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1.
J Head Trauma Rehabil ; 36(6): 418-423, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33656481

RESUMO

OBJECTIVE: The evaluation of memory complaints in mild traumatic brain injury (mTBI) remains an important clinical consideration, especially in the context of comorbid psychiatric symptoms such as posttraumatic stress disorder (PTSD). We compared subjective memory complaints in veterans with and without a history of mTBI, examined ratings between those with single versus multiple mTBIs, and investigated associations between memory complaints and PTSD symptom severity. METHODS: 117 outpatient veterans (mTBI: n = 79 [single mTBI: n = 22, multiple mTBI: n = 57], military controls [MCs]: n = 38) completed a TBI history assessment, the Prospective-Retrospective Memory Questionnaire (PRMQ), and the PTSD Checklist-Military Version (PCL-M). RESULTS: Hierarchical multiple regression showed that greater PCL-M scores significantly predicted elevated PRMQ-Total scores, accounting for 38% of the variance explained (P < .001). mTBI status predicted an additional 5% of variance in memory complaints (P < .01). The multiple-mTBI group endorsed more memory complaints than either MCs (P < .01) or the single-mTBI group (P < .05), who did not differ from MCs (P > .50). CONCLUSIONS: Comorbid PTSD symptoms are an important factor when considering memory complaints in veterans with a reported history of mTBI. However, independent of comorbid PTSD symptoms, mTBI status-particularly in the context of repetitive neurotrauma-uniquely contributes to memory complaints. Findings suggest that veterans with a history of multiple mTBIs may be a particularly vulnerable group in need of specialized interventions and/or psychoeducation.

2.
JMIR Med Inform ; 8(10): e18395, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33006565

RESUMO

BACKGROUND: Although many efforts have been made to develop comprehensive disease resources that capture rare disease information for the purpose of clinical decision making and education, there is no standardized protocol for defining and harmonizing rare diseases across multiple resources. This introduces data redundancy and inconsistency that may ultimately increase confusion and difficulty for the wide use of these resources. To overcome such encumbrances, we report our preliminary study to identify phenotypical similarity among genetic and rare diseases (GARD) that are presenting similar clinical manifestations, and support further data harmonization. OBJECTIVE: To support rare disease data harmonization, we aim to systematically identify phenotypically similar GARD diseases from a disease-oriented integrative knowledge graph and determine their similarity types. METHODS: We identified phenotypically similar GARD diseases programmatically with 2 methods: (1) We measured disease similarity by comparing disease mappings between GARD and other rare disease resources, incorporating manual assessment; 2) we derived clinical manifestations presenting among sibling diseases from disease classifications and prioritized the identified similar diseases based on their phenotypes and genotypes. RESULTS: For disease similarity comparison, approximately 87% (341/392) identified, phenotypically similar disease pairs were validated; 80% (271/392) of these disease pairs were accurately identified as phenotypically similar based on similarity score. The evaluation result shows a high precision (94%) and a satisfactory quality (86% F measure). By deriving phenotypical similarity from Monarch Disease Ontology (MONDO) and Orphanet disease classification trees, we identified a total of 360 disease pairs with at least 1 shared clinical phenotype and gene, which were applied for prioritizing clinical relevance. A total of 662 phenotypically similar disease pairs were identified and will be applied for GARD data harmonization. CONCLUSIONS: We successfully identified phenotypically similar rare diseases among the GARD diseases via 2 approaches, disease mapping comparison and phenotypical similarity derivation from disease classification systems. The results will not only direct GARD data harmonization in expanding translational science research but will also accelerate data transparency and consistency across different disease resources and terminologies, helping to build a robust and up-to-date knowledge resource on rare diseases.

3.
Pain Med ; 21(11): 2789-2798, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32529199

RESUMO

OBJECTIVE: This study assessed the prevalence of abusive partner relationships among individuals presenting for chronic pain treatment. In addition, this study examined the association between partner abuse histories and pain-relevant outcome variables. DESIGN: Cross-sectional. SETTING: This study took place at a specialty pain rehabilitation treatment center in the Midwestern United States. SUBJECTS: Participants in this study (N = 108) included adults (Mage = 45.73 [15.95] years) presenting for chronic pain treatment who consented to participate in a research study on stress, relationships, and chronic pain. METHODS: Participants completed self-report measures about relationship and abuse histories, physical and mental health, and demographic information. Participants were categorized into the following groups: no intimate partner violence (IPV), past IPV (>12 months ago), or current/recent IPV (≤12 months ago). RESULTS: Results indicated that over half (56%) of the sample endorsed a history of partner abuse and around one-third (29%) of the sample had experienced abuse within the past year. Psychological/emotional abuse was the most common form of abuse reported. Those with current/recent abuse histories reported greater impairment in pain interference, post-traumatic stress symptoms, mental health functioning, and pain self-efficacy compared with those who had not experienced abuse in the past year. CONCLUSIONS: Partner abuse appears common among individuals with chronic pain and is associated with pain-relevant outcomes, warranting additional clinical attention and research in this area.


Assuntos
Dor Crônica , Violência por Parceiro Íntimo , Maus-Tratos Conjugais , Adulto , Criança , Dor Crônica/epidemiologia , Estudos Transversais , Humanos , Prevalência
4.
Nano Lett ; 20(5): 3828-3835, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32267711

RESUMO

To exploit the high-temperature superinsulation potential of anisotropic thermal management materials, the incorporation of ceramic aerogel into the aligned structural networks is indispensable. However, the long-standing obstacle to exploring ultralight superinsulation ceramic aerogels is the inaccessibility of its mechanical elasticity, stability, and anisotropic thermal insulation. In this study, we report a recoverable, flexible ceramic fiber-aerogel composite with anisotropic lamellar structure, where the interfacial cross-linking between ceramic fiber and aerogel is important in its superinsulation performance. The resulting ultralight aerogel composite exhibits a density of 0.05 g/cm3, large strain recovery (over 50%), and low thermal conductivity (0.0224 W m-1 K-1), while its hydrophobicity is achieved by in situ trichlorosilane coating with the water contact angle of 135°. The hygroscopic tests of such aerogel composites demonstrate a reversible thermal insulation. The mechanical elasticity and stability of the anisotropic composites, with its soundproof performance, shed light on the low-cost superelastic aerogel manufacturing with scalability for energy saving building applications.

5.
Am J Speech Lang Pathol ; 28(2): 408-423, 2019 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-31091132

RESUMO

Purpose The aim of this study was to assess knowledge, self-rated confidence, and perceived relevance of genetics in the clinical practice of audiologists and speech-language pathologists (SLPs) toward a better understanding of the need for genetics education, given that genetics plays a growing role in the diagnosis of hearing impairment and communication disorders. Method A survey consisting of 8 demographic items and 16 content questions was returned by 233 audiologists and 283 SLPs. Knowledge of applied genetics was queried with clinical scenarios in a multiple-choice format. Self-assessment of clinical confidence and perceived relevance of genetics in one's field was queried with questions and statements rated on 5-point Likert scales. The benefit of additional training in genetics was rated with a yes/no question, and if answered with yes, suggested topics were entered. Results A large significant gap between confidence in one's own genetics skills and the perceived relevance of genetics was evident, regardless of professional group. Over one third of the audiologists and over two thirds of the SLPs indicated low or somewhat low confidence in their own ability to implement principles of genetics, whereas over two thirds of both groups agreed that genetics is relevant for their field. Regardless of group, confidence scores were significantly and positively associated with relevance scores. Over 80% of respondents in both groups indicated that they would benefit from additional training in genetics. Most commonly suggested topics included genetic causes, general information about genetics, and making referrals. Conclusion Both audiologists and SLPs felt that genetics is relevant for their fields and that additional training in genetics would be beneficial. Future studies should evaluate the effect of genetics training on patient outcomes and the need for incorporating genetics more extensively into audiology and speech-language pathology training programs.


Assuntos
Atitude do Pessoal de Saúde , Audiologistas/educação , Transtornos da Comunicação , Educação Profissionalizante , Genética/educação , Pessoal de Saúde/educação , Transtornos da Audição , Patologia da Fala e Linguagem/educação , Adulto , Idoso , Audiologistas/psicologia , Competência Clínica , Transtornos da Comunicação/diagnóstico , Transtornos da Comunicação/genética , Transtornos da Comunicação/terapia , Currículo , Escolaridade , Feminino , Pessoal de Saúde/psicologia , Transtornos da Audição/diagnóstico , Transtornos da Audição/genética , Transtornos da Audição/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
6.
Child Youth Serv Rev ; 101: 99-112, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32831444

RESUMO

Families who enter the Child Welfare System (CWS) as a result of a caregiver's substance use fare worse at every stage from investigation to removal to reunification (Marsh et. al 2007). Intervening with caregivers with Substance Use Disorders (SUDs) and their children poses unique challenges related to the structure and focus of the current CWS. Research demonstrates that caregivers with SUDs are at a greater risk for maladaptive parenting practices, including patterns of insecure attachment and difficulties with attunement and responsiveness (Suchman, 2006). Caregivers with SUDs have also often experienced early adversity and trauma. However, traditional addiction services generally offer limited opportunities to focus on parenting or trauma, and traditional parenting programs rarely address the special needs of parents with SUDs. This article details four innovative interventions that integrate trauma-informed addiction treatments with parenting for families involved in the child welfare system. Common mechanisms for change across programs are identified as critical components for intervention. This work suggests the need for a paradigm shift in how cases involving caregivers with substance use disorders are approached in the child welfare system.

7.
Inflamm Bowel Dis ; 24(7): 1582-1588, 2018 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-29788055

RESUMO

Background: Ileocolonoscopy and computed tomography (CT) or magnetic resonance (MR) enterography (CTE/MRE) are utilized to evaluate patients with small bowel (SB) Crohn's disease (CD). The purpose of our study was to estimate the impact of capsule endoscopy (CE) on patient management after clinical assessment, ileocolonoscopy, and CTE/MRE. Methods: We prospectively analyzed 50 adult CD patients without strictures at clinically indicated ileocolonoscopy and CTE/MRE exams. Providers completed pre- and post-CE clinical management questionnaires. Pre-CE questionnaire assessed likelihood of active SBCD and management plan using a 5-point level of confidence (LOC) scales. Post-CE questionnaire assessed alteration in management plans and contribution of CE findings to these changes. A change of ≥2 on LOC scale was considered clinically meaningful. Results: Of the 50 patients evaluated (60% females), median age was 38 years, median disease duration was 3 years, and median Crohn's Disease Activity Index (CDAI) score was 238 points. All CTE/MRE studies were negative for proximal disease. CE detected proximal disease in 14 patients (28%) with a median Lewis score of 215 points. CE findings altered management in 17 cases (34%). The most frequent provider-perceived benefits of CE were addition of new medication (29%) and exclusion of active SB mucosal disease (24%). Conclusion: CE is a safe imaging modality that alters clinical management in patients with established SBCD by adding incremental information not available at ileocolonoscopy and cross-sectional enterography.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Intestino Delgado/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Neuropsychol Rehabil ; 27(7): 1031-1046, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27535726

RESUMO

Post-traumatic fatigue (PTF) is a common, disabling, and often chronic symptom following traumatic brain injury (TBI). Yet, the impact of chronic cognitive and physical fatigue and their associations with psychiatric, sleep, cognitive, and psychosocial sequelae in mild-moderate TBI remain poorly understood. Sixty Veterans with a history of mild-moderate TBI and 40 Veteran controls (VC) were administered the Modified Fatigue Impact Scale, a validated measure of TBI-related cognitive and physical fatigue as well as measures of neuropsychiatric, psychosocial, sleep, and objective cognitive functioning. Compared to VC, TBI Veterans endorsed significantly greater levels of cognitive and physical fatigue. In TBI, psychiatric symptoms, sleep disturbance, and post-traumatic amnesia (PTA) were associated with both cognitive and physical fatigue, while loss of consciousness (LOC) and poor attention/processing speed were related to elevations in cognitive fatigue only. In regression analyses, anxiety, sleep disturbance, and LOC significantly predicted cognitive fatigue, while only post-traumatic stress symptoms and PTA contributed to physical fatigue. Cognitive and physical fatigue are problematic symptoms following mild-moderate TBI that are differentially associated with specific injury and psychiatric sequelae. Findings provide potential symptom targets for interventions aimed at ameliorating fatigue, and further underscore the importance of assessing and treating fatigue as a multi-dimensional symptom following TBI.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Lesões Encefálicas Traumáticas/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Transtorno Depressivo/fisiopatologia , Fadiga/fisiopatologia , Transtornos do Sono-Vigília/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Veteranos , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/etiologia , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/fisiopatologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Fadiga/diagnóstico , Fadiga/etiologia , Feminino , Humanos , Masculino , Fadiga Mental/diagnóstico , Fadiga Mental/etiologia , Fadiga Mental/fisiopatologia , Pessoa de Meia-Idade , Prognóstico , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Estados Unidos
10.
Brain Imaging Behav ; 11(5): 1548-1554, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27738990

RESUMO

No known studies have directly examined white matter microstructural correlates of cognitive fatigue post-TBI in a Veteran sample. We therefore investigated the relationship between cognitive fatigue and white matter integrity in Veterans with history of mild to moderate TBI (mmTBI). 59 Veterans (TBI = 34, Veteran Controls [VCs] = 25]) with and without history of mmTBI underwent structural 3T DTI scans and completed questionnaires related to cognitive fatigue and psychiatric symptoms. Tractography was employed on six regions of interest, including the anterior and posterior limbs of the internal capsule; genu; body and splenium of the corpus callosum; and cingulum bundle. Group analyses revealed that those with history of mmTBI displayed significantly greater levels of cognitive fatigue relative to those with no history of head injury (p = .02). Within the mmTBI group, independent of psychiatric symptoms, decreased white matter microstructural integrity of the left anterior internal capsule was associated with greater levels of cognitive fatigue (p = .01). Results show that the subjective experience of cognitive fatigue following neurotrauma may be linked to the disruption of striato-thalamo-cortical tracts that are important in mediating arousal and higher-order cognitive processes. These findings build upon those from existing functional neuroimaging studies in those with history of TBI, providing further evidence for the neural basis of cognitive fatigue in head injured adults.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Cápsula Interna/diagnóstico por imagem , Fadiga Mental/diagnóstico por imagem , Fadiga Mental/etiologia , Adulto , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/psicologia , Estudos de Coortes , Imagem de Tensor de Difusão , Feminino , Humanos , Cápsula Interna/patologia , Modelos Lineares , Imageamento por Ressonância Magnética , Masculino , Fadiga Mental/patologia , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Inquéritos e Questionários , Veteranos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
11.
J Clin Exp Neuropsychol ; 38(10): 1115-30, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27430280

RESUMO

INTRODUCTION: Given that little is known about the associations between alcohol use, cognition, and psychiatric symptoms among veterans with a history of mild traumatic brain injury (mTBI), we aimed to (a) characterize how they differ from veteran controls on a measure of problem drinking; (b) investigate whether problem drinking is associated with demographic or mTBI characteristics; and (c) examine the associations between alcohol use, mTBI history, psychiatric functioning, and cognition. METHOD: We assessed 59 veterans (n = 32 with mTBI history; n = 27 military controls) for problem alcohol use (Alcohol Use Disorders Identification Test: AUDIT), psychiatric symptoms, and neuropsychological functioning. RESULTS: Compared to controls, veterans with mTBI history were more likely to score above the AUDIT cutoff score of 8 (p = .016), suggesting a higher rate of problem drinking. Participants with mTBI history also showed elevated psychiatric symptoms (ps < .001) and lower cognitive scores (ps < .05 to < .001). Veterans with higher AUDIT scores were younger (p = .05) and had less education (p < .01) and more psychiatric symptoms (ps < .01), but mTBI characteristics did not differ. After controlling for combat and mTBI history (R(2) = .04, ns) and posttraumatic stress disorder (PTSD) symptoms (ΔR(2) = .08, p = .05), we found that higher AUDIT scores were associated with poorer attention/processing speed, F(9, 37) = 2.55, p = .022; ΔR(2) = .26, p = .03. CONCLUSIONS: This preliminary study suggested that veterans with mTBI history may be at increased risk for problem drinking. Problem alcohol use was primarily associated with more severe PTSD symptoms and poorer attention/processing speed, though not with combat or mTBI characteristics per se. Importantly, findings emphasize the importance of assessing for and treating problematic alcohol use and comorbid psychiatric symptoms among veterans, including those with a history of neurotrauma.


Assuntos
Alcoolismo/complicações , Concussão Encefálica/complicações , Cognição/fisiologia , Veteranos/psicologia , Adulto , Alcoolismo/psicologia , Concussão Encefálica/psicologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
12.
Headache ; 56(4): 699-710, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27028095

RESUMO

OBJECTIVES: To determine differences in neuropsychiatric complaints between Veterans with mild to moderate traumatic brain injury (TBI), with and without headache, compared with Veteran controls, and to identify neuropsychiatric predictors of headache severity. BACKGROUND: Mild to moderate TBI is a common occurrence in Veterans, and is frequently associated with complaints of headache. Neuropsychiatric complaints are also common among individuals who have sustained head injury, although the relationship between these factors and headache after injury is unclear. Research is needed to comprehensively determine differences between individuals with mild to moderate traumatic brain injury who differ with respect to headache, and which injury, psychological, or sleep and fatigue factors predict headache severity. METHODS: A cross-sectional study compared 85 Veterans in three groups (positive for TBI and headache, positive for TBI without significant headache, and a control group) on a set of injury characteristics and neuropsychiatric variables. Correlates of headache severity were examined, and a regression model was used to identify significant independent predictors of headache severity. RESULTS: Individuals with mild to moderate TBI and headache endorsed significantly greater neuropsychiatric symptoms than participants in the other groups (η(p)2 = .23-.36) Neuropsychiatric complaints, as well as presence of posttraumatic amnesia, were correlated with headache in the subsample with TBI (rs = .44-.57). When entering all predictors into a regression model, only fatigue represented a significant independent predictor of headache severity (ß = .59, R2 = .35). CONCLUSIONS: Rather than being a global risk factor, mild to moderate TBI was associated with poorer mental health outcomes, particularly for those who endorse headache. Findings underscore the possibility that Veterans with history of TBI who present with complaints of headache may represent a particularly vulnerable subgroup. Additionally, our findings suggest that clinical outcomes may be improved in those with neurotrauma by incorporating a focus on fatigue in treatment.


Assuntos
Concussão Encefálica/complicações , Concussão Encefálica/psicologia , Cefaleia/etiologia , Cefaleia/psicologia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Estudos Transversais , Feminino , Guerra do Golfo , Cefaleia/epidemiologia , Humanos , Guerra do Iraque 2003-2011 , Masculino , Testes Neuropsicológicos , Transtornos de Estresse Pós-Traumáticos/epidemiologia
13.
Child Welfare ; 94(4): 161-83, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26827481

RESUMO

Family-based in-home treatment can effectively meet the needs of mothers and fathers struggling with the dual challenges of substance abuse recovery and parenting infants and toddlers. This article describes one such program, Family-Based Recovery (FBR), which integrates substance abuse treatment for parents and infant mental health intervention with the goal of preventing child maltreatment and family disruption. Program design, implementation, and results are provided. Outcome data suggest that FBR is a promising model.


Assuntos
Saúde da Família , Serviços de Assistência Domiciliar , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pais
14.
J Head Trauma Rehabil ; 30(4): E21-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24922041

RESUMO

OBJECTIVE: To assess the relationship between postconcussive symptoms and quality of life (QOL) in Veterans with mild to moderate traumatic brain injury (TBI). METHODS: Sixty-one Operation Enduring Freedom/Operation Iraqi Freedom/Persian Gulf War Veterans with a history of mild or moderate TBI, more than 6 months postinjury, and 21 demographically matched Veteran controls were administered self-report measures of QOL (World Health Organization Quality of Life-BREF) and postconcussive symptom severity (Neurobehavioral Symptom Inventory). RESULTS: Perceived QOL was significantly worse in Veterans with mild-moderate TBI than in controls. In the TBI group, QOL was predominantly associated with affective symptoms, and moderate to strong correlations with fatigue and depression were evident across all QOL areas. Multivariate analyses revealed depression and fatigue to be the best predictors of Psychological, Social, and Environmental QOL, whereas sleep difficulty best predicted Physical QOL in mild-moderate TBI. CONCLUSION: Veterans with post-acute mild-moderate TBI evidence worse QOL than demographically matched Veteran controls. Affective symptoms, and specifically those of fatigue, depression, and sleep difficulty, appear to be the most relevant postconcussive symptoms predicting QOL in this population. These findings underscore the importance of examining specific symptoms as they relate to post-acute TBI QOL and provide guidance for treatment and intervention studies.


Assuntos
Síndrome Pós-Concussão/psicologia , Qualidade de Vida , Veteranos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Modelos Lineares , Masculino , Autorrelato , Índices de Gravidade do Trauma , Estados Unidos , Adulto Jovem
15.
J Psychopharmacol ; 28(11): 1080-7, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25237125

RESUMO

OBJECTIVE: Adolescents who engage in regular marijuana use may have a higher propensity to take unsafe risks despite the possible negative consequences. We compared adolescents with a history of regular marijuana use to non-using teens on a behavioral measure of risk-taking. Given the involvement of the pre-frontal cortex in both risk-taking and executive functioning, we also examined whether risk-taking was associated with measures of executive functioning. METHOD: Fifty-eight demographically similar community youth (ages 17-20; 29% female), including 24 marijuana users and 34 non-using controls, completed the computerized Balloon Analog Risk Task (BART; Lejuez et al., 2002) and measures of substance use and executive function. Primary BART outcome measures included total number of popped balloons and average adjusted pumps (mean pumps excluding popped balloons). RESULTS: Marijuana users had more popped balloons than controls (p<0.05) but did not differ on average adjusted pumps. Using hierarchical multiple regression controlling for age, riskier BART performance (popped balloons) was predictive of past 18-month hard drug use (ß=0.30; p<0.05). Having a higher number of popped balloons was also predictive of past 18-month marijuana use (p<0.05), but age was a stronger predictor than marijuana use. Marijuana users performed worse on one test of executive functioning (psychomotor set-shifting, p<0.05), but this did not correlate with risk-taking. CONCLUSIONS: Our finding of elevated risk-taking among marijuana users is consistent with previous research that substance users may have impaired risk processing. Further, our results suggest that risk-taking is not always associated with executive dysfunction, implying the involvement of distinct neural subsystems.


Assuntos
Comportamento do Adolescente/psicologia , Usuários de Drogas/psicologia , Fumar Maconha/psicologia , Assunção de Riscos , Adolescente , Função Executiva , Feminino , Humanos , Masculino , Testes Psicológicos
16.
J Int Neuropsychol Soc ; 20(8): 784-95, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25241623

RESUMO

To assess recovery of cognitive effects, we investigated neuropsychological performance after 1 month of monitored abstinence in teens with histories of heavy episodic drinking, protracted marijuana use, or concomitant use of alcohol and marijuana. Adolescents (ages 16-18 years) with histories of heavy episodic drinking (HED; n=24), marijuana use (MJ; n=20), both heavy alcohol and marijuana use (HED+MJ; n=29), and socio-demographically similar control teens (CON; n=55) completed a neuropsychological battery following 4 weeks of monitored abstinence. Groups were similar on 5th grade standardized test scores, suggesting comparable academic functioning before onset of substance use. Relative to CON, HED showed poorer cognitive flexibility (p=.006), verbal recall (p=.024), semantic clustering (p=.011), and reading skills (p=.018). MJ performed worse than CON on inhibition task accuracy (p=.015), cued verbal memory (p=.031), and psychomotor speed (p=.027). Similar to HED youth, HED+MJ showed differences relative to CON on cognitive flexibility (p=.024) and verbal recall (p=.049). As with MJ teens, HED+MJ showed poorer task accuracy (p=.020). Unique to the HED+MJ group was poorer working memory (p=.012) relative to CON. For all substance using participants, worse performance across domains correlated with more lifetime use of alcohol and of marijuana, more withdrawal symptoms from alcohol, and earlier age of onset of marijuana use (ps<.05). Heavy alcohol use, marijuana use, and concomitant use of both substances during adolescence appear to be associated with decrements in cognitive functioning, and each substance (or combination of substances) may be linked to poorer performance in specific cognitive domains.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Cognitivos/etiologia , Fumar Maconha/efeitos adversos , Fumar Maconha/psicologia , Transtornos da Memória/etiologia , Logro , Adolescente , Atenção/fisiologia , Distribuição de Qui-Quadrado , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Transtornos do Humor , Análise Multivariada , Testes Neuropsicológicos , Desempenho Psicomotor , Síndrome de Abstinência a Substâncias/psicologia
17.
Alcohol Clin Exp Res ; 38(6): 1761-9, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24818520

RESUMO

BACKGROUND: Negative affect and low distress tolerance have been associated with increased likelihood of alcohol consumption and relapse. This study utilized the Paced Auditory Serial Attention Test - Computerized Version (PASAT-C) to examine affective reactivity, cognitive performance, and distress tolerance during early abstinence among heavy drinking adolescents. METHODS: Participants, ages 16 to 18 (50% female), were 23 heavy episodic drinking youth (HED) and 23 demographically matched, nondrinking teens (CON). Both groups were drawn from the same schools and assessed at 3 time points: HED was first studied within 10 days (M = 4.26, SD = 4.4) of heavy episodic drinking and then at two 2-week intervals over 4 subsequent weeks of abstinence from alcohol and drugs. CON were studied at the same 2-week intervals. RESULTS: From the findings, it was observed that HED responded with greater emotional response to the PASAT-C (i.e., greater increases in frustration and irritability and greater decreases in happiness) at the initial assessment, but their affective responses diminished with sustained abstinence. CON and HED task performance did not differ at the initial assessment or across time. HED showed faster task discontinuation times to the PASAT-C at the first assessment, and both groups reduced task persistence across testings. Among HED, greater lifetime and recent alcohol consumption, alcohol-induced blackouts, and withdrawal symptoms were associated with increases in negative affect with PASAT-C exposure. Earlier age of onset of alcohol use was linked to poorer performance. CONCLUSIONS: Heavy episodic drinking adolescents demonstrated heightened emotional reactivity and poorer distress tolerance to a cognitively challenging task during early abstinence. The combination of elevated negative affect and low distress tolerance may place adolescents at a heightened risk of escalations in or return to alcohol involvement.


Assuntos
Abstinência de Álcool/psicologia , Alcoolismo/complicações , Emoções/efeitos dos fármacos , Estresse Psicológico/psicologia , Adolescente , Alcoolismo/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Testes Psicológicos
18.
J Int Neuropsychol Soc ; 20(2): 218-29, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24512674

RESUMO

The present study investigated the rate and pattern of neuropsychological recovery in heavy episodic drinking teens during the initial days to weeks of abstinence from alcohol. Adolescents (ages, 16-18 years) with histories of heavy episodic drinking (HED; N = 39) and socio-demographically similar control teens (CON; N = 26) were recruited from San Diego area schools. HED and CON were comparable on 5th grade standardized math and language arts test performance to ensure similar functioning before onset of substance use. Participants were administered three neuropsychological test batteries with 2-week intervals during a 4-week monitored abstinence period. HED teens performed worse overall than CON on tests of prospective memory (p = .005), cognitive switching (p = .039), inhibition task accuracy (p = .001), verbal memory (p's < .045), visuospatial construction (p's < .043), and language and achievement (p's < .008). The statistically significant group × time interaction for block design demonstrated normalization within the 4 weeks of abstinence for the HED (p = .009). This study identified cognitive performance deficits associated with heavy episodic drinking in adolescence during early abstinence and with sustained 4-week abstention. These findings suggest alcohol-related influences on several underlying brain systems that may predate the onset of alcohol abuse or dependence or take longer than 4 weeks to recover.


Assuntos
Abstinência de Álcool , Consumo de Bebidas Alcoólicas/fisiopatologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Logro , Adolescente , Função Executiva , Feminino , Humanos , Intenção , Idioma , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Testes Neuropsicológicos , Estimulação Luminosa , Escalas de Graduação Psiquiátrica , Percepção Visual/fisiologia
19.
J Head Trauma Rehabil ; 29(1): 21-32, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23640539

RESUMO

OBJECTIVE: We investigated using diffusion tensor imaging (DTI) and the association between white matter integrity and executive function (EF) performance in postacute mild traumatic brain injury (mTBI). In addition, we examined whether injury severity, as measured by loss of consciousness (LOC) versus alterations in consciousness (AOC), is related to white matter microstructural alterations and neuropsychological outcome. PARTICIPANTS: Thirty Iraq and Afghanistan War era veterans with a history of mTBI and 15 healthy veteran control participants. RESULTS: There were no significant overall group differences between control and mTBI participants on DTI measures. However, a subgroup of mTBI participants with EF decrements (n = 13) demonstrated significantly decreased fractional anisotropy of prefrontal white matter, corpus callosum, and cingulum bundle structures compared with mTBI participants without EF decrements (n = 17) and control participants. Participants having mTBI with LOC were more likely to evidence reduced EF performances and disrupted ventral prefrontal white matter integrity when compared with either mTBI participants without LOC or control participants. CONCLUSIONS: Findings suggest that altered white matter integrity contributes to reduced EF in subgroups of veterans with a history of mTBI and that LOC may be a risk factor for reduced EF as well as associated changes to ventral prefrontal white matter.


Assuntos
Campanha Afegã de 2001- , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Função Executiva/fisiologia , Guerra do Iraque 2003-2011 , Leucoencefalopatias/diagnóstico , Leucoencefalopatias/fisiopatologia , Testes Neuropsicológicos/estatística & dados numéricos , Inconsciência/diagnóstico , Inconsciência/fisiopatologia , Veteranos/psicologia , Adulto , Encéfalo/fisiopatologia , Lesões Encefálicas/psicologia , Lista de Checagem , Imagem de Difusão por Ressonância Magnética , Escala de Coma de Glasgow , Humanos , Interpretação de Imagem Assistida por Computador , Leucoencefalopatias/psicologia , Masculino , Psicometria , Inconsciência/psicologia
20.
Genet Med ; 15(2): 139-45, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22955112

RESUMO

PURPOSE: Genomic microarrays can detect copy-number variants not detectable by conventional cytogenetics. This technology is diffusing rapidly into prenatal settings even though the clinical implications of many copy-number variants are currently unknown. We conducted a qualitative pilot study to explore the experiences of women receiving abnormal results from prenatal microarray testing performed in a research setting. METHODS: Participants were a subset of women participating in a multicenter prospective study "Prenatal Cytogenetic Diagnosis by Array-based Copy Number Analysis." Telephone interviews were conducted with 23 women receiving abnormal prenatal microarray results. RESULTS: We found that five key elements dominated the experiences of women who had received abnormal prenatal microarray results: an offer too good to pass up, blindsided by the results, uncertainty and unquantifiable risks, need for support, and toxic knowledge. CONCLUSION: As prenatal microarray testing is increasingly used, uncertain findings will be common, resulting in greater need for careful pre- and posttest counseling, and more education of and resources for providers so they can adequately support the women who are undergoing testing.


Assuntos
Aberrações Cromossômicas , Testes Genéticos/métodos , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/psicologia , Adulto , Transtornos Cromossômicos/diagnóstico , Transtornos Cromossômicos/genética , Transtornos Cromossômicos/psicologia , Feminino , Aconselhamento Genético/métodos , Aconselhamento Genético/psicologia , Humanos , Projetos Piloto , Gravidez , Revelação da Verdade
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