Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury...Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.展开更多
Background and Objective: American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians...Background and Objective: American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians would be of clinical and public health value. Methods and Results: A total of 3483 (2043 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2010 for incident stroke. Overall, 297 stroke cases (179 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to develop stroke risk prediction models. Assessment of the developed stroke risk prediction models regarding discrimination and calibration was performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow statistic (HL), respectively, and validated internally through use of Bootstrapping methods. Results: Age, smoking status, alcohol consumption, waist circumference, hypertension status, antihypertensive therapy, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease/heart failure, atrial fibrillation, or Left ventricular hypertrophy, and parental history of stroke were identified as the significant optimal risk factors for incident stroke. Discussion: The models produced a C = 0.761 and HL = 4.668 (p = 0.792) for women, and a C = 0.765 and HL = 9.171 (p = 0.328) for men, showing good discrimination and calibration. Conclusions: Our stroke risk prediction models provide a mechanism for stroke risk assessment designed for American Indians. The models may be also useful to other populations with high prevalence of obesity and/or diabetes for screening individuals for risk of incident stroke and designing prevention programs.展开更多
基金supported by Merit Review Award#I 01 RX000637-01A3 from the United States Department of Veterans Af airs Rehabilitation Research and Development Service Programsupport for the preparatory phase of the project was provided through the Med Star Health Research Institute,a component of the Georgetown Howard Universities Center for Clinical and Translational Sciencesupported by Grant U54 RR026076-01 from the National Center for Research Resources,a component of the National Institutes of Health
文摘Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
文摘Background and Objective: American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians would be of clinical and public health value. Methods and Results: A total of 3483 (2043 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2010 for incident stroke. Overall, 297 stroke cases (179 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to develop stroke risk prediction models. Assessment of the developed stroke risk prediction models regarding discrimination and calibration was performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow statistic (HL), respectively, and validated internally through use of Bootstrapping methods. Results: Age, smoking status, alcohol consumption, waist circumference, hypertension status, antihypertensive therapy, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease/heart failure, atrial fibrillation, or Left ventricular hypertrophy, and parental history of stroke were identified as the significant optimal risk factors for incident stroke. Discussion: The models produced a C = 0.761 and HL = 4.668 (p = 0.792) for women, and a C = 0.765 and HL = 9.171 (p = 0.328) for men, showing good discrimination and calibration. Conclusions: Our stroke risk prediction models provide a mechanism for stroke risk assessment designed for American Indians. The models may be also useful to other populations with high prevalence of obesity and/or diabetes for screening individuals for risk of incident stroke and designing prevention programs.
