Biomedical subjects

Aaron P Turner

Publications and source records attributed to Aaron P Turner.

11 recordsLinked to original sources

PubMed2006

Does having a computerized prosthetic knee influence cognitive performance during amputee walking?

OBJECTIVE: To compare objective cognitive performance and perception of cognitive burden during walking tasks using 2 different prosthetic knees: a computerized hydraulic knee (Otto Bock C-leg) and a noncomputerized hydraulic knee (Ossur Mauch SNS). DESIGN: Two-group crossover trial, with participants randomly assigned to order of prosthesis. Participants completed assessments under 2 conditions, a self-selected speed walk and a controlled speed walk, on 2 separate occasions (precrossover, postcrossover). SETTING: Veterans Health Administration hospital. PARTICIPANTS: Eight transfemoral amputees. INTERVENTION: Computerized versus noncomputerized prosthetic knee. MAIN OUTCOME MEASURES: Objective cognitive performance measures included verbal fluency (Controlled Oral Word Association Test, Category Test), attention and working memory (serial subtraction), and walking speed during cognitive tasks. Measures of perceived cognitive burden included subjective attentional requirements of walking and cognitive tasks and subjective general cognitive burden of prosthesis. RESULTS: There were no significant differences in objective cognitive performance on any task between prostheses, nor did walking speed vary by prosthesis during the free-speed walk. Participants reported that walking required less attention while wearing the C-leg and that the C-leg was less of a cognitive burden than the noncomputerized prosthesis. CONCLUSIONS: In nondemanding walking conditions with experienced amputees, participants reported that the more costly C-leg required less cognitive attention than the noncomputerized knee. However, this subjective experience did not translate to improved performance on neuropsychologic screening instruments or on walking speed. Noncomputerized prostheses may be adequate for a majority of amputees, and further research is needed to identify particular groups of amputees (ie, new amputees, amputees with complex physical or cognitive demands) who may benefit from computerized prostheses.

Adult↗

PubMed2006

Suicidal ideation in multiple sclerosis.

OBJECTIVE: To examine risk factors for suicidal ideation among people with multiple sclerosis (MS). DESIGN: Cohort study linking computerized medical records with a mailed self-report survey. SETTING: Veteran's Health Administration (VHA) region covering the northwestern United States. PARTICIPANTS: VHA patients with MS (N=445) who returned mailed surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent. RESULTS: One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%). CONCLUSIONS: Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.

Chi-Square Distribution↗

PubMed2005

Identifying a negative mood subtype in incarcerated adolescents: relationship to substance use.

OBJECTIVE: The following study tested the empirical validity and clinical meaningfulness of a negative mood subtype of incarcerated adolescent males (N=270). Differences in alcohol and marijuana use and consequences were examined. METHOD: Participants were subtyped according to reports of depressive and anxious symptoms using the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. RESULTS: Cluster analysis confirmed the presence of negative mood (34%) and normal mood (66%) subtypes. Incarcerated adolescents in the negative mood subtype reported higher levels of alcohol use, higher levels of use-related consequences for both alcohol and marijuana, greater use of both substances to regulate mood states, and more use of avoidant coping. CONCLUSION: Results underscore the need for identification and treatment of mental health and substance use difficulties in the juvenile justice system.

Adaptation, Psychological↗

PubMed2005

Predictors of prescriptions for management of fatigue among veterans with multiple sclerosis.

OBJECTIVE: To determine predictors of fatigue-modifying medication use. DESIGN: Cross-sectional cohort. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: Veterans with multiple sclerosis (MS) in the VHA in the northwestern United States from 1995 to 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A self-administered survey distributed by mail sought information from veterans with MS about demographics, symptoms, barriers to care, and disease characteristics. The variables were compared with prescriptions for fatigue-modifying medications during the study period. RESULTS: Of 1032 patients, 451 (44%) completed the survey, and 306 (68%) reported moderate or high fatigue levels. Only 40% of the 306 were prescribed fatigue-modifying medications. Those using specialized fatigue services or who received care at tertiary centers were more likely to receive fatigue treatments. Patient-perceived barriers to accessing care and other patient characteristics were not associated with prescription rates. CONCLUSIONS: Fatigue is undertreated among veterans with MS. However, there is considerable variability in the provision of fatigue care. Interventions to improve the quality and uniformity of fatigue care are warranted.

Adult↗

PubMed2004

Transition planning and recidivism among mentally ill juvenile offenders.

OBJECTIVES: To determine the extent to which transition planning and community service would predict lower levels of recidivism among mentally ill juvenile offenders. DESIGN: Review of legal, medical and social service records including examination of 3-month period following community release. PARTICIPANTS: Juvenile offenders incarcerated for 6 months or more (N = 44) transitioning to community. MEASURES: Child and Adolescent Functional Assessment Scale (CAFAS), sum of different documented pre- and post-release discharge planning contacts, documented community service contacts. OUTCOMES: Re-offense during the first year post-release. RESULTS: Documented community service contacts in the 3 months following discharge were rare for mental health (20.5%), substance abuse (38.6%), financial assistance (29.5%), and school placement (34.1%). The average number of different pre-release and post-release discharge planning contacts was also low, M(SD)=1.86(1.68) and M(SD)= 2.34(1.71) respectively. Post-release discharge planning and the receipt of financial assistance and mental health services were all associated with lower levels of reoffending. CONCLUSIONS: Community transition planning, including the coordination and provision of community services, is an essential component of community reintegration for juvenile offenders and is associated with lower rates of recidivism during the first year post-discharge.

Adolescent↗

PubMed2004

Anger expression, coping, and substance use in adolescent offenders.

The present study examined anger expression and avoidant coping and their relationship to substance use and use-related consequences in a sample of 270 incarcerated adolescents. Outwardly expressed anger was significantly associated with both alcohol and marijuana use and use-related consequences. Avoidant coping was also significantly associated with all outcome variables. There were no significant interactions between anger expression (outward or inward) and avoidant coping. Collectively, results suggest that expression of anger and avoidant coping are independent risk factors for substance use and use-related consequences across two classes of drugs in adolescent offenders.

Adaptation, Psychological↗

PubMed2004

Predicting drinking behavior and alcohol-related problems among fraternity and sorority members: examining the role of descriptive and injunctive norms.

The authors examined the relation between Greek students' perceptions of alcohol consumption in their pledge classes (descriptive norms) and acceptability of drinking (injunctive norms) and the ability of these normative influences to predict drinking behavior, alcohol-related negative consequences, and symptoms of alcohol dependence concurrently and prospectively over 1 year. Participants were 279 men and 303 women recruited from incoming pledge classes of 12 fraternities and 6 sororities, who completed measures of descriptive and injunctive norms, alcohol use, and consequences. Results revealed that descriptive norms significantly predicted concurrent drinking. After controlling for baseline drinking, injunctive norms significantly predicted drinking 1 year later and predicted alcohol-related consequences and dependency symptoms at baseline and follow-up. The potential to incorporate injunctive norms into preventive interventions is discussed.

Adolescent↗

PubMed2003

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching.

OBJECTIVE: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions. RESULTS: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. CONCLUSION: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.

Acute Disease↗

PubMedDate not supplied

Complementary and alternative medicine use in veterans with multiple sclerosis: Prevalence and demographic associations.

The present study explored complementary and alternative medicine (CAM) use in veterans with multiple sclerosis (MS). We administered self-report questionnaires to 451 veterans who received healthcare from Veterans Health Administration facilities. CAM use among veterans with MS was widespread; 37% of respondents reported current or past use. Roughly 33% of CAM users reported using multiple interventions, and 40% of respondents desired interventions that they were not already using. Logistic regression suggested that CAM use was more likely among participants with graduate-level education, poor self-reported health over the past year, and a progressive relapsing MS subtype. Participants who used traditional medical services were also more likely to use CAM, which suggests that CAM services are used in addition to, as opposed to in place of, traditional services. As others have proposed, these results suggest that care providers who work with persons with MS would be well served to understand, routinely screen for, and make use of CAM when appropriate.

Adult↗

PubMedDate not supplied

Depression and multiple sclerosis: Review of a lethal combination.

Depression is the most frequent psychiatric disorder in multiple sclerosis (MS) patients. The etiology of depression is multifactorial and likely associated with psychosocial stress, focal demyelinating lesions, and immune dysfunction. Proper diagnosis and severity assessment are critical prior to initiation of therapy. Patients with suicidal ideation should be referred for immediate psychiatric consultation and be closely monitored. While more therapeutic trials for depression in MS are needed, MS patients have been shown to respond to current antidepressant medications and psychotherapy. Unfortunately, patients with MS and major depression or suicidal thoughts are often underassessed and therefore not diagnosed. Unlike other aspects of MS, depression is treatable. Early intervention in depression can prevent declines in quality of life and even death from suicide. This article reviews the unique features, assessment, and treatment of depression in MS. MS care providers should vigilantly assess depression and suicide risk in their patients.

Adaptation, Psychological↗

PubMedDate not supplied

Exploring educational needs of multiple sclerosis care providers: Results of a care-provider survey.

Our objective was to survey experienced multiple sclerosis (MS) care providers, determine their ongoing professional educational needs, and develop future education programs. We asked providers across a variety of disciplines to identify the areas in which clinical consultation and continuing medical education (CME) would most improve their ability to provide care to individuals with MS; their preferred education modalities; and their confidence in providing care related to disease-modifying agents (DMAs), fatigue, depression, spasticity, and bladder management. At a national meeting of MS professionals, 152 MS care providers completed a self-report survey that was designed for this cross-sectional cohort study. Areas of greatest interest for clinical consultation and CME were identical and included cognition, fatigue, DMA use, spasticity, pain, sex, diagnosis of MS, and depression. Participants expressed a preference for live and interactive CME modalities. Confidence in providing specific disease-related care sometimes differed between Veterans Health Administration (VHA) and non-VHA providers. The results indicate that clinical consultations and CME should be targeted to the topics of greatest interest identified by providers and delivered in a live or interactive modality whenever possible.

Clinical Competence↗