Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes.

OBJECTIVE: Mild traumatic brain injury (mTBI) and postconcussion syndrome (PCS) are common among military combatants. Hyperbaric oxygen (HBO2 ) is a proposed treatment for these conditions, but it has not been rigorously studied. The objective of this study was to determine the effects of HBO2 by 3 months post compression at 2 commonly employed dosing levels to treat PCS; whether specific subgroups may have benefited; and if no overall effect was found, whether benefit is masked by other conditions. METHODS: This randomized, double-blind, sham-controlled study was conducted at the Naval Air Station in Pensacola, Florida on 61 male Marines with a history of mTBI and PCS. Intervention consisted of 40 once daily 60-minute hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA) at 1 of 3 randomly preassigned oxygen fractions, resulting in respective blinded groups with an oxygen-breathing exposure equivalent to (1) surface air (sham), (2) 100% oxygen at 1.5ATA, or (3) 100% oxygen at 2.0ATA. The main outcome measure was the Rivermead Post-Concussion Questionnaire-16 (RPQ-16) collected before compressions and at 2 later points. RESULTS: The interaction of time by intervention group was not significant for improvement on the RPQ-16. Nor was there evidence of efficacy on the RPQ-16 for any subgroup. No significant time by intervention interaction was found for any functional, cognitive, or psychomotor secondary outcome measure at an unadjusted 0.05 significance level. INTERPRETATION: Using a randomized control trial design and analysis including a sham, results showed no evidence of efficacy by 3 months post-compression to treat the symptomatic, cognitive, or behavioral sequelae of PCS after combat-related mTBI.

The effect of hyperbaric oxygen on persistent postconcussion symptoms.

BACKGROUND: The high incidence of persistent postconcussion symptoms in service members with combat-related mild traumatic brain injury has prompted research in the use of hyperbaric oxygen (HBO2) for management. OBJECTIVE: The effects of HBO2 on persistent postconcussion symptoms in 60 military service members with at least 1 combat-related mild traumatic brain injury were examined in a single-center, double-blind, randomized, sham-controlled, prospective trial at the Naval Medicine Operational Training Center at Naval Air Station Pensacola. METHODS: Over a 10-week period, subjects received a series of 40, once-daily, hyperbaric chamber compressions at 2.0 atmospheres absolute (ATA). During each session, subjects breathed 1 of 3 preassigned oxygen fractions (10.5%, 75%, or 100%) for 60 minutes, resulting in an oxygen exposure equivalent to breathing surface air, 100% oxygen at 1.5 ATA, or 100% oxygen at 2.0 ATA, respectively. Individual, subscale and total item responses on the Rivermead Postconcussion Symptom Questionnaire and individual and total Posttraumatic Disorder Checklist-Military Version were measured just prior to intervention and immediately postintervention. RESULTS: Between-group testing of pre- and postintervention means revealed no significant differences on individual or total scores on the Posttraumatic Disorder Checklist-Military Version or Rivermead Postconcussion Symptom Questionnaire, demonstrating a successful randomization and no significant main effect for HBO2 at 1.5 or 2.0 ATA equivalent compared with the sham compression. Within-group testing of pre- and postintervention means revealed significant differences on several individual items for each group and difference in the Posttraumatic Disorder Checklist-Military Version total score for the 2.0 ATA HBO2 group. DISCUSSION: The primary analyses of between group differences found no evidence of efficacy for HBO2. The scattered within group differences are threatened by Type 2 errors and could be explained by nonspecific effects. CONCLUSION: This study demonstrated that HBO2 at either 1.5 or 2.0 ATA equivalent had no effect on postconcussion symptoms after mild traumatic brain injury when compared with sham compression.

The accessibility of substance abuse treatment facilities in the United States for persons with disabilities.

This study assessed the accessibility of a nationally representative sample of substance abuse treatment facilities in the United States for persons with disabilities (PWDs). A stratified random sample of 159 substance abuse treatment facilities in 40 states completed a survey regarding physical accessibility and the provision of services that could enhance the ability to serve individuals with disabilities. Most responding facilities self-reported a variety of barriers to physical accessibility, as well as the lack of services and physical accommodations for persons with sensory limitations. Such widespread inaccessibility may be a factor that promotes the low representation of PWDs in the treatment population.

Physical inaccessibility negatively impacts the treatment participation of persons with disabilities.

This research assessed the impact that physical inaccessibility of provider locations has on the substance abuse treatment participation of two groups of persons with disabilities. A random sample of treatment providers in the Mid-Atlantic region were surveyed and asked if they had declined services to persons with spinal cord (SCI) or traumatic brain (TBI) injuries due to the inaccessibility of their practices. Over half of those who had been approached by persons with SCI and nearly half of those approached by persons with TBI were unable to provide services due to physical barriers. The inability to serve such individuals was not related to practice affiliation (public or private) or practice type (hospital based, non-medical residential, or outpatient). These findings support earlier research indicating the treatment participation of persons with disabilities is negatively affected by physical accessibility concerns.

Workplace discrimination and cancer.

Data from the Equal Employment Opportunity Commission (EEOC) Integrated Mission System database were analyzed with specific reference to allegations of workplace discrimination filed by individuals with cancer under ADA Title One. These 6,832 allegations, filed between July 27, 1992 and September 30, 2003, were compared to 167,798 allegations from a general disability population on the following dimensions: type of workplace discrimination; demographic characteristics of the charging parties (CPs); the industry designation, location, and size of employers; and the outcome or resolution of EEOC investigations. Results showed allegations derived from CPs with cancer were more likely than those in the general disability population to include issues involving discharge, terms and conditions of employment, lay-off, wages, and demotion. Compared to the general disability group, CPs with cancer were more likely to be female, older, and White. Allegations derived from CPs with cancer were also more likely to be filed against smaller employers (15-100 workers) or those in service industries. Finally, the resolution of allegations by CPs with cancer were more likely to be meritorious than those filed from the general disability population; that is, actual discrimination is more likely to have occurred.

Rates and Correlates of Binge Drinking Among College Students With Disabilities, United States, 2013.

OBJECTIVE: Our objective was to provide the first comprehensive picture of alcohol use and binge drinking by US college students with disabilities (SWDs), who represent at least 11% (1.6 million) of the US college student population. METHODS: In fall 2013, we used a stratified random sampling technique to identify and recruit 2440 SWDs from 122 US colleges and universities. A total of 1285 (53%) SWDs from 61 (50%) colleges and universities completed a survey of alcohol and other drug use and the use of substances by student peers. We conducted 4 multiple logistic regression analyses to compare binge-drinking and non-binge-drinking SWDs by potential correlates of such use and a final model that included only significant variables. RESULTS: SWDs aged <21 vs ≥21 (odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.82-0.99) who spent more time vs less time socializing (OR = 1.24; 95% CI, 1.11-1.38), who spent less time vs more time studying (OR = -0.89; 95% CI, -0.80 to -0.99), and who used vs did not use marijuana (OR = 1.44; 95% CI, 1.18-1.75) or amphetamines (OR = 1.82; 95% CI, 1.15-2.89) were significantly more likely to binge drink. SWDs who reported using barbiturates were less likely to binge drink than were those who did not use barbiturates (OR = -0.36; 95% CI, -0.21 to -0.61). In the final model, use of amphetamines (OR = 1.74; 95% CI, 1.15-2.65) or marijuana (OR = 1.60; 95% CI, 1.32-1.94) was the highest predictor of binge drinking. CONCLUSION: SWDs' reported rates of binge drinking, although high, were not as high as those of nondisabled college students. Nevertheless, prevention efforts should be targeted toward college SWDs.

A survey of substance abuse prevention efforts at Virginia's colleges and universities.

The extremes of college student substance use and the negative consequences students face as a result of such use are of great public health concern. Although a multitude of campus-based substance abuse prevention efforts have appeared in literature, a clear picture of the programs and policies currently in use at colleges and universities is not readily available. This research was undertaken to detail both the efforts aimed at general student samples and those targeting at-risk (eg, Greeks, student athletes) and historically underserved (eg, ethnic minorities, students with disabilities) student groups at colleges and universities in the Commonwealth of Virginia. While a variety of efforts were being made, there was a reliance on program orientations with limited scientific support. Four-year institutions used a wider array of outlets for their prevention messages. Targeted programs for at-risk groups were common but were largely unavailable specifically for ethnic minority students and students with disabilities.

Workplace discrimination and diabetes: the EEOC Americans with Disabilities Act research project.

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with diabetes is documented. Researchers compare and contrast the key dimensions of workplace discrimination involving Americans with diabetes and persons with other physical, sensory, and neurological impairments. Specifically, the researchers examine demographic characteristics of the charging parties; the industry designation, location, and size of employers against whom complaints are filed; the nature of discrimination (i.e., type of adverse action) alleged to occur; and the legal outcome or resolution of these complaints. Findings indicate that persons with diabetes were more likely to encounter discrimination involving discharge, constructive discharge, discipline and suspension - all job retention issues. Persons with diabetes were less likely to encounter discrimination involving hiring, reasonable accommodation, non-pension benefits, and layoff. They were also more likely to encounter discrimination when they were older or from specific ethnic backgrounds, or when they worked for small employers or in the Southern United States. Implications for policy and advocacy are addressed.

Workplace discrimination and cumulative trauma disorders: the national EEOC ADA research project.

Employment discrimination of persons with cumulative trauma disorders (CTDs) was explored using the Integrated Mission System dataset of the US Equal Employment Opportunity Commission. Demographic characteristics and merit resolutions of the Charging Parties (persons with CTD) were compared to individuals experiencing other physical, sensory and neurological impairments. Factors compared also included industry designation, geographic region, and size of Respondents against which allegations were filed. Persons with CTD had proportionately greater allegations among large Respondents (greater than 500 workers) engaged in manufacturing, utilities, transportation, finance insurance and real estate. The types of discrimination Issues that were proportionately greater in the CTD group included layoff, failure to reinstate, and failure to provide reasonable accommodation. The CTD group was significantly less likely than the comparison group to be involved in discrimination Issues such as assignment to less desirable duty, shift or work location; demotion; termination, or failure to hire or provide training. Persons with CTD had higher proportions of merit Resolutions where allegations were voluntarily withdrawn by the Charging Party with benefits.

Workplace discrimination and disfigurement: the national EEOC ADA research project.

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with disfigurement is documented. Key dimensions of workplace discrimination involving Americans with disfigurement and persons with missing limbs are compared and contrasted. Specifically, the researchers examine demographic characteristics of Charging Parties; the industry designation, location and size of Respondents/employers; the discrimination Issue (i.e., type of adverse action) alleged to occur; and the legal outcome or Resolution of these allegations. Charging Parties with disfigurement who are female or between 30 and 39 years of age are more likely to encounter employment discrimination than their counterparts with missing limbs. Harassment and Non-wage Benefits are the Issues that emerge in higher proportion. Allegations derived from persons with disfigurement are more common in among mid-size employers, those located in the South, or those in Retail or Service industries. Following investigation, allegations derived from persons with disfigurement are less likely to have Merit Resolutions than those brought by Charging Parties with missing limbs.

Workplace discrimination and missing limbs: the national EEOC ADA research project.

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with missing limbs is documented. Researchers compare and contrast the key dimensions of workplace discrimination involving Americans with missing limbs and persons with back and other non-paralytic orthopedic impairments. Specifically, the researchers examine demographic characteristics of the charging parties; the industry designation, location, and size of employers against whom complaints are filed; the nature of discrimination (i.e., type of adverse action) alleged to occur; and the legal outcome or resolution of these complaints. Findings indicate that persons with missing limbs were more likely to encounter discrimination if they were male, under 20 or over 65 years of age, and White or Native American. They were also more likely to encounter more frequent discrimination when they worked for employers in the Southern United States, those with 200 or fewer employers, or whose industry designation involved manufacturing, construction, or transportation. Finally, the nature of job discrimination experienced by Americans with missing limbs is more likely to involve hiring, promotion, or job training than other issues. Implications for policy and advocacy are addressed.

Workplace discrimination and traumatic brain injury: the national EEOC ADA research project.

Using the Integrated Mission System of the Equal Employment Opportunity Commission, the employment discrimination experience of Americans with traumatic brain injury is documented. Researchers compare and contrast the key dimensions of workplace discrimination involving Americans with traumatic brain injury and persons with other physical, sensory, and neurological impairments. Specifically, the researchers examine demographic characteristics of the charging parties; the industry designation, location, and size of employers against whom complaints are filed; the nature of discrimination (i.e., type of adverse action) alleged to occur; and the outcome or resolution of the investigations. Findings indicate that persons with traumatic brain injury were more likely to encounter discrimination after obtaining employment as opposed to during the hiring process. They were also more likely to encounter discrimination when they were younger or Caucasian or when employed in the Midwestern or Western United States. Implications are addressed.

The VA/DoD Chronic Effects of Neurotrauma Consortium: An Overview at Year 1.

This federally funded program identifies gaps in research and provides support services for scientific, clinical, and translational research projects focused on the long-term effects of mild traumatic brain injury in veterans and active-duty service members.

Substance use among persons with traumatic brain injury: a review.

This paper provides a review of the current literature in the area of substance use and traumatic brain injury (TBI). Collectively, these studies demonstrate that substance use and SUD are common in the TBI population both pre- and post-injury, are a frequent causative factor in injury acquisition, complicate the rehabilitation process, and have substantial negative impact on individual health and well being. Further, individuals with a demonstrated SUD and concurrent TBI are likely to be severely limited in their ability to access SUD care due to physical barriers. This literature is reviewed and then considered in terms of its general weaknesses. Finally, a brief outline of future research needs is provided.

A comparison of EEOC closures involving hiring versus other prevalent discrimination issues under the Americans with Disabilities Act.

INTRODUCTION: This article describes findings from a causal comparative study of the Merit Resolution rate for allegations of Hiring discrimination that were filed with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. An allegation is the Charging Party's perception of discrimination, but a Merit Resolution is one in which the EEOC has determined that a discriminatory event did indeed occur. A Non-Merit Resolution is an allegation that is closed due to a technicality or lacks sufficient evidence to conclude that discrimination occurred. Merit favors the Charging Party; Non-Merit favors the Employer. METHODS: The Merit Resolution rate of 19,527 closed Hiring allegations is compared and contrasted to that of 259,680 allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of subcategories of Merit and Non-Merit outcomes. RESULTS: The overall Merit Resolution rate for Hiring is 26% compared to Non-Hiring at 20.6%. Employers are less likely to settle claims of hiring discrimination without mediation, and less likely to accept the remedies recommended by the EEOC when hiring discrimination has been determined. CONCLUSION: Hiring is not an unusual discrimination issue in that the overwhelming majority of allegations are still closed in favor of the Employer. However, it is counterintuitive that hiring has a higher merit resolution rate than other prevalent issues. This finding contradicts the assumption that hiring is an "invisible process." Considering that the EEOC makes merit determinations at a competitive rate, it is clear that hiring is sufficiently transparent.

Hiring discrimination against people with disabilities under the ADA: characteristics of employers.

INTRODUCTION: This article describes findings from a causal comparative study of the characteristics of employers against whom allegations of hiring discrimination were filed with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. METHODS: Employer characteristics derived from 19,527 closed Hiring allegations are compared and contrasted to 259,680 closed allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of factors including industry classification, size of workforce, and location. RESULTS: As compared to non-hiring allegations, hiring allegations were more likely to be filed against employers with 15-100 employees, in the West U.S. Census track region, or in industries including educational services; public administration; transportation and warehousing; professional, scientific, and technical services; agriculture, forestry, fishing, and hunting; and construction. CONCLUSION: More outreach regarding ADA responsibilities appears indicated for those employers who share the aforementioned characteristics.

Hiring discrimination against people with disabilities under the ADA: characteristics of charging parties.

INTRODUCTION: This article describes findings from a causal comparative study of the characteristics of Charging Parties who filed allegations of Hiring discrimination with the U.S. Equal Employment Opportunity Commission (EEOC) under Title I of the Americans with Disabilities Act (ADA) between 1992 and 2005. METHODS: Charging Party Characteristics derived from 19,527 closed Hiring allegations are compared and contrasted to 259,680 closed allegations aggregated from six other prevalent forms of discrimination including Discharge and Constructive Discharge, Reasonable Accommodation, Disability Harassment and Intimidation, and Terms and Conditions of Employment. Tests of Proportion distributed as chi-square are used to form comparisons along a variety of factors including age, gender, impairment, and ethnicity. RESULTS: Most allegations of ADA job discrimination fall into the realm of job retention and career advancement as opposed to job acquisition. Hiring allegations, however, tend to be filed by Charging Parties who are disproportionately male, younger or older applicants, white, and coping with physical or sensory disabilities. CONCLUSION: Prevailing theories about stigma suggest that negative attitudes are more prevalent toward persons with behavioral disabilities. However, this study provides clear evidence that one behavioral manifestation of negative attitudes, Hiring discrimination, is more often directed at persons with physical or sensory impairments. More outreach regarding ADA rights appears indicated for individuals who share the aforementioned characteristics.

An examination of the psychometric properties of the attention deficit scales for adults with outpatient substance abusers.

A growing body of research has established a high co-morbidity in the rates of attention deficit/hyperactivity disorder (ADHD) and substance abuse. The co-occurrence of these two conditions and the negative impact of untreated ADHD on the course and treatment of substance abuse highlights the need for ADHD assessment in individuals seeking substance abuse treatment. In this article, we investigated the clinical utility of the Attention Deficit Scales for Adults (ADSA) in a sample of substance abusers in an outpatient treatment program by assessing its sensitivity, specificity, positive and negative predictive values, and likelihood ratios at two potential cut-off levels (161 and 181) using a DSM-IV based ADHD diagnosis as the criterion. The ADSA had strong reliability (Cronbach's alpha .93; Guttman split-half .92) and correlated well with DSM-IV diagnostic criteria. Sensitivity and specificity of the device were relatively strong at both cut-off levels, as were the positive and negative predictive values.

Project D.A.R.E. outcome effectiveness revisited.

OBJECTIVES: We provide an updated meta-analysis on the effectiveness of Project D.A.R.E. in preventing alcohol, tobacco, and illicit drug use among school-aged youths. METHODS: We used meta-analytic techniques to create an overall effect size for D.A.R.E. outcome evaluations reported in scientific journals. RESULTS: The overall weighted effect size for the included D.A.R.E. studies was extremely small (correlation coefficient = 0.011; Cohen d = 0.023; 95% confidence interval = -0.04, 0.08) and nonsignificant (z = 0.73, NS). CONCLUSIONS: Our study supports previous findings indicating that D.A.R.E. is ineffective.

Factor Analysis of the Attention Deficit Scales for Adults (ADSA) with a clinical sample of outpatient substance abusers.

Individuals with adult symptoms of ADHD who are in treatment for substance abuse have been identified as being at greater risk of failure to complete treatment and relapse. The identification of such clients must thus become an important part of assessment and treatment planning. The Attention Deficit Scale for Adults (ADSA) is one device designed to assess ADHD symptomology in adults. This study investigated the application of the ADSA in a substance-abusing population by assessing its psychometric properties with a clinical sample of 268 adult patients (170 males, 92 females, gender missing for 6) in an outpatient substance abuse treatment program. The findings indicate that the ADSA is unidimensional with this population yet possess high reliability (alpha=.93 for entire sample:.89 for males,.94 for females) and correlate consistently with DSM-IV diagnostic criteria. The data tentatively support the use of the ADSA with substance-abusing populations as a reliable and valid assessment tool for clinical use and research.