Objective: To examine the relationship between environmental enrichment (EE) and hippocampal atrophy in the chronic stages of moderate to severe traumatic brain injury (TBI).Design: Retrospective analysis of prospectively collected data; observational, within-subjects.Participants: Patients (N = 25) with moderate to severe TBI.Measures: Primary predictors: (1) An aggregate of self-report rating of EE (comprising hours of cognitive, physical, and social activities) at 5 months post-injury; (2) pre-injury years of education as a proxy for pre-morbid EE (or cognitive reserve). Primary outcome: bilateral hippocampal volume change from 5 to 28 months post-injury.Results: As predicted, self-reported EE was significantly negatively correlated with bilateral hippocampal atrophy (p < 0.05), with greater EE associated with less atrophy from 5 to 28 months. Contrary to prediction, years of education (a proxy for cognitive reserve) was not significantly associated with atrophy.Conclusion: Post-injury EE may serve as a buffer against hippocampal atrophy in the chronic stages of moderate-severe TBI. Clinical application of EE should be considered for optimal maintenance of neurological functioning in the chronic stages of moderate-severe TBI.
Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast.
The MMPI-2 (Butcher, Graham, et al., 2001) is the measure most commonly used to assess personality and psychopathology in a variety of assessment contexts (Camara, Nathan, & Puente, 2000; Greene, 2000). Although there are many attributes of this instrument that contribute to its frequent and wide-ranging use, perhaps one of its greatest strengths, distinguishing it from other instruments, is the inclusion of a number of extensively examined and well-validated scales to detect response bias. Indeed, since its inception, the MMPI and its revision, the MMPI-2, have included validity scales to detect the underreporting (i.e., fake-good responding) and overreporting (i.e., fake-bad responding). It is widely accepted that test takers may be motivated for a variety of reasons not to respond honestly or in a straightforward manner to items on instruments measuring psychopathology. Such responding, of course, directly affects scores on the content and clinical scales, which comprise the interpretative meaning of test results.
Objective. Hepatitis C virus (HCV) infection disproportionately affects certain populations, including those born between 1945 and 1965 (i.e., baby boomers) and African Americans. As part of the Hepatitis Testing and Linkage to Care initiative, which promoted hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, we conducted routine HCV screening to identify previously undiagnosed, primarily African American baby boomers with chronic hepatitis C infection and link them to care.
Methods. We launched the Internal Medicine Trainees Identifying and Linking to Treatment for Hepatitis C (TILT-C) initiative at the Grady Memorial HospitalPrimary Care Center and Grady Liver Clinic in Atlanta, Georgia, in October 2012, and present results from the first year. TILT-C faculty implemented an electronic medical record prompt and conducted educational sessions to boost HCV screening. A project coordinator tracked testing outcomes and linked HCV-positive patients to care.
Results.Of 2,894 patients tested for anti-HCV, 201 (6.9%) tested positive. Men had a significantly higher (p,0.001) prevalence of HCV infection than women, with 106 of 1,091 (9.7%) men compared with 95 of 1,803 (5.3%) women testing anti-HCV positive. A total of 174 of 201 (86.6%) anti-HCVpositive patients received HCV ribonucleic acid (RNA) testing. Of 124 patients with a positive HCV RNA test, 122 were referred to care and 120 attended the first appointment.Conclusion. The TILT-C screening program was feasible and effective in detecting previously undiagnosed HCV infection and linking patients to care. The unexpectedly high prevalence of HCV infection in this primarily African American, baby boomer population underscores the need for aggressive HCV screening efforts in similar populations.
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