Longitudinal Outcome Study Research Articles

Do Patient Risk Factors Impact 90-Day Readmission after Total Ankle Arthroplasty?

Category: Ankle,Ankle Arthritis Introduction/Purpose: The Comprehensive Care for Joint Replacement model (CJR) provides bundled payments for in-hospital and 90-day post-discharge care of patients undergoing lower extremity joint replacement including hip, knee, and ankle arthroplasty (THA, TKA, and TAA). Pre-operative risk factors influencing in-hospital and post-discharge costs are, thus, of keen interest. While THA and TKA have been reported to have a 5.3% 90-day readmission rate associated with race, gender, increased BMI, >2 medical comorbidities, increased length of stay, and discharge to inpatient rehab, little is known about factors that influence readmission rates after TAA. The purpose of this study is to identify risk factors associated with 90-day readmission after TAA. Methods: 1,048 patients undergoing TAA (ICD-9 81.56 or ICD-10 0SRF/G) at a single academic institution were prospectively enrolled into an ongoing, IRB-approved longitudinal TAR outcome study between 2007 and 2016. Records were retrospectively reviewed to determine patient, operative, and post-operative characteristics including age, gender, race, risk factors of the Charlson-Deyo comorbidity and Elixhauser indices, post-discharge disposition, BMI, length of stay, and ASA score. Pre-operative Elixhauser and Charlson-Deyo comorbidities were recorded using standardized ICD-9 and ICD-10 codes. Univariate tests of significance (t-tests for continuous inputs and chi-square tests for categorical inputs) were performed to determine the potential relationship between patient characteristics and 90-day readmission using JMP Pro version 13.0.0. The tables display pre-operative cohort-level and outcome-specific patient characteristics as well as the results of significance testing for comorbidities with >1% prevalence. Results: Thirty of 1048 (2.9%) patients were readmitted after TAA during the 90 day post-discharge window. Twenty-two (73%) of the patients were readmitted for surgical wound complication. The majority of the remaining 8 admissions were for medical illnesses not clearly related to the index procedure. Prevalent comorbidities included hypertension, cardiac arrhythmias, depression, obesity, rheumatoid arthritis, diabetes, hypothyroidism, and chronic obstructive pulmonary disease. However, there were no significant differences in patient characteristics between those who were readmitted and those who were not readmitted although patients that were readmitted tended to be slightly older, were less likely to be discharged to SNF or in-hospital rehabilitation, and had higher ASA score and Charlson-Deyo comorbidity index. No individual patient comorbidities were statistically associated with 90-day readmission. Conclusion: The 90-day readmission rate of 2.9% after TAA at our institution is lower than reported rates for THA and TKA nationally (5.3%). Although our patient population had a similar prevalence of risk factors when compared to THA/TKA patients, none of these factors were significantly associated with 90-day readmission. These data suggest that grouping TAA with THA and TKA for CJR may not be advisable. In an emerging era of bundled payments, further work is needed to delineate factors strongly associated with costly readmissions specific to surgical treatment and individualized based on pre-operative patient profile.

Early psychosis in central Vietnam: A longitudinal study of short-term functional outcomes and their predictors.

Few longitudinal studies have investigated the functional outcomes of individuals with recent-onset psychotic illness in low- and middle-income countries. To investigate short-term functional remission and its predictors in a central Vietnamese sample. A naturalistic 6-month prospective cohort study recruited 79 patients of public health facilities who had experienced a first episode of schizophrenia or related illness in the past 18 months. Individuals and their family members were interviewed using standardised assessments of community functioning, symptoms, treatment, demographics and various psychosocial variables. Rates of functional remission (i.e. no or minimal impairment) were calculated based on rigorous, culturally appropriate criteria. Generalised estimating equations were used to explore predictors of remission. Rates of global functional remission were 28% at baseline and 53% at follow-up. In individual functional domains, remission was least common for occupational activities, intermediate for relationships and relatively common for daily living activities. Global functional remission was significantly associated with absence of negative and cognitive symptoms, average or better household economic status and unimpaired premorbid functioning. Remission rates appeared similar to those seen in many international intervention studies. However, individuals from poor households had markedly unfavourable outcomes, suggesting the need for community-based interventions targeting low-socioeconomic status (SES) groups.

A longitudinal study of cognitive and educational outcomes of those born small for gestational age.

AimThis study examined the long‐term cognitive and educational outcomes of being born small for gestational age (SGA) and assessed whether the family's attitude towards education modified the effect of being born SGA on educational attainment.MethodsWe used anonymised data on 9598 individuals from the Stockholm Birth Cohort. This study focused on babies born in 1953 in the Stockholm metropolitan area, who were followed up for 50 years, and included educational data at the age of 13 and 48. Ordinary least squares regression analyses, modification analyses and logistic regression analyses were conducted.ResultsThe findings suggested that individuals who were born SGA (n = 798) had lower mean verbal, spatial and numerical test scores than those born appropriate for gestational age (AGA) (n = 7364) and large for gestational age (n = 1436). The SGA/AGA differences were small, but statistically significant, and the effects of being born SGA on the test scores was modified by the family's attitude towards education. The findings also suggested that attaining higher education was largely, but not entirely, explained by the family's attitude towards education.ConclusionThe detrimental effects of being born SGA were limited on cognitive and educational outcomes, but may have been reduced by positive family attitudes.

The National Elder Mistreatment Study: An 8-year longitudinal study of outcomes

ABSTRACTObjectives: To conduct an 8-year follow-up of the National Elder Mistreatment Study (NEMS) and specify risk ratios for negative outcomes of elder abuse, including DSM-5 defined depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and poor self-reported health.Methods: Attempts were made to re-contact, via Computer Assisted Telephone Interview, all 752 NEMS participants who reported mistreatment since age 60 at Wave I, as well as a randomly selected sample of non-mistreated NEMS participantsResults: 183 NEMS Wave I elder abuse victims and 591 non-victims provided data. In bivariate analyses, elder mistreatment 8 years earlier increased risk of negative outcomes by 200–700%. However, multivariate analyses revealed that Current (Wave II) social support was highly protective against most negative outcomes (excepting PTSD), and even appeared to nullify effects of mistreatment on GAD and poor self-reported health.Conclusions: Outcomes of elder mistreatment have not been studied prospectively in a national sample. The NEMS 8-year follow-up findings indicate a strong relationship between elder mistreatment at Wave I and negative emotional and physical health 8 years later. Fortunately, current (Wave II) social support appears to be both consistently and powerfully protective against most negative outcomes.

Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups.

The purpose of this study is to compare disease severity in ankylosing spondylitis (AS) in three ethnic groups. We assessed 925 AS patients (57 Blacks, 805 Whites, 63 Latinos) enrolled in the longitudinal Prospective Study of Outcomes in AS (PSOAS) for functional impairment, disease activity, and radiographic severity. Comparisons of clinical characteristics and HLA-B27 frequency for each group were performed, in two multivariable regression models, we compared the baseline Bath Ankylosing Spondylitis Radiographic Index (BASRI) and modified Stokes Ankylosing Spondylitis Spine Score (mSASSS) by ethnicity, adjusting for covariates. Blacks had greater functional impairment (Bath Ankylosing Spondylitis Functional Index) (median 62.5 vs. 27.8 in Whites and 38.1 in Latinos; p<0.0001); higher disease activity (Bath Ankylosing Spondylitis Disease Activity Index), (median 5.9 vs. 3.5 in Whites and 4.5 in Latinos; p<0.0001), erythrocyte sedimentation rate (median 27.0 in Blacks vs. 10.0 in Whites and 17.0; p<0.0001), and C-reactive protein levels (median 1.2 vs. 0.4mg/dL in Whites and 0.9 in Latinos; p<0.0001). Baseline BASRI and mSASSS were higher in Blacks (mean 9.5 and median 38.2, respectively) compared to Whites (7.3 and 6.4) and Latinos (7.3 and 8.1), (p=0.004, 0.007), respectively, more significant as disease duration increased. HLA-B27 occurred in 62.5% of Blacks, 85.3% of Whites, and 86.7% of Latinos (p<0.0001). On multivariable analysis, higher BASRI and mSASSS were associated with Black ethnicity, after adjusting for disease duration and gender as well as TNF inhibitor (TNFi) usage, smoking status, or education level. Blacks with AS have more severe disease compared to either Whites or Latinos.

Preparing Graduates to Meet the Allied Health Workforce Needs in Rural Australia: Short-Term Outcomes from a Longitudinal Study

The future allied health workforce needs to be flexible to meet the needs of an ageing population with increasing chronic health care needs and geographically dispersed populations in many developed countries. Existing research shows the maldistribution of the Australian health workforce, with allied health professionals being poorly represented in rural and remote areas. This mixed-methods longitudinal workforce outcomes study is ongoing to determine the rural and remote allied health workforce outcomes from an immersive student placement program based in rural New South Wales, Australia. Outcomes, to date, show 52% of graduates working in a rural or remote area (RA2–RA5) after one year and 37.5% at three years post-graduation. Students from a rural or remote background were 2.35 times (95% CI 1.056–5.229) more likely to be located in a rural or remote workplace after one year than graduates from a metropolitan background. Graduates provided reasons for their plans to move from or stay in their current position. Four key themes emerged: Seeking new and different opportunities; Better income and job security; Personal change and lifestyle improvement and Level of job satisfaction. An existing program to develop the allied health workforce in rural Australia is demonstrating positive short-term outcomes. Ongoing monitoring of workforce outcomes is required to determine the long-term outcomes for rural and remote communities.

Longitudinal study of changing psychological outcomes following the Victorian Black Saturday bushfires.

To map the changing prevalence and predictors of psychological outcomes in affected communities 5 years following the Black Saturday bushfires in Victoria. Follow-up assessment of longitudinal cohort study in high, medium and non-affected communities in Victoria, Australia. Participants included 1017 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 and January 2013, and 735 (76.1%) eligible participants were retested between July and November 2014 (Wave 2). The survey included measures of fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive episode, alcohol use and severe distress. There were reduced rates of fire-related posttraumatic stress disorder (8.7% vs 12.1%), general posttraumatic stress disorder (14.7% vs 18.2%), major depressive episode (9.0% vs 10.9%) and serious mental illness (5.4% vs 7.8%). Rates of resilience increased over time (81.8% vs 77.1%), and problem alcohol use remained high across Wave 1 (22.1%) and Wave 2 (21.4%). The most robust predictor of later development of fire-related posttraumatic stress disorder (odds ratio: 2.11; 95% confidence interval: [1.22, 3.65]), general posttraumatic stress disorder (odds ratio: 3.15; 95% confidence interval: [1.98, 5.02]), major depressive episode (odds ratio: 2.86; 95% confidence interval: [1.74, 4.70]), serious mental illness (odds ratio: 2.67; 95% confidence interval: [0.57, 1.72]) or diminished resilience (odds ratio: 2.01; 95% confidence interval: [1.32, 3.05]) was extent of recent life stressors. Although rates of mental health problems diminished over time, they remained higher than national levels. Findings suggest that policy-makers need to recognize that the mental health consequences of disasters can persist for many years after the event and need to allocate resources towards those who are most at risk as a result of substantive losses and ongoing life stressors.

Obesity impedes functional improvement in youth with chronic pain: An initial investigation.

Youth with chronic pain are at higher risk for obesity than the general population. In youth with chronic pain, obesity exacerbates pain-specific activity limitations, and in adults with chronic pain, obesity perpetuates a cycle of disability. The current study examined whether weight status predicts functional disability outcomes over time in youth with chronic pain. Data were obtained from a retrospective chart review of patients who consented to participate in a longitudinal outcomes study. The Child Activity Limitations Questionnaire was used to assess functional disability at intake, 1-, and 3-month follow-up. Height and weight were measured at intake. A linear mixed model was used to test whether weight status and time predicted functional disability. Trend analysis with polynomial contrasts was used to test whether improvements in functional disability showed a linear trend over time. The linear mixed model analysis showed a main effect of weight, suggesting that youth with higher BMI demonstrated less improvement in functional disability over time. The trend analysis suggested that improvements in functional disability were consistent with a linear trend for both healthy weight and overweight participants, but not for obese participants. These findings demonstrate that obesity impedes improvement in functioning for youth with chronic pain. Despite multidisciplinary pain treatment, youth with comorbid chronic pain and obesity demonstrate greater functional disability at follow-up and little improvement over time. These results support the need for interventions specifically tailored to the unique challenges faced by youth with comorbid chronic pain and obesity. This study shows that obesity impedes improvement in functioning for youth with chronic pain. On the basis of these findings, interventions should be tailored to the unique challenges of this population.

Positive youth development practices and better outcomes for high risk youth

This paper reports on the findings from a New Zealand longitudinal study of outcomes for a group of high risk, service-using youth (13–21 years, n = 495). Consistent use of positive youth development practices (PYD) (rather than the total number of services used) predicted better outcomes. Patterns of risk and resilience endured over time. Individual risks undermined outcomes while resilience had a significant positive impact on outcomes. Contextual risks predicted increases in individual risks, but service delivery that adopted PYD practices contributed to reductions in levels of contextual risks over time. Youth with higher individual and contextual risks were less likely to report PYD service experiences. Individual risks were highest for indigenous youth (Māori) at entry to the study, levels which dropped significantly over time. White (Pākehā) youth had the lowest resilience and highest contextual risks over the course of the study. These differential patterns in risks and resilience indicate a need for services to adapt their responses to youth based on ethnicity and overall study findings confirm that when used consistently across service systems PYD-oriented service delivery produces better outcomes for high risk youth.

Epilepsy: Long-term outcomes in MRI-negative patients with epilepsy.

Patients with drug-resistant focal epilepsy who lack structural abnormalities on MRI constitute a challenge in presurgical work-up. A longitudinal single-centre study of long-term seizure outcomes in patients with nonlesional epilepsy showed that 59% of the cohort was free from disabling seizures 10 years after resective epilepsy surgery. These results are encouraging and valuable for patient counselling.

Individual Placement and Support in Spinal Cord Injury: A Longitudinal Observational Study of Employment Outcomes

ObjectiveTo determine the effects of a 24-month program of Individual Placement and Support (IPS) supported employment (SE) on employment outcomes for veterans with spinal cord injury (SCI). DesignLongitudinal, observational multisite study of a single-arm, nonrandomized cohort. SettingSCI centers in the Veterans Health Administration (n=7). ParticipantsVeterans with SCI (N=213) enrolled during an episode of either inpatient hospital care (24.4%) or outpatient care (75.6%). More than half the sample (59.2%) had a history of traumatic brain injury (TBI). InterventionIPS SE for 24 months. Main Outcome MeasureCompetitive employment. ResultsOver the 24-month period, 92 of 213 IPS participants obtained competitive jobs for an overall employment rate of 43.2%. For the subsample of participants without TBI enrolled as outpatients (n=69), 36 obtained competitive jobs for an overall employment rate of 52.2%. Overall, employed participants averaged 38.2±29.7 weeks of employment, with an average time to first employment of 348.3±220.0 days. Nearly 25% of first jobs occurred within 4 to 6 months of beginning the program. Similar employment characteristics were observed in the subsample without TBI history enrolled as outpatients. ConclusionsAlmost half of the veterans with SCI participating in the 24-month IPS program as part of their ongoing SCI care achieved competitive employment, consistent with their expressed preferences at the start of the study. Among a subsample of veterans without TBI history enrolled as outpatients, employment rates were >50%. Time to first employment was highly variable, but quite long in many instances. These findings support offering continued IPS services as part of ongoing SCI care to achieve positive employment outcomes.

Longitudinal Studies of Antisocial Outcome in Individuals with Childhood Attention Deficit Hyperactivity Disorder

Longitudinal Studies of Antisocial Outcome in Individuals with Childhood Attention Deficit Hyperactivity Disorder

Researching outcomes from forensic services for people with intellectual or developmental disabilities: a systematic review, evidence synthesis and expert and patient/carer consultation

BackgroundInpatient services for people with intellectual and other types of developmental disabilities (IDD) who also have forensic or risk issues are largely provided in secure hospitals. Although this is a health service sector with high levels of expenditure, there is limited empirical information on patient outcomes from such services. In order for a future substantive longitudinal outcomes study in forensic IDD services to be informed and feasible, more needs to be understood about the outcome domains that are of relevance and importance and how they should be measured. A preliminary series of studies was therefore undertaken.ObjectivesTo synthesise evidence in relation to the outcome domains that have been researched in the existing literature from hospital and community forensic services for people with IDD, within the broad domains of service effectiveness, patient safety and patient experience. To identify a definitive framework of outcome domains (and associated measures and indicators) based both on this research evidence and on the views of patients, carers and clinicians. To synthesise the information gathered in order to inform design of future multisite longitudinal research in the sector.DesignThree linked studies were conducted. Stage 1 was a systematic review and evidence synthesis of outcome domains and measures as found within the forensic IDD literature. Stage 2 was a consultation exercise with 15 patients with IDD and six carers. Stage 3 was a modified Delphi consensus exercise with 15 clinicians and experts using the information gathered at stages 1 and 2.ResultsAt stage 1, 60 studies that researched a range of outcomes in forensic IDD services were identified from the literature. This resulted in the construction of an initial framework of outcome domains. The consultation with patients and carers at stage 2 added to these framework domains that related particularly to carer experience and the level of support post discharge in the community. The Delphi process at stage 3 confirmed the validity of the resulting framework for clinician. This survey also identified the outcome measures preferred by clinicians and those that are currently utilised in services. Thus, indicators of appropriate measures in some important domains were identified, although there was a paucity of measures in other domains.ConclusionsTogether, these three linked studies led to the development of an evidence-based framework of key outcome domains and subdomains. A provisional list of associated measures and indicators was developed, although with the paucity of measures in some domains development of specific indicators may be required. With further refinement this could eventually be utilised by services and commissioners for comparative purposes, and in future empirical research on outcomes in forensic IDD services. An outline research proposal closely linked to recent policy initiatives was proposed. Limitations of the study include the relatively small number of carers and patients and range of experts consulted.Future workThis would comprise a national longitudinal study tracking IDD in patients through hospitalisation and discharge.Study registrationThis study is registered as PROSPERO CRD42015016941.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms.

This study examines the main and moderating effects of childhood abuse or neglect severity, income, and family social support on the presence of postpartum depressive symptoms (PDS). Participants included 183 postpartum mothers who endorsed a history of childhood maltreatment (CM) and enrolled in a longitudinal study of mother and child outcomes. Participants completed questionnaires to assess CM severity, associated societal and maternal characteristics, and depressive symptom severity. The results confirm previously identified links between CM severity and PDS. Further, hierarchical linear regression analyses indicate the interaction of household income and interpersonal support from the family attenuates the relationship between CM severity and PDS. The final model accounted for 29% of the variance of PDS scores, a large effect size. This study is the first to demonstrate interrelationships between income and social support on resilience to postpartum psychopathology in childhood trauma-surviving women. Social support appeared to protect against PDS for all mothers in this study while income only conferred a protective effect when accompanied by family support. For clinicians, this implies the need to focus on improving family and other relationships, especially for at-risk mothers.

Developmental Outcomes of Preterm Infants With Neonatal Hypoglycemia.

Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of developmental delays, although historical and recent studies show conflicting results. We compared the cognitive, academic, and behavioral outcomes of preterm infants with neonatal hypoglycemia with those of normoglycemic controls at 3 to 18 years of age. A secondary analysis of data from the Infant Health and Development Program, a national, multisite, randomized controlled longitudinal intervention study of long-term health and developmental outcomes in preterm infants. Of the 985 infants enrolled in the Infant Health and Development Program, 745 infants had glucose levels recorded. Infants were stratified into 4 groups by glucose level. By using standardized cognitive, academic, and behavioral assessments performed at 3, 8, and 18 years of age, we compared groups after adjusting for intervention status, birth weight, gestational age, sex, severity of neonatal course, race, maternal education, and maternal preconception weight. No significant differences were observed in cognitive or academic skills between the control and effected groups at any age. Participants with more severe neonatal hypoglycemia reported fewer problem behaviors at age 18 than those without hypoglycemia. No significant differences in intellectual or academic achievement were found between preterm infants with and without hypoglycemia. A statistical difference was found in behavior at age 18, with hypoglycemic children showing fewer problematic behaviors than normoglycemic children. This difference was not clinically meaningful. Using extended outcomes, our results are consistent with previous studies that found no significant neurodevelopmental outcomes associated with neonatal hypoglycemia in preterm-born children.

Longterm Beneficial Effect of Canakinumab in Colchicine-resistant Familial Mediterranean Fever.

To assess the efficacy and safety of the interleukin-1β (IL-1β) inhibitor canakinumab in all adolescent and adult patients with familial Mediterranean fever (FMF) identified from the Greek National Registry for off-label drug use between 2010 and 2015. In this retrospective longitudinal outcome study, clinical and laboratory data were collected from 14 patients (7 men) aged median 38.5 years (range 13-70), with median disease duration of 14 years, and active FMF despite colchicine (n = 9) or both colchicine and anakinra (n = 5). All patients continued to receive canakinumab at last visit (median of 18 mos, range 13-53), which was initially given as monotherapy (n = 8) or in combination with colchicine and/or corticosteroids, every 4 (n = 7), 6 (n = 2), or 8 weeks (n = 5). Eleven patients (79%), including 6 receiving monotherapy, achieved complete clinical remission within 2 months (median), while normalization of all laboratory variables denoting inflammation occurred in 92% at 3 months (median). The remaining 3 patients achieved partial responses. Responses were sustained in all but 4 patients, who relapsed. Reducing the canakinumab administration interval from 8 or 6 weeks to 4 weeks led to suppression of disease activity in the relapsing patients. On the other hand, drug administration interval could be safely increased in 2 patients in remission. Corticosteroid doses were significantly reduced during followup. Canakinumab was well tolerated; 1 patient experienced a urinary tract infection and another one a viral gastroenteritis. Treatment with canakinumab in an individualized dosing scheme results in rapid and sustained remission in colchicine-resistant FMF.

Intensive enhanced cognitive behavioural therapy for severe and enduring anorexia nervosa: A longitudinal outcome study

ObjectiveThis study aimed to evaluate short- and long-term outcomes in patients with severe and enduring anorexia nervosa (SE-AN), as compared with those with non SE-AN (NSE-AN), both treated via an inpatient programme based on a “recovery model” approach. MethodsSixty-six adult patients with anorexia nervosa (AN) were recruited from among consecutive referrals to a community-based eating disorder clinic offering inpatient enhanced cognitive behavioural therapy for eating disorders (CBT-E). Body mass index (BMI), and Eating Disorder Examination (EDE) and Brief Symptom Inventory (BSI) scores were recorded at admission, at the end of treatment, and at 6- and 12-month follow-ups. ResultsThirty-two patients (48.5%) were classified as SE-AN (i.e., duration of illness >7 years), and 34 (51.5%) as NSE-AN. During the treatment, both groups displayed similarly large increases in BMI, as well as improvements in eating-disorder and general psychopathology. After discharge minor deterioration did occur, but both NSE-AN and SE-AN groups showed similar rates of ‘good BMI outcome’ (BM ≥ 18.5; 44.0% and 40.7%, respectively) and ‘full response’ (BMI ≥ 18.5 and minimal eating-disorder psychopathology; 32.0% and 33.3%, respectively) at 12-month follow-up. ConclusionsThese findings suggest that inpatient CBT-E is well accepted by patients with AN, and could also be a viable and promising treatment for those with SE-AN.

The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients

BackgroundThe mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing. ObjectivesThe purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability. DesignThis exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury. SettingParticipants were recruited from the Emergency Department of an urban hospital in the United States. ParticipantsA cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded. MethodsPsychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury. ResultsAdjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p≤0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p≤0.05) bed days at 3, 6, and 12 months and work performance at 3 months. ConclusionsDepression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions.

A Review of Outcomes for Colorectal Adenomas.

Using data from former reports, this study reviews and analyzes the outcomes of tumor recurrence, tumor progression, and tumor-specific survival of patients with colorectal adenomas. Data were collected from 32 longitudinal studies of outcomes after the first diagnosis of colorectal adenoma and collected as individual patient results, that is, as failure times from the first tumor to the three outcomes. Altogether, there were 45,286 patients, including 22,148 for the outcome of additional adenomas, 23,796 for the outcome of progression to invasive carcinoma, and 2,602 for the outcome of disease-specific survival (some patients were available for more than one outcome). In these data, the mean time to additional adenomas was 6 years, the mean time to invasive carcinoma was 15.9 years, and the mean tumor-specific survival time was 21.9 years. Although greater than 50% of those with colorectal adenomas will have additional adenomas, few progress to invasive tumor or die of colorectal cancer.

Social networks and recovery (SONAR): characteristics of a longitudinal outcome study in five therapeutic communities in Australia

Purpose The purpose of this paper is to demonstrate how social identity change can support the TC objective of promoting “right living”. This is compatible with the literature on addiction recovery which has shown that identity change is central to this process. While much of the earlier literature focussed primarily on an individual analysis of change, there is a growing body of research showing the important contribution that social networks, social group membership and associated social identities make to sustainable change. Design/methodology/approach The paper describes baseline data for a multi-site prospective cohort study of 308 clients entering therapeutic community (TC) treatment and characterizes the presenting profile of this cohort on a range of social identity and recovery measures at the point of TC entry. Findings The sample was predominantly male with a mean age of 35 years, with the large majority having been unemployed in the month before admission. The most commonly reported primary substance was methamphetamine, followed by alcohol and heroin. The sample reported low rates of engagement in recovery groups, but access to and moderate degrees of social support was also reported in the period prior to admission. Research limitations/implications The paper highlights the important role that TCs play in facilitating identity change and in promoting sustainable recovery. Practical implications The paper discusses opportunities for working with social identities both during residence and in community re-integration, and highlights what TCs can do to support and sustain recovery. Social implications The paper brings to light the potential contribution of social group membership and social identity change to management of recovery in TC settings. Originality/value The study described provides an innovative way of assessing TC effectiveness and testing novel questions about the role of social identity and recovery capital as key predictors of change.