The Nature and Clinical Significance of Preinjury Recall Bias Following Mild Traumatic Brain Injury.

OBJECTIVE: Patients with mild traumatic brain injury (MTBI) often underestimate their preinjury symptoms. This study aimed to clarify the mechanism underlying this recall bias and its contribution to MTBI outcome. SETTING: Level I trauma center. PARTICIPANTS: Patients with uncomplicated MTBI (N = 88) and orthopedic injury (N = 67). DESIGN: Prospective longitudinal. MAIN MEASURES: Current and retrospective ratings on the British Columbia Postconcussion Symptom Inventory, completed at 6 weeks and 1 year postinjury. RESULTS: Preinjury symptom reporting was comparable across groups, static across time, and associated with compensation-seeking. High preinjury symptom reporting was related to high postinjury symptom reporting in the orthopedic injury group but less so in the MTBI group, indicating a stronger positive recall bias in highly symptomatic MTBI patients. Low preinjury symptom reporting was not a risk factor for poor MTBI outcome. CONCLUSION: The recall bias was stronger and more likely clinically significant in MTBI patients with high postinjury symptoms. Multiple mechanisms appear to contribute to recall bias after MTBI, including the reattribution of preexisting symptoms to MTBI as well as processes that are not specific to MTBI (eg, related to compensation-seeking).

Atypical Somatic Symptoms in Adults With Prolonged Recovery From Mild Traumatic Brain Injury.

Somatization may contribute to persistent symptoms after mild traumatic brain injury (mTBI). In two independently-recruited study samples, we characterized the extent to which symptoms atypical of mTBI but typical for patients suffering from somatization (e.g., gastrointestinal upset, musculoskeletal, and cardiorespiratory complaints) were present in adult patients with prolonged recovery following mTBI. The first sample was cross-sectional and consisted of mTBI patients recruited from the community who reported ongoing symptoms attributable to a previous mTBI (n = 16) along with a healthy control group (n = 15). The second sample consisted of patients with mTBI prospectively recruited from a Level 1 trauma center who had either good recovery (GOSE = 8; n = 32) or poor recovery (GOSE < 8; n = 29). In all participants, we evaluated atypical somatic symptoms using the Patient Health Questionnaire-15 and typical post-concussion symptoms with the Rivermead Post-Concussion Symptom Questionnaire. Participants with poor recovery from mTBI had significantly higher "atypical" somatic symptoms as compared to the healthy control group in Sample 1 (b = 4.308, p < 0.001) and to mTBI patients with good recovery in Sample 2 (b = 3.169, p < 0.001). As would be expected, participants with poor outcome in Sample 2 had a higher burden of typical rather than atypical symptoms [t (28) = 4.750, p < 0.001, d = 0.88]. However, participants with poor recovery still reported atypical somatic symptoms that were significantly higher (1.4 standard deviations, on average) than those with good recovery. Our results suggest that although "typical" post-concussion symptoms predominate after mTBI, a broad range of somatic symptoms also frequently accompanies mTBI, and that somatization may represent an important, modifiable factor in mTBI recovery.

Saúde bucal do idoso atendido na Policlínica Geral do Rio de Janeiro: uma análise radiográfica / Oral health status of elderly patients with consultations at the General Polyclinic of Rio de Janeiro: a radiographic analysis

O objetivo do presente trabalho foi realizar um perfil epidemiológico da saúde bucal de idosos atendidos na Policlínica Geral do Rio de Janeiro. Foram avaliados quarenta e oito exames radiográficos, selecionados aleatoriamente do arquivo de prontuários odontológicos, de pacientes idosos atendidos na Policlínica Geral do Rio de Janeiro, por um único examinador, utilizando negatoscópio. Os dados foram armazenados e PS percentuais analisados. Os resultados evidenciaram 46% de edentulismo e em 56% dos casos dentes presentes. Dos dentes presentes, 37% eram acometidos por doença periodontal, 24% apresentavam prótese unitária, 20% continham obturações, 15% apresentavam tratamento endodôntico e 2% tinham restos radiculares. Os resultados do presente estudo são similares aos achados na literatura, fazendo-se necessário maior ênfase no tratamento odontológico dos idosos.

The aim of this study was to establish an oral health status of elderly patients with consultations at the General Polyclinic of Rio de Janeiro. Forty-eight radiographs exams, randomly selected, were evaluated by a single examiner using lightbox. Data were stored and analyzed. The results showed 44% (Na versão em Português consta 46%) of edentulousness and 56% of patients with teeth. In the last case, 37% had periodontal disease; 24% had unitary prostodontic; 20% had restorations; 15% had endodontic treatment and 2% still had radicular roots. The results of this study were similar to the literature, which emphasizes the need for dental treatment in the elderly population.