Pamela L. Ferguson

A population‐based study of risk of epilepsy after hospitalization for traumatic brain injury

Purpose:  This study was undertaken to determine the risk of developing posttraumatic epilepsy (PTE) within 3 years after discharge among a population‐based sample of older adolescents and adults hospitalized with traumatic brain injury (TBI) in South Carolina. It also identifies characteristics related to development of PTE within this population.

Prevalence of Traumatic Brain Injury in an Offender Population: A Meta-Analysis

Traumatic brain injury (TBI) can create challenges to managing offenders and to their successful community reentry upon release. In this study, the researchers reviewed relevant articles in Pubmed, PsycInfo, Medline, and EmBase (1983 to 2009) and communicated with other researchers to identify 20 epidemiologic studies that met preestablished inclusion criteria. Random-effects meta- and subgroup analyses were conducted to calculate the prevalence of TBI and the effects of gender, offender type, and definition and method of identifying TBI. The estimated prevalence of TBI in the overall offender population was 60.25 (95% confidence interval: 48.08 to 72.41). A truer estimate of TBI prevalence in offending populations could lead to more appropriate resource allocation, screening, and management of offenders.

Patterns of alcohol use 1 year after traumatic brain injury: A population-based, epidemiological study

This study delineated patterns of alcohol use 1 year after traumatic brain injury (TBI) in a large, population-based, epidemiological, nonclinical sample, and identified predictors of heavy alcohol use in these individuals. Participants were 1,606 adults identified by review of a South Carolina statewide hospital discharge data set, on the basis of satisfying the Centers for Disease Control case definition of TBI, and were interviewed by telephone 1 year after TBI-related discharge. Alcohol use in the month prior to interview was classified according to categories from the Quantity-Frequency-Variability Index; heavy drinking was defined as nearly daily use with > or = 5 drinks at least occasionally, or at least three occasions with > or = 5 drinks. A polychotomous logistic regression with 3 response levels (heavy, moderate, and abstinent/infrequent/light drinking) was used to identify predictors of heavy drinking. Heavy drinking in the month prior to interview was reported by 15.4% of participants, while 14.3% reported moderate drinking and 70.3% reported abstinence or light/infrequent drinking. Risk factors for heavy drinking included male gender, younger age, history of substance abuse prior to TBI, diagnosis of depression since TBI, fair/moderate mental health, and better physical functioning. There was no association between drinking patterns and TBI severity.

Risk of Posthospitalization Mortality Among Persons With Traumatic Brain Injury, South Carolina 1999-2001

Traumatic brain injury (TBI) negatively impacts long-term survival. However, little is known about the likelihood of death within the first year following hospital discharge. This study examined mortality among a representative sample of 3679 persons within 1 year of being discharged from any of 62 acute care hospitals in South Carolina following TBI and identified the factors associated with early death using a multivariable Cox proportional hazards model. The mortality experience of the cohort was also compared with that of the general population by using standardized mortality ratios for selected causes of death by age, adjusted for race and sex.

Low birth weight as a risk factor for hypertension

While the geographic and demographic disparities in the prevalence of hypertension have been recognized for decades, the reasons for these differences in disease risks remain unknown. The demographic and geographic patterns of hypertension are similar to those of low birth weight, giving support to the “Barker Hypothesis” which proposes a fetal origin of adult‐onset disease. In fact, ecologic and observational studies throughout the world have detected significant associations of low birth weight and increased risks of hypertension. Nonetheless, the mechanisms for the association have not been fully described and documented. With some supportive evidence, proposed mechanisms include reduced nephrogenesis with a higher threshold for pressure natriuresis and greater susceptibility to progressive renal disease, impaired development of the endothelium, and increased sensitivity to glucocorticoids. Still, considerable work needs to be done to explain the birth weight/blood pressure relationship. The findings to date and the clinical significance warrant continued research in this intriguing area of study.

Psychosocial factors associated with stigma in adults with epilepsy.

Living Well with Epilepsy II called for further attention to stigma and its impact on people with epilepsy. In response, the South Carolina Health Outcomes Project on Epilepsy (SC HOPE) is examining the relationship between socioeconomic status, epilepsy severity, health care utilization, and quality of life in persons diagnosed with epilepsy. The current analysis quantifies perceived stigma reported by adults with epilepsy in relation to demographic, seizure-related, health, and psychosocial factors. It was found that reported levels of stigma were associated with interactions of seizure worry and employment status, self-efficacy and social support, and quality care and age at seizure onset. This information may be used to target and develop evidence-based interventions for adults with epilepsy at high risk for perceived stigma, as well as to inform epilepsy research in self-management.

Pilot study of an integrated cognitive-behavioral and self-management intervention for youth with epilepsy and caregivers: Coping Openly and Personally with Epilepsy (COPE)

The aim of this study was to pilot test an intervention based on empirically supported cognitive-behavioral techniques and theory-driven self-management content. The Coping Openly and Personally with Epilepsy (COPE) Program focused on enhancing coping skills, self-efficacy, and self-management to promote resilience in youth with epilepsy and their caregivers. Nine youth aged 10-15 and a parent completed several self-report measures pre- and post-intervention. Results revealed that parents did rate significant improvements in their childrens coping skills following the COPE intervention. Further, compared with pre-assessment, children rated significant improvements in self-efficacy for seizure management. Child knowledge of epilepsy also significantly improved following the intervention. Two children reported mild suicidal ideation prior to the intervention, whereas no children reported ideation following the intervention. Results provide a foundation for further development of the COPE Program and suggest a randomized, controlled trial to examine the effectiveness of COPE for youth with epilepsy and their parents.

Prevalence of traumatic brain injury among prisoners in South Carolina

Objective:To determine lifetime prevalence of traumatic brain injury (TBI) in a statewide sample of prisoners. Design:Retrospective and cross-sectional cohort study. Participants:Stratified random sample of prisoners scheduled to be released by release type for each gender (275 men and 267 women with completed sentences and 19 men and 15 women granted parole) and a random sample of prisoners by gender with lifetime or death sentences (26 men and 34 women). Primary Measure:Weighted prevalence of TBI. In-person interviews ascertained history of TBI using a customized version of the Ohio State University TBI Identification Method. Results:Sixty-five percent of male releases and nonreleases, and 72% and 73% of female releases and nonreleases, reported at least 1 TBI with an alteration of consciousness. Forty-two percent of male releases and 50% of nonreleases, and 50% of female releases and 33% of nonreleases, reported at least 1 TBI with loss of consciousness. Thirty-five percent of male releases and 42% of nonreleases, and 55% of female releases and 58% of nonreleases, reported ongoing symptoms from TBI. Conclusions:A substantial proportion of prisoners reported having experienced a TBI during their lifetime. The ongoing TBI symptoms reported by prisoners may impact their success on release.

Prevalence of self-reported epilepsy, health care access, and health behaviors among adults in South Carolina

Behavioral Risk Factor Surveillance System data from South Carolina for 2003-2005 were used to determine epilepsy prevalence and prevalence variation by demographic subgroups, and to compare health insurance coverage, health care visits, and health-related behaviors among persons with epilepsy and the general population. Two percent of respondents reported they had ever been told by a doctor that they had epilepsy, and 1% reported active epilepsy. Almost half of those with active epilepsy reported a seizure in the prior 3 months. More than one-third of respondents with active epilepsy reported that there was a time in the past 12 months when they needed to see a doctor but could not because of cost. Persons with epilepsy were more likely to smoke and have less physical activity. Persons with epilepsy need better access to health care, as well as interventions focused on smoking cessation and increased physical activity.

A Hopelessness Model of Depressive Symptoms in Youth with Epilepsy

OBJECTIVE To test the cognitive diathesis-stress and mediational components of the theory of learned hopelessness in youth with epilepsy. METHODS Seventy-seven participants ages 9-17 (35 girls, 42 boys) completed measures of depressive symptoms, hopelessness, self-efficacy for seizure management, and attitude toward epilepsy. Caregivers provided information on seizure activity. Diagnostic and treatment information was obtained via medical record review. RESULTS Regression analyses revealed that hopelessness mediated the attitude towards epilepsy-depressive symptom relationship. While attitude toward epilepsy and self-efficacy were independent predictors of depressive symptoms, the relationship of attitudes toward epilepsy and depressive symptoms was not enhanced with low self-efficacy for seizure management. CONCLUSIONS Findings support the mediation component of the learned hopelessness theory in youth with epilepsy, suggesting the importance of interventions that assist youth in identifying epilepsy-related aspects of functioning over which they can realistically exercise control and challenging negative thoughts about situations they cannot control.