Outcomes from a US military neurology and traumatic brain injury telemedicine program

Posted on October 20, 2012 by Maurice Preter MD

Articles

Outcomes from a US military neurology and traumatic brain injury telemedicine program

Ilana R. Yurkiewicz, BS,

Charles M. Lappan, MPA, MBA,

Edward T. Neely, MD,

Roger R. Hesselbrock, MD,

Philip D. Girard, MS,

Aimee L. Alphonso, BS and

Jack W. Tsao, MD, DPhil

+ Author Affiliations

From the Harvard Medical School (I.R.Y.), Boston, MA; Office of the Surgeon General Teleconsultation Programs Project Manager (C.M.L.), Telehealth, Southern Regional Medical Command, Ft. Sam Houston, TX; Department of Neurology (E.T.N., A.L.A.), Walter Reed National Military Medical Center, Bethesda, MD; Aerospace Medicine Consultation Division (R.R.H.), United States Air Force School of Aerospace Medicine, Dayton, OH; Department of Veterans Affairs, Center (P.D.G.), Gainesville, FL; US Navy Bureau of Medicine and Surgery (J.W.T.), Washington, DC; and Department of Neurology (J.W.T.), Uniformed Services University of the Health Sciences, Bethesda, MD.

Correspondence & reprint requests to Dr. Tsao: jack.tsao@usuhs.edu

View Complete Disclosures

Abstract

Objective: This study evaluated usage of the Army Knowledge Online (AKO) Telemedicine Consultation Program for neurology and traumatic brain injury (TBI) cases in remote overseas areas with limited access to subspecialists. We performed a descriptive analysis of quantity of consults, response times, sites where consults originated, military branches that benefitted, anatomic locations of problems, and diagnoses.

Methods: This was a retrospective analysis that searched electronic databases for neurology consults from October 2006 to December 2010 and TBI consults from March 2008 to December 2010.

Results: A total of 508 consults were received for neurology, and 131 consults involved TBI. For the most part, quantity of consults increased over the years. Meanwhile, response times decreased, with a mean response time of 8 hours, 14 minutes for neurology consults and 2 hours, 44 minutes for TBI consults. Most neurology consults originated in Iraq (67.59%) followed by Afghanistan (16.84%), whereas TBI consults mainly originated from Afghanistan (40.87%) followed by Iraq (33.91%). The most common consultant diagnoses were headaches, including migraines (52.1%), for neurology cases and mild TBI/concussion (52.3%) for TBI cases. In the majority of cases, consultants recommended in-theater management. After receipt of consultant’s recommendation, 84 known neurology evacuations were facilitated, and 3 known neurology evacuations were prevented.

Conclusions: E-mail−based neurology and TBI subspecialty teleconsultation is a viable method for overseas providers in remote locations to receive expert recommendations for a range of neurologic conditions. These recommendations can facilitate medically necessary patient evacuations or prevent evacuations for which on-site care is preferable.

Footnotes

Supplemental data at www.neurology.org

Received June 24, 2011.

Accepted May 1, 2012.

Copyright © 2012 by AAN Enterprises, Inc.

via Outcomes from a US military neurology and traumatic brain injury telemedicine program.

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Hypothalamic-Pituitary-Thyroid Axis Function in Women With a Menstrually Related Mood Disorder: Association With Histories of Sexual Abuse

Posted on October 20, 2012 by Maurice Preter MD

Hypothalamic-Pituitary-Thyroid Axis Function in Women With a Menstrually Related Mood Disorder: Association With Histories of Sexual Abuse

Adomas Bunevicius, MD,

Jane Leserman, PhD and

Susan S. Girdler, PhD

+ Author Affiliations

From the Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Address correspondence and reprint requests to Adomas Bunevicius, MD, Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7175, Medical School Wing D, Chapel Hill, NC 27599-7175. E-mail: a.bunevicius@yahoo.com

Abstract

Introduction We previously reported a unique hypothalamic-pituitary-thyroid (HPT) axis profile in women with a menstrually related mood disorder (MRMD) who also had a history of sexual abuse (SA). In the present study, we sought to extend that work by examining the association of an SA history with HPT-axis disturbance in both women with MRMD and women without MRMD.

Methods Fifty-seven women met the prospective criteria for MRMD (23 with an SA history), and 52 women were non-MRMD (18 with an SA history). Thyroid-stimulating hormone, thyroxin (T4; total and free), and triiodothyronine (T3; total and free) were evaluated in serum, together with thyroid hormone ratios reflecting T4 to T3 conversion.

Results Women with MRMD, compared with women without MRMD, had elevated T3/T4 ratios (p values ≤ .01; reflecting increased conversion of T4 to T3) and lower free and total T4 concentrations (p values = .01). Higher T3/T4 ratios and lower T4 concentrations predicted more severe premenstrual symptoms in all women. An SA history, irrespective of MRMD status, was associated with elevated thyroid-stimulating hormone concentrations (p = .03). However, in women with MRMD, an SA history was associated with elevated T3 concentrations (p = .049), whereas in women without MRMD, an SA history was associated with decreased T3 concentrations (p = .02).

Conclusions An MRMD and an SA history are associated with independent and interactive effects on the HPT axis. The evidence that an MRMD moderates the influence of SA on T3 concentrations contributes to a growing body of work suggesting that an SA history may identify a distinct subgroup of women with MRMD.

Key words

menstrually related mood disorders

sexual abuse

thyroid hormones

Abbreviations:

HPT

hypothalamic-pituitary-thyroid

MRMD

menstrually related mood disorder

PTSD

posttraumatic stress disorder

SA

sexual abuse

T4

thyroxin

T3

triiodothyronine

TBG

thyroid-binding globulin

TSH

thyroid-stimulating hormone

Received April 2, 2012.

Revision received June 9, 2012.

Copyright © 2012 by the American Psychosomatic Society

via Hypothalamic-Pituitary-Thyroid Axis Function in Women With a Menstrually Related Mood Disorder: Association With Histories of Sexual Abuse.

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A Population Study of Childhood Maltreatment and Asthma Diagnosis: Differential Associations Between Child Protection Database Versus Retrospective Self-Reported Data

Posted on October 20, 2012 by Maurice Preter MD

A Population Study of Childhood Maltreatment and Asthma Diagnosis: Differential Associations Between Child Protection Database Versus Retrospective Self-Reported Data.

  1. Kate M. Scott, PhD,
  2. Don A.R. Smith, MA and
  3. Pete M. Ellis, PhD, BM BCh

+ Author Affiliations


  1. From the Department of Psychological Medicine (K.M.S.), Dunedin School of Medicine, University of Otago, Dunedin; and Department of Psychological Medicine (D.A.R.S., P.M.E.), University of Otago, Wellington, New Zealand.
  1. Address correspondence and reprint requests to Kate M. Scott, PhD, Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. E-mail: kate.scott@otago.ac.nz

Abstract

Objective Despite growing evidence from longitudinal studies of a link between early-life stress and the development of asthma, very few of these examine one of the most severe types of early-life stress: childhood maltreatment. Cross-sectional studies on this topic have relied on retrospective self-reports of maltreatment. This study investigates associations between childhood maltreatment indicated by child protection agency records versus self-reports and lifetime asthma diagnosis in young adults, adjusting for socioeconomic status and mental disorders.

Methods A nationally representative general population survey of DSM-IV mental disorders in New Zealand (n = 12,992) obtained information on lifetime diagnoses of chronic physical conditions. Information from a subsample of survey respondents aged 16 to 27 years (n = 1413) was linked with a national child protection database to identify respondents with a history of agency involvement, which was used as a proxy for childhood maltreatment. Retrospective reports of maltreatment were also obtained.

Results Child protection agency history was associated with elevated odds (odds ratio = 2.88 [95% confidence interval = 1.7–4.74]) of a lifetime diagnosis of asthma. After adjusting for a variety of indicators of socioeconomic status, lifetime mental disorders, lifetime smoking, and body mass index, this association remained significantly elevated (odds ratio = 2.26 [95% confidence interval = 1.33–3.83]). Retrospectively self-reported maltreatment in childhood was not associated with asthma.

Conclusions Childhood maltreatment was associated with elevated odds of asthma diagnosis. These findings are consistent with the possibility that early-life stress may be one of the environmental factors that increase the risk of asthma in genetically vulnerable individuals.

Key words

  • Abbreviations:
    CI
    confidence interval
    HPA
    hypothalamic-pituitary-adrenal
  • Received November 9, 2011.
  • Revision received June 5, 2012.

 

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Selective serotonin reuptake inhibitors and brain hemorrhage

Posted on October 18, 2012 by Maurice Preter MD

Selective serotonin reuptake inhibitors and brain hemorrhage

A meta-analysis

  1. Daniel G. Hackam, MD, PhD, FRCPC and
  2. Marko Mrkobrada, MD, FRCPC

+ Author Affiliations


  1. From the Stroke Prevention and Atherosclerosis Research Centre (SPARC) (D.G.H.) and Clinical Trials Unit (M.M.), Robarts Research Institute, and Departments of Medicine (D.G.H., M.M.), Clinical Neurological Sciences (D.G.H.), and Epidemiology and Biostatistics (D.G.H.), Western University, London, Canada.
  1. Correspondence & reprint requests to Dr. Hackam: dhackam@uwo.ca

View Complete Disclosures

Abstract

Objective: We synthesized the epidemiologic evidence concerning selective serotonin reuptake inhibitor (SSRI) exposure and the risk of CNS hemorrhage.

Methods: We searched for controlled observational studies comparing SSRI therapy with a control group not receiving SSRIs. We used DerSimonian and Laird fixed effect models to compute summary risk associations.

Results: Intracranial hemorrhage was related to SSRI exposure in both unadjusted (rate ratio [RR] 1.48, 95% confidence interval [CI] 1.22–1.78) and adjusted analyses (RR 1.51, 95% CI 1.26–1.81). Intracerebral hemorrhage was also associated with SSRI exposure in both unadjusted (RR 1.68, 95% CI 1.46–1.91) and adjusted (RR 1.42, 95% CI 1.23–1.65) analyses. In a subset of 5 studies (3 of intracranial hemorrhage and 1 each reporting hemorrhagic stroke and intracerebral hemorrhage), SSRI exposure in combination with oral anticoagulants was associated with an increased risk of bleeding compared with oral anticoagulants alone (RR 1.56, 95% CI 1.33–1.83). When all studies were analyzed together, increased risk was seen across cohort studies (1.61, 95% CI 1.04–2.51), case-control studies (odds ratio [OR] 1.34, 95% CI 1.20–1.49), and case-crossover studies (OR 4.24, 95% CI 1.95–9.24).

Conclusions: SSRI exposure is associated with an increased risk of intracerebral and intracranial hemorrhage, yet given the rarity of this event, absolute risks are likely to be very low.

  • Received March 5, 2012.
  • Accepted June 7, 2012.
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Findings reveal brain mechanisms at work during sleep, and other sleep news from the SFN Annual meeting

Posted on October 17, 2012 by Maurice Preter MD

Sleepiness disrupts the coordinated activity of an important network of brain regions; the impaired function of this network is also implicated in Alzheimer’s disease (Andrew Ward, abstract 909.05).

via Findings reveal brain mechanisms at work during sleep.

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