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Biomedical subjects

A Colantonio

Publications and source records attributed to A Colantonio.

At least 19 recordsLinked to original sources
PubMed2006

Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury.

PURPOSE: To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI). METHOD: This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7-24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes. RESULTS: Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes. CONCLUSIONS: The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.

Adolescent↗
PubMed2005

Long term symptoms and limitations of activity of people with traumatic brain injury: a ten-year follow-up.

This study examined the effect of Traumatic Brain Injury 10 years post-injury. Frequencies of head injury symptoms and activity limitation by level of severity were measured in a consecutive series of 61 adults who were admitted to a tertiary-care center for traumatic brain injury. Irritability and Anxiety were the most frequently reported symptoms from the Head Injury Symptom Checklist. Bothered by noise and Bothered by light were the least frequently reported. Trouble hearing what is said in a group conversation and Trouble hearing what is said in a one-to-one conversation were the most commonly reported limitations of activity from the Health and Activity Limitations Survey. Overall, this study illustrates that symptoms remain many years following brain injury, irrespective of the injury's severity.

Activities of Daily Living↗
PubMed2004

Long-term outcomes after moderate to severe traumatic brain injury.

OBJECTIVE: This research examined the long-term outcomes of rehabilitation patients with moderate to severe traumatic brain injury (TBI). DESIGN: Retrospective cohort study. SETTING AND SUBJECTS: We examined consecutive records of persons with moderate to severe traumatic brain injury who were discharged from a large rehabilitation hospital in Pennsylvania from 1973 to 1989. We interviewed consenting participants (n = 306) up to 24 years post-injury. MAIN OUTCOME MEASURES: Self-rated health, activity limitations, employment, living arrangements, marital status, Community Integration Questionnaire, and use of rehabilitation services. RESULTS: Participants were most limited in activities such as managing money and shopping. Twenty-nine per cent of our participants were working full time. There were significant relationships between activity limitations and residual cognitive impairment at follow-up. Self-rated health was correlated with most instrumental activities of daily living. CONCLUSION: Our findings document health and function in a large post acute TBI population and implications for rehabilitation are discussed.

Activities of Daily Living↗
PubMed2004

Aging with traumatic brain injury: long-term health conditions.

Although traumatic brain injury (TBI) is a leading cause of death and disability in young adults, older adults over the age of 75 are also at high risk for TBI. As even mild injury can lead to disabling consequences, the long-term consequences of TBI need to be better understood, especially as the survival rate has increased dramatically in the last few decades. This research examined the prevalence of long-term health conditions after TBI. Using a retrospective cohort design, we examined consecutive records of adults with moderate to severe TBI discharged from a large rehabilitation hospital in Pennsylvania from 1974 to 1989. Baseline clinical information was abstracted from medical records. We interviewed consenting participants up to 24 years after injury. Our findings show a higher than expected prevalence of self-reported arthritis in the middle-aged population. There was also a high prevalence of problems with sleep and nerves many years post-injury. Some of the health conditions documented in this study could potentially be addressed early in rehabilitation; this study supports the screening of more physical health conditions in persons aging with TBI.

Adult↗
PubMed2003

Mental health and vitality among Canadian women with physical disabilities.

This study investigated scores for mental health and vitality in a large community-based sample of women with physical disabilities. The scores from two subscales of the SF-36 were collected from 1,096 women with physical disabilities through a mailed survey regarding health and well-being. These scores were compared to normative data using t tests. The mean scores of the vitality subscale were significantly lower than that of the normed sample when analyzed by age groups. The mental health scores were significantly lower as well, except for one age group (65-74 yr.). These results suggest that health care workers should address aspects of mental health and energy when caring for women with physical disabilities, as these areas are often overlooked in this population. Health promotion programs aimed at these topics should be designed specifically for this population as well.

Adolescent↗
PubMed2001

Assessing support needs of caregivers of persons with dementia: who wants what?

This paper documents the use and interest in support strategies such as telephone support, newsletters, and computer services, among caregivers of all ages. Data obtained from telephone interviews with community living caregivers of persons with dementia (n = 148) showed substantial interest in the use of these types of services. Using a theoretical framework, this paper identifies caregiver and care-receiver characteristics associated with those interested in the utilization of these support strategies. The implications of these findings for program planning and future research are discussed.

Adult↗
PubMed2001

Factors associated with perceived quality of life many years after traumatic brain injury.

OBJECTIVES: To explore factors associated with perceived quality of life (QOL) 8 to 24 years after traumatic brain injury (TBI). DESIGN: Retrospective cohort study. PARTICIPANTS: Two hundred seventy-five individuals who sustained moderate to severe TBI who were discharged from a rehabilitation hospital participated in this study. We interviewed consenting participants up to 24 years after injury. OUTCOME MEASURES: Self-rated Quality of Life Scale. RESULTS: Multivariate linear regression analyses revealed that perceived mental health, self-rated health, gender (women rating QOL higher), participation in work and leisure, and the availability of emotional support were significantly associated with QOL (P <.05). CONCLUSION: The importance of designing ongoing support programs to further reintegrate TBI survivors several years after injury is discussed.

Adolescent↗
PubMed2000

Clients' perspectives on problems many years after traumatic brain injury.

This study investigated the types of self-reported main problems that persons report many years following a traumatic brain injury. This preliminary study is part of a large ongoing study of disability and handicap in adults following traumatic brain injury. As part of an extensive interview, subjects were asked an open-ended question regarding their current main problems which they thought resulted from their traumatic brain injury. Responses were obtained from 166 adult subjects (119 men and 47 women) whose time postinjury ranged from 9 to 24 years. Categories for responses were subsequently developed. The most commonly reported categories of problems were those relating to movement (39%), cognition (36%), and sensory impairment (31%). Findings suggest that subjects' long-term concerns were related to specific impairments more than to psychosocial, emotional, or behavioral issues. Methodological issues concerning this research are discussed in relation to findings.

Adaptation, Psychological↗
PubMed1999

Mild traumatic brain injury from motor vehicle accidents: factors associated with return to work.

OBJECTIVES: To describe return to work (RTW) for motor vehicle accident (MVA) survivors with mild traumatic brain injury (MTBI) and to examine relationships between RTW and injury severity, cognitive impairment, social interaction, discharge disposition, and sociodemographics. DESIGN: Inception cohort assessed within 1 month of injury and at follow-up 6 to 9 months (mean = 7.4) after injury, for comparisons on outcome of RTW. SETTING: Tertiary care center in Toronto (time 1); at home for follow-up. PARTICIPANTS: Fifty patients with MTBI resulting from MVA who were consecutively admitted during a 20-month period ending April 1994. Thirteen of 63 eligible patients refused consent or were lost to follow-up. Mean age was 31; 62% were men. ELIGIBILITY CRITERIA: (1) patients had been working; (2) they had no history of head injury, neurologic disease, or psychiatric illness requiring hospitalization; and (3) they had no catastrophic impairment from accident. MAIN OUTCOME MEASURE: Return to work (at premorbid or modified level). RESULTS: Of the 42% who returned to work, 12% resumed their premorbid level of employment and 30% returned to modified work. There were significant differences (p<.05) between the groups in level of social interaction, premorbid occupation, and discharge disposition. On one test of cognitive functioning the difference was at p = .06. CONCLUSION: Social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this population. Cognitive impairment within the first month was not a reliable indicator of RTW potential.

Accidents, Traffic↗
PubMed1998

Age-related changes in the tiger salamander retina.

Tiger salamanders have been used in visual science because of the large size of their cells and the ease of preparation and maintenance of in vitro retinal preparations. We have found that salamanders over 27 cm in length show a variety of visual abnormalities. Compared to smaller animals (15-23 cm), large animals exhibited a decrease in visual responses determined by tests of the optomotor reflex. Small animals responded correctly an average of 84.5% of the time in visual testing at three light levels compared to an average of 68.4% for the large animals with the poorest visual performance at the lowest level of illumination. In addition, large animals contained (i) histological degeneration of the outer retina, in particular, loss and disruption of outer segments and abnormalities of the retinal pigmented epithelium, (ii) loss of cells, including photoreceptors, by apoptosis as evaluated with the TUNEL technique, and (iii) an increase in the number of macrophages and lymphocytes within the retina as determined by morphological examination. These histological changes were present in all large animals and all quadrants of their retinas. In contrast, small animals showed virtually no retinal degeneration, no TUNEL-positive cells, and few immune-like cells in the retina. Since large animals are also older animals. the visual changes are age-related. Loss of visual function and histological degeneration in the outer retina also typify aged human eyes. Thus, we propose that large salamanders serve as an animal model for age-related retinal degeneration. In addition to providing a source of aging retina that is readily accessible to experimental manipulation, the salamander provides a pigmented retina with a mixed (2:1, rod:cone) population of photoreceptors, similar to the degeneration-prone parafoveal region of the human eye.

Aging↗
PubMed1998

Head injury in young adults: long-term outcome.

OBJECTIVE: To describe the long-term outcome 5 years after injury of young adults who were 15 to 19 years old at the time of their head injuries. DESIGN: A retrospective cohort. The health records of 62 consecutive eligible subjects were abstracted for baseline sociodemographic, health, and injury variables. A telephone interview was administered to assess quality of life, impairment, disability, and handicap. SETTING: Canada's largest trauma center, Sunnybrook Health Science Centre, Toronto, Canada. SUBJECTS: Of the 58 subjects (94%) who were traced at follow-up, 51 agreed to participate. MAIN OUTCOME MEASURES: The Medical Outcomes Study SF-36, Head Injury Symptom Checklist, selected disability measures, Community Integration Questionnaire. RESULTS: Of the 8 summary items of the Medical Outcomes Study SF-36, subjects scored lowest on mental health. There were no significant differences between mild and more severely injured groups in all quality of life measures. Subjects classified with mild head injury overall reported more symptoms from the Head Injury Symptom Checklist. Subjects with more severe injuries had lower community integration scores (p < .05). CONCLUSIONS: Overall, mental health is an important area of concern at follow-up for all subjects. Adolescents with apparent mild head injury can have disabling symptoms many years after injury.

Adolescent↗
PubMed1996

Prestroke physical function predicts stroke outcomes in the elderly.

OBJECTIVE: To determine whether physical function before stroke is an independent predictor of physical function and institutionalization 6 months after discharge from hospital in elderly stroke patients. DESIGN: Population-based prospective cohort design where incidence of stroke was monitored from 1982 through 1988. Baseline demographic and health information including prestroke function was collected prospectively. Eligible subjects who had a stroke were interviewed 6 months after discharge from hospital to assess outcomes. SETTING: New Haven, Connecticut. PATIENTS: Subjects were recruited from an initial sample of 2,812 older adults. Of 79 subjects who survived a first stroke at 6 months postdischarge, complete follow-up data were obtained on 63 subjects. MAIN OUTCOME MEASURE: Physical function as measured by the Katz scale and institutionalization. RESULTS: Fewer limitations in activities of daily living before stroke were associated with fewer limitation in physical function after stroke controlling for stroke severity and other relevant health and sociodemographic conditions (p < .01). Fewer limitations in gross mobility function before stroke were also independently associated with a lower risk of institutionalization (p < .05). CONCLUSION: This study provides useful information in assessing the prognosis of elderly stroke patients upon admission to hospital. It also supports the concept of general frailty being a risk factor for poorer health and institutionalization overall in aged persons. Studies have shown that factors related to physical frailty, such as decline in muscle function, can be reversed. The effect of interventions aimed at improving the physical function of the elderly on stroke incidence, stroke outcomes, and all-cause mortality, however, needs to be determined.

Activities of Daily Living↗
PubMed1994

Outcome from central nervous system injury.

In general, coma portends a very poor outcome in ICU patients except when a drug overdose is the cause. Interactions with concurrent diseases and the cause of the comatose state are important variables that modify mortality rates. Recent studies have made it possible to predict irreversibility with a high degree of specificity in many cases. Three approaches show promise for early prediction of poor outcome--multivariate analysis, neurologic findings, and technologic innovations. Multivariate analysis of combinations of clinical conditions common in ICUs appears to have defined some patients whose prognosis is nearly hopeless, empirically. It would seem reasonable to consider withholding or withdrawing life support from these patients so that mere prolongation of death is avoided. Additional studies are needed and are relatively easy to perform with computerized statistical analyses of a readily available database derived from large patient populations in multicenter studies. A second useful approach for predicting irreversibility has arisen from studies using neurologic findings at defined time points after brain injury. The studies of Levy and colleagues exemplify this approach; their data suggest that coma can be declared irreversible with a high degree of confidence in a large subset of patients, delineated by simple sequential neurologic observations. Finally, technologies are evolving that may lead to noninvasive measurements to provide quantitative evidence of irreversible brain damage. Additional clinical studies are needed to validate the predictive value of these approaches to identifying patients who are certain to have a poor ultimate outcome. It then may be possible to predict function and irreversibility of central nervous system injury in individual cases with a high degree of certainty early in the clinical course.

Brain Injuries↗
PubMed1993

Psychosocial predictors of stroke outcomes in an elderly population.

The influence of premorbid psychosocial factors on physical function and institutionalization 6 weeks after hospital discharge was studied in elderly stroke patients. The predictor variables of interest were social networks, availability of social support, pre-stroke depression (CES-D), and religiousness. The data were obtained from a prospective longitudinal study based on 2,812 noninstitutionalized individuals aged 65 years and older living in New Haven, Connecticut. Incident stroke cases from this study were followed for post-stroke outcomes. Results from 87 survivors indicated that larger social networks were associated with fewer limitations in physical function, controlling for relevant health and sociodemographic conditions. Larger networks were also associated with a lower risk of institutionalization (p < .05). None of the other psychosocial factors assessed appeared to be related to these outcomes.

Aged↗
PubMed1993

Effects of a history of heavy alcohol consumption on Alzheimer's disease.

Neuropsychological and psychiatric evaluations were made of 39 subjects with possible Alzheimer's disease and a history of excessive alcohol consumption (AD + ETOH), who had been abstinent or had drunk minimally for at least three months before evaluation, and 225 patients with probable Alzheimer's disease (PAD) of comparable age, years of education, and baseline global impairment. At baseline, there were no significant differences between the groups in terms of age of onset of dementia, neuropsychological test scores, or current behavioural or psychiatric symptoms. One year later, no differences in rates of decline between 20 abstinent AD + ETOH patients and 88 PAD subjects could be shown. Thus, past heavy alcohol consumption does not appear to modify the presentation of dementia of the Alzheimer's type, nor does it modify progression over a one-year interval.

Aged↗
PubMed1992

Depressive symptoms and other psychosocial factors as predictors of stroke in the elderly.

The aim of this paper is to assess the influence of selected psychosocial factors as predictors of stroke incidence in a probability sample of noninstitutionalized elderly. The main psychosocial factor of interest was depression. Marital status, social support, social networks, and religiousness were also assessed as potential antecedent or mediating factors. The data were obtained from a prospective longitudinal study based on 2,812 individuals aged 65 years and over living in New Haven, Connecticut. The incidence of stroke was monitored from the baseline interview in 1982 until December 1988. Depression, measured by the Center for Epidemiologic Studies Depression Scale (CES-D), was measured at baseline as were other predictor variables. Univariate Cox regression analyses revealed that higher CES-D scores were predictive of greater stroke incidence (p < 0.05). More frequent attendance at religious services was associated with lower incidence (p < 0.001). CES-D scores were also correlated with many measures of sociodemographic, health, and physical function factors in our multivariate analysis (p < 0.05). When combined with other significant predictor variables such as age, sex, hypertension, diabetes, physical function, and smoking, neither depression nor religious attendance retained its significance.

Aged↗
PubMed1992

Level of function predicts first stroke in the elderly.

BACKGROUND AND PURPOSE: Our aim in this study was to assess physical function as a predictor of stroke incidence in a probability sample of noninstitutionalized elderly subjects with no previous history of stroke. SUMMARY OF REPORT: The data were obtained from a prospective longitudinal study of 2,812 individuals aged 65 years of age and older living in New Haven, Connecticut. Incidence of stroke was monitored from the baseline interview in 1982 until December 1988 (n = 167). Physical function was measured by the Katz scale of activities of daily living and a three-item scale measuring gross mobility function (Rosow scale). Both measures of impairment of function were independently associated with stroke incidence controlling for age, sex, diabetes, hypertension, and angina (p less than 0.001). CONCLUSIONS: Our findings suggest that in elderly persons, physical disability is a newly identified risk factor for stroke.

Activities of Daily Living↗