history, or injury-related factors predicted SI.     

康复护理在儿童重型颅脑外伤手术后的效果观察

目的分析康复护理对重型颅脑外伤患儿术后的效果。方法选取42例重型颅脑外伤患儿为研究对象,随机分成观察组和对照组两组,每组21例,对照组采取常规护理措施,观察组采取早期康复护理,对比两组的护理效果。结果观察组护理后ADL评分、Fugl-Meyer评分、家长的护理满意度显著高于对照组(P<0.05),术后并发症发生率显著低于对照组(P<0.05)。结论重型颅脑外伤患儿实施早期康复护理可显著改善患儿的运动能力及生活能力,同时可提高患儿家长的满意度。     

A Survey of Rural Parents' Attitudes Toward Sexuality Education

ABSTRACT: Although local attitudes and values influence a community's support for sexuality education, educators rarely assess local views in a systematic way. A survey of community parents provides a simple, relatively inexpensive way to assess support for sexuality education and strengthen the school's leadership in implementing an effective curriculum. This paper describes the use of a parent survey for building a comprehensive sexuality education program in a rural community. Most respondents supported sexuality education even for the elementary grades. Compared to a survey conducted 10 years earlier, respondents were significantly less confident of themselves and other parents as sexuality educators. Attitudes varied by demographic characteristics. Using these findings, the paper illustrates how the strategic use of a parent survey can strengthen school-based sexuality education by minimizing potential controversy and building a broader base of active community support and involvement for sexuality education. (J Sch Health. 1994; 64(9): 347–352)     

Mental Health in Women With Traumatic Brain Injury: A Systematic Review on Depression and Hope

The prevalence of traumatic brain injury (TBI) in women has recently increased from 25% to 40%. Current literature inadequately captures challenges women face after injury, including depression. The limited focus on depression is problematic as rates of depression are increasing simultaneously with rates of TBI. A disabling symptom of depression is lack of hope; thus, depression, comorbid with TBI, leads to disability among women. Unfortunately, depression and hope among women with TBI has yet to be systematically examined. The purpose of this systematic review is to examine and synthesize current literature focusing on women with TBI, comorbid with depression, and hope.     

选择性亚低温对脑外伤大鼠脑组织Fas-L基因表达的影响

目的 研究选择性亚低温治疗大鼠脑外伤时对脑组织Fas-L基因表达的影响.方法 72只大鼠随机分为假手术组、亚低温组和常温对照组.采用改进的Feeney自由落体法制作重型外伤性颅脑损伤模型,局部降温法在伤后30 min内达到亚低温目标并保持6 h,RT-PCR检测3组大鼠伤后不同时间点脑组织Fas-L基因表达.结果 亚低温组大鼠在损伤后不同时间点(6 h,24 h,48 h和72 h)脑组织的Fas-L mRNA的相对含量分别为0.54±0.07、0.47±0.06、0.41±0.06、0.67±0.08,常温对照组分别为1.53±0.21、0.91±0.11、1.33±0.15、1.56±0.171.53,相同时间点两组间比较均有显著性差异(P<0.05).结论 亚低温对大鼠外伤性颅脑损伤急性期具有降低Fas-LmRNA的作用.     

Talking About Sexuality in the Context of Rehabilitation Following Traumatic Brain Injury: An Integrative Review of Operational Aspects

Sexuality and Disability - An integrative review of the literature reporting operational aspects (how, when, who, with what) of rehabilitation professionals’ discussion of sexuality with...     

高压氧结合功能训练对脑损伤后康复预后的影响

目的 观察脑损伤患者实施常规治疗基础上增加高压氧结合功能训练的临床治疗效果,从而进一步提高患者的康复预后.方法 选取了2017年1月—2019年8月收治的脑损伤患者作为研究的对象.对84例患者采用数字随机分组,分两组进行分析.对照组患者采用常规治疗措施,观察组在常规治疗基础上增加高压氧治疗及功能训练.结果 观察组患者在...     

Sexual Function in Men with Traumatic Brain Injury

Traumatic brain injury has been linked with higher incidence of sexual problems. As there have been few published reports regarding sexual functioning in men with traumatic brain injury in Latin America, this study sought to compare sexual measures in men with traumatic brain injury with healthy controls. The hypotheses that males with TBI would experience significantly lower indices of sexual functioning compared to unaffected individuals and that increased age and injury severity would predict lower sexual functioning among participants with TBI were tested. Seventy-one Spanish-speaking Colombian men with a history of moderate to severe TBI who were at least 6 months post-injury, and 71 healthy controls participated by completing the Sexual Desire Inventory, International Index of Erectile Function, Index of Premature Ejaculation, Sexual Quality of Life Questionnaire, Index of Sexual Satisfaction. SPSS 22 was used to analyze the results. When compared to matched controls, males with TBI had significantly lower overall and dyadic sexual desire, sexual satisfaction and sexual quality of life. Erectile functioning, ejaculation control, satisfaction with ejaculation control were reported to by lower in the TBI group than in the control group. Almost 44% of participants with TBI had moderate to severe erectile dysfunction, whereas nearly 10% of the control group had the same.     

Sexuality Re-education Program Logic Model for People with Traumatic Brain Injury (TBI): Synthesis via Scoping Literature Review

Acknowledging the heightened risk of psychological, physical, and sexual harm for people with brain injury promotes sexual health and safety. Ignoring sexuality concerns is a serious deficit of modern-day rehabilitation programs. This article utilizes a disability lens to form the basis for our scoping review by illustrating how institutions can repress people with disabilities. The literature regarding brain injury shows socio-cultural characteristics undermine efforts to address sexuality programming for people with brain injury. The authors examine the effects of traumatic brain injury (TBI) and explore the components for a sexuality re-education program by building a Logic Model. A content analysis approach is used to form a literature map for the Logic Models’ inputs, outputs, and outcomes. Key themes to the sexuality re-education of people with TBI include: anatomical vocabulary, sexual safety, resiliency and rejection, social skills training and communication, and sexual self-identity, amongst others. This article supports the healthy and safe sexual re-adjustment of people with brain injury. Full disclosure through human sexuality re-education ensures people with a brain injury remain active citizens by maintaining equality with their community members.