abstract: According to sources of the Centers for Disease Control and Prevention, approximately 1.7 million traumatic brain injury (TBI) cases occur annually in the United States. TBI results in 50 thousand deaths, nearly 300 thousand hospitalizations and 2.2 million emergency room visits causing a $76 billion economic burden in direct and indirect costs. Furthermore, it is estimated that over 5 million TBI survivors in the US are struggling with long-term disabilities. And yet, a point-of-care TBI diagnostic has not replaced the non-quantitative cognitive and physiological methods used today. Presently, pupil dilation and the Glasgow Coma Scale (GCS) are clinically used to diagnose TBI. However, GSC presents difficulties in detecting subtle patient changes, oftentimes leaving mild TBI undiagnosed. Given the long-term deficits associated with TBIs, a quantitative method that enables capturing of subtle and changing TBI pathologies is of great interest to the field. The goal of this research is to work towards a test strip and meter point-of-care technology (similar to the glucose meter) that will quantify several TBI biomarkers in a drop of whole blood simultaneously. It is generally understood that measuring only one blood biomarker may not accurately diagnose TBI, thus this work lays the foundation to develop a multi-analyte approach to detect four promising TBI biomarkers: glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE), S-100β protein, and tumor necrosis factor-α (TNF-α). To achieve this, each biomarker was individually assessed and modeled using sensitive and label-free electrochemical impedance techniques first in purified, then in blood solutions using standard electrochemical electrodes. Next, the biomarkers were individually characterized using novel mesoporous carbon electrode materials to facilitate detection in blood solutions and compared to the commercial standard Nafion coating. Finally, the feasibility of measuring these biomarkers in the same sample simultaneously was explored in purified and blood solutions. This work shows that a handheld TBI blood diagnostic is feasible if the electronics can be miniaturized and large quantity production of these sensors can be achieved. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2017

abstract: Military veterans have a significantly higher incidence of mild traumatic brain injury (mTBI), depression, and Post-traumatic stress disorder (PTSD) compared to civilians. Military veterans also represent a rapidly growing subgroup of college students, due in part to the robust and financially incentivizing educational benefits under the Post-9/11 GI Bill. The overlapping cognitively impacting symptoms of service-related conditions combined with the underreporting of mTBI and psychiatric-related conditions, make accurate assessment of cognitive performance in military veterans challenging. Recent research findings provide conflicting information on cognitive performance patterns in military veterans. The purpose of this study was to determine whether service-related conditions and self-assessments predict performance on complex working memory and executive function tasks for military veteran college students. Sixty-one military veteran college students attending classes at Arizona State University campuses completed clinical neuropsychological tasks and experimental working memory and executive function tasks. The results revealed that a history of mTBI significantly predicted poorer performance in the areas of verbal working memory and decision-making. Depression significantly predicted poorer performance in executive function related to serial updating. In contrast, the commonly used clinical neuropsychological tasks were not sensitive service-related conditions including mTBI, PTSD, and depression. The differing performance patterns observed between the clinical tasks and the more complex experimental tasks support that researchers and clinicians should use tests that sufficiently tax verbal working memory and executive function when evaluating the subtle, higher-order cognitive deficits associated with mTBI and depression. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2017

O trauma crânio-encefálico contuso (TCEC) é freqüentemente seguido por um período de amnésia pós-traumática (APT), importante indicador da gravidade desse tipo de trauma e subsídio nas decisões sobre a reabilitação dessas vítimas. Considerando as diversas dificuldades que têm sido apontadas na literatura para estabelecer a duração da APT e algumas lacunas no conhecimento dessa síndrome, este estudo teve como objetivos: identificar os fatores relacionados à APT de longa duração (> 24 horas) entre as características apresentadas pelas vítimas de TCEC na fase aguda do trauma, comparar a qualidade de vida das vítimas que apresentaram APT de longa duração, com as demais e analisar a relação entre qualidade de vida e duração da APT, computando ou não o período de coma. Foi realizado um estudo prospectivo longitudinal, com abordagem quantitativa, descritiva correlacional, utilizando dados tanto da fase aguda de tratamento (internação hospitalar pós-trauma), como também da avaliação de qualidade de vida realizada entre três e seis meses após o evento traumático. Foram alvo desta investigação 187 vítimas de TCEC, com idade superior a 14 anos, sem diagnóstico anterior de demência ou TCEC, atendidas em Pronto-Socorro de hospital de referência para atendimento de trauma na cidade de São Paulo, nas primeiras 12 horas após evento traumático e internadas nesse hospital entre dezembro de 2006 e outubro de 2007. As variáveis independentes analisadas para identificar fatores associados a longo tempo de APT foram idade, sexo, gravidade do trauma crânio-encefálico, local e tipo de lesão, número de lesões encefálicas diagnosticadas e uso de medicação com atividade em sistema nervoso central ou corticóides. A maioria da casuística era sexo masculino (86,2%), vítimas de acidentes de trânsito (58,3%), com indicação de TCEC leve pela ECGl (61,5%). A média da idade foi 38 anos (± 16,81), da duração de APT foi 7,8 dias (±12,2), incluindo o tempo de coma e 5,0 dias (±6,7), sem incluir esse período. Os fatores associados a APT de longa duração, identificados em modelo de regressão logística ajustado pela variável área de lesão (intra/extra axial), foram: ECGl inicial <= 12 (OR= 20,17) MAIS/cabeça >=3 (OR= 2,80) e uso de Fenitína (OR= 2,60), Midazolan (OR=2,83) ou ambas as drogas (OR= 3,83). Quando comparada à qualidade de vida entre as vítimas que apresentaram APT de longa e curta duração, observou-se diferença significativa entre os grupos nos domínios Capacidade Funcional, Limitação para Atividades Físicas e Atividade Social da SF-36 Health Survey (SF-36). O grupo com APT de longa duração apresentou resultados mais desfavoráveis do que o de curta nesses três domínios. As análises de correlação entre domínios da SF-36 e duração da APT considerando ou não o tempo de coma indicaram que a medida do tempo de APT deve excluir o período coma, tendo em vista que as correlações foram mais expressivas quando essa forma de medida da APT foi utilizada / The closed traumatic brain injury (CTBI) is usually followed by a post-traumatic amnesia (PTA) period, important indicative of gravity to this kind of trauma and used to decisions for rehabilitation of the victims. Considering difficulties to establish the permanence of PTA in the available literature, as well as lack of knowledge of this Sindrome, this study had as main objectives: identify main points related to PTA of long term (> 24 hours) for CTBI victims during the hard period of trauma, compare victims\' quality of life for those who presented long term with those who doesn´t, and analysis the relationship between quality of life and PTA period, being the patients or not, in coma period. This is a quantitative study that was made using prospective, longitudinal and correlational approach, using data from both main intense phase of the treatment (pos trauma hospitalization) and quality of life valuation considered 3 to 6 months after the traumatic event. It was aim of this research 187 CTBI victims, with their age superior of 14 years old, with no demency diagnosis before the event or TBI, all attended by the emergency of a Refence hospital for trauma patients in São Paulo city, in their first 12 hours after the trauma and interned in this same hospital in the period of December 2006 and October 2007. The independent variables analysed to identify association points for the long term PTA was age, sex, brain encephalic trauma gravity, local and lesion kind, number of encephalic lesion diangosticated and medicament with action in the central neurologic system used or corticoids. The main patients were male (86.2%), victims from traffic accidents (58.3%), with indication of mild CTBI by GCS (61.5%). Age media of 38 years old (± 16.81), PTA period was 7.8 days (±12.2), including coma period and 5.0 days (±6.7), without including this period. Points associated with long term PTA, identified by logistic regression model adjusted by the variable of the lesion area (intra/extra axial), was: GCS initial <= 12 (OR= 20.17) AIS/head >=3 (OR= 2.80) and use of Fenitoin (OR= 2.60), Midazolan (OR=2.83) or both drugs (OR= 3.83). When compared to quality of life of the victims that presented PTA long and short term, it is seen significant difference in the groups observing domain, functional capacity, limitation for physical and social activities from the SF-36 Health Survey (SF-36). The group with long term PTA has presented worst results than the short term in these three domains. The related analysis made between domain of SF-36 and PTA time (duration) considering or not coma period of time has indicated that the measure of time from PTA must exclude coma period, as well as the studies and correlations were much more expressive when this measure of PTA was used

Orientador: Plinio Almeida Barbosa / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-10T11:46:05Z (GMT). No. of bitstreams: 1 Vieira_JussaraMelo_D.pdf: 3447938 bytes, checksum: baa53bcff3e3572313562da26d96e687 (MD5) Previous issue date: 2007 / Resumo: A disartria é uma desordem da fala decorrente de comprometimentos neuromusculares. Tais comprometimentos podem causar alterações na respiração, na fonação, na ressonância e na articulação da fala. Estes comprometimentos podem ser decorrentes de traumatismo craniano (TC). O TC é uma agressão cerebral resultante de uma pancada na cabeça e/ou uma queda com fratura craniana. Na fala disártrica pode haver, também, falha no mecanismo velofaríngeo devido à paralisia/paresia do palato mole. Neste caso, o resultado acústico para a fala é a hipernasalidade e a emissão de ar nasal, que podem ser tratadas através do uso de uma prótese de palato elevadora (PPE). Na disartria, o ritmo da fala também pode estar alterado, implicando alterações nos locais de acento frasal (AF), na inserção e na duração das pausas silenciosas (PS). Sendo assim, interessou-nos investigar a estruturação rítmica da fala disártrica decorrente de TC. Para tanto, obtivemos a colaboração de uma falante disártrica, usuária de PPE, falante nativa do português brasileiro (PB) acometida por TC. O estudo desta fala isártrica teve como objetivos: comparar as condições de uso e não uso da PPE; comparar a estruturação rítmica da fala disártrica brasileira (FDB) com uma fala sem comprometimentos (FSC); comparar a estruturação rítmica da FDB com uma fala isártrica francesa (FDF); estudar a relação sintaxeprosódia na estruturação rítmica da fala tanto na comparação com a FSC quanto na comparação com a FDF; adquirir melhor entendimento da fala disártrica pós TC, considerando o modelo de ritmo da fala para o PB de Barbosa (2006). Para cumprir estes objetivos, acompanhamos o tratamento com PPE da falante disártrica de 1995 a 2005. Neste período coletamos e analisamos oito leituras de um mesmo texto realizadas por ela usando a PPE e duas leituras sem esta prótese: uma em 1995 e outra em 2005. A FSC correspondeu à leitura do mesmo texto da FDB. A FDF correspondeu à leitura de outro texto francês. Nestas leituras realizamos análises acústicas e de sua organização rítmica em unidades vogal-vogal (VV), grupos acentuais (GA), AF e PS. Nas análises das oito leituras da FDB houve redução no número de PS, redução da participação das PS na duração do texto lido e aumento da taxa de elocução (TE). A estruturação rítmica da FDB com e sem a prótese foi a mesma. Houve diferença significante entre a FDB e a FSC para a TE e para a duração das PS, mas não para a duração dos GA nem para o número de unidades VV. Na comparação entre a FDB e a FDF não houve diferenças significativas quanto à TE, taxa de articulação e número de unidades VV por GA. Na relação sintaxe-prosódia, as marcas sintáticas IDF (independência forte) e COORD (independência de uma conjunção coordenada) foram significativas tanto para a FDB quanto para a FSC. Mas não para a FDF. Nosso trabalho contribuiu para destacar a pertinência de estudos que considerem a relação dinâmica entre fatores biomecânicos e lingüísticos da fala, notadamente para a fala comprometida e, em especial, para a fala disártrica pós TC / Abstract: Dysarthria is a speech disorder caused by neuromotors problems. These neuromotors problems may cause breath, phonation, resonance and speech articulation disturbance. The cause of these neuromotors problems can be the traumatic brain injury (TBI). TBI is a lesion that result of cerebral aggression, a collision in the head/or a fall happening cranial breaking. Dysarthric speech can have too velopharyngeal dysfunction by total/partial paralysis soft palate. In case of soft palate palsy the hypernasality may be present, with emission of nasal air during oral sounds. In order to deal with hypernasality and nasal air emission a palatal lift (PL) is indicated. The use of PL stimulates the correct movement of the soft palate, which produces the appropriate closure of the velopharyngeal port. Rhythm speech can be altered in dysarthric speech. We realize then a study of the rhythmic structure of the dysarthric speech by TBI. For doing so, eight dysarthric speaker?s readings during prosthesis treatment with the palatal lift, are compared with readings without prosthesis, with a reference speaker and a French dysarthric speaker. These comparisons are done by analyzing vowel-to-vowel units (VV), stress groups, phrase stress and silent pauses under the theoretical framework of Barbosa (2006)?s speech rhythm model applied to Brazilian Portuguese. In the eight readings of the Brazilian dysarthric speaker, there were reductions on the number of silent pauses and pause occurrence. An increase of speech rate was also observed. The results showed that there is no distinction in rhythmic structure with and without prosthesis. The comparative analysis between the Brazilian dysarthric speaker and the reference speaker showed significant differences in speech rate and silent pause duration, but no significant difference in the duration of stress groups or in the number of VV units. The comparative analysis between the Brazilian dysarthric speaker and the French dysarthric speaker showed no significant differences in speech rate, articulation rate and number of VV units inside stress groups. As regards the syntax-prosody interface, the syntactic markers IDF (strong independency) and COORD (coordinated conjunction independency) were significant for both the Brazilian dysarthric and the reference speaker. However, these markers were not significant for the French dysarthric speaker. This work reinforces the importance of considering both linguistics and biomechanics aspects on the analysis of dysarthric speech / Doutorado / Doutor em Linguística

In Brazil and in the world, the trauma constitutes a serious public health problem, not only by magnitude but also hitting productive young people. The perception of quality of life may reflect the level of satisfaction, social integration, well-being of victims of head brain trauma and remains a challenge for public health policies. It is a research study, a descriptive cross-sectional and quantitative approach, whose aim was to evaluate the quality of life of victims of head brain injury by the World Health Organization Quality of Life (WHOQOL) Bref. Data were collected at a Center of Medical Specialties and a public reference hospital in trauma of Sergipe, by the months of December 2009 to March 2010. We interviewed 47 victims of head brain trauma treated during the period January 2008 to December 2009. The results showed that trauma victims had a mean age of 29 years, most were male (91.5%), single (51.1%), from capital (74.5%), schooling <8 years (57.4%), with activity (70.2%). The trauma mechanism was traffic accident (61.7%), with reports of alcohol consumption (59.6%), who suffered cerebral contusion (n = 25), there are 10.5 months and stayed in hospital for 13, 5 days (median). After trauma, most victims report headache (n = 33) did not alter the marital status (87.2%) and resumed the occupation after the previous event (68.1%). The victims reported satisfaction with the quality of life (65.9%) and health (66%). The psychological domain had the highest average score in (68.4) and highest correlation was found between the physical domains and social relationships (0.903). The victims who returned to productive activity, higher mean score in the domain of social relations (79.9). / No Brasil e no mundo, o trauma se constitui-se em um grave problema de saúde pública, não só pela sua magnitude como também por atingir jovens em idade produtiva. A percepção da qualidade de vida pode refletir no nível de satisfação, reintegração social, bem-estar das vítimas de trauma cranioencefálico e permanece como um desafio às políticas públicas de saúde. Está pesquisa é um estudo trata-se de um estudo descritivo, de corte transversal e com abordagem quantitativa, cujo objetivo foi avaliar a qualidade de vida das vítimas de trauma cranioencefálico por meio do World Health Organization Quality of Life (WHOQOL) Bref. Os dados foram coletados em um Centro de Especialidades Médicas e em um hospital público referência em trauma de Sergipe, durante os meses de dezembro de 2009 a março de 2010. Foram entrevistadas 47 vítimas de trauma cranioencefálico atendidas no período de janeiro de 2008 a dezembro de 2009. Os resultados evidenciaram que as vítimas de trauma tinham idade média de 29 anos, a maioria do gênero masculino (91,5%), solteiras (51,1%), oriundas da capital (74,5%), com escolaridade < 8 anos (57,4%), com atividade remunerada (70,2%). O mecanismo do trauma foi o acidente de transporte (61,7%), com relato de ingesta alcoólica (59,6%), que sofreram contusão cerebral (n=25), há 10,5 meses e permaneceram no hospital durante 13,5 dias (mediana). Após o trauma, a maioria das vítimas apresentou cefaleia (n=33), não alterou a situação conjugal (87,2%) e retomou a ocupação anterior após o evento (68,1%). As vítimas informaram satisfação com a qualidade de vida (65,9%) e sua saúde (66%). O domínio psicológico apresentou a maior média no escore (68,4) e a correlação mais alta foi verificada entre os domínios físicos e as relações sociais (0,903). As vítimas que retornaram à atividade produtiva, apresentaram maior média no escore do domínio das relações sociais (79,9).

Orientador: Yvens Barbosa Fernandes, Sebastião Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T19:37:05Z (GMT). No. of bitstreams: 1 Pasini_RenataLenize_M.pdf: 1921410 bytes, checksum: 17bcb0d3a217f0284da26d92e3b8a5da (MD5) Previous issue date: 2007 / Resumo: A traqueostomia é um procedimento comumente realizado em pacientes dependentes da ventilação mecânica (VM), internados em Unidade de Terapia Intensiva (UTI). Alguns autores acreditam que a realização precoce desse procedimento em tais pacientes diminui o tempo de dependência do aparelho ventilatório, bem como apresenta outros benefícios associados. Entretanto, o período mais adequado para a realização do procedimento ainda não se encontra bem estabelecido para pacientes com traumatismo craniencefálico (TCE), o que justificou a realização do presente estudo, cujo objetivo foi avaliar a influência da traqueostomia no tempo de ventilação mecânica e tempo de internação hospitalar de pacientes com TCE. Foi realizado um estudo prospectivo e não intervencionista, em que foram avaliados 33 pacientes com TCE de moderado a grave, cuja pontuação na escala de coma de Glasgow (ECG) foi = 10, com idade entre 14 e 80 anos e necessidade de traqueostomia. Os pacientes foram distribuídos em três grupos determinados a partir do momento da realização da traqueostomia: traqueostomia precoce (TP), realizada até o 6º dia de VM; traqueostomia intermediária (TI), realizada entre o 7° e 11° dias de VM; e a traqueostomia tardia (TT), realizada após o 12° dia de VM. Dos 33 pacientes avaliados, 28 eram do sexo masculino, com idade média de 30,7 ± 14,0 anos para a TP; 39,0 ± 18,4 anos para a TI e 37,7 ± 18,4 anos para a TT. No grupo submetido à traqueostomia precoce houve redução do tempo de ventilação mecânica e tendência a uma diminuição do tempo de internação hospitalar. O momento de realização da traqueostomia não influenciou na incidência de infecção pulmonar e mortalidade / Abstract: Tracheostomy has been performed frequently in ventilator-dependent patients in intensive care unit (ICU). Some authors believe that early tracheostomy can reduce mechanical ventilation (MV) time and can provide other associated benefits. However, its influence on weaning from MV is not clear in pacients with traumatic brain injury (TBI). The aim of this study was to evaluate the influence of tracheostomy on MV weaning in TBI patients. It was a prospective and non interventional study; including 33 patients with TBI (GCS < 10), aging between 14 and 80 years and that were submitted to a tracheostomy. The patients had been distributed into three groups: early tracheostomy (ET) (performed until 6th day of MV); intermediate tracheostomy (IT) (performed from the 7th to 11th day of MV) and late tracheostomy (LT) (performed after the 12th day of MV). Of the 33 evaluated patients, 28 were male and 5 female, aging 30.7 ± 14.0 years in ET group; 39.0 ± 18.4 years in IT group; and 37.7 ± 18.4 years in LT group. In the ET group, those patients with lower GCS and higher APACHE II at admission have shown a lesser hospital length of stay (HLOS); the IT group has shown a lesser HLOS in younger individuals and with lower APACHE II values. Regarding total MV time (orotracheal tube + tracheostomy), ET group has shown a lesser average time in relation to the other groups. However weaning times with tracheostomy alone were not different between groups. Also, pulmonary infection incidences have not been different between groups. Early tracheostomy can reduce total MV time and HLOS in patients with severe TBI, but it appears to have no influence on weaning time, incidence of pulmonary infection and mortality / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

Orientadores: Maria Valeriana Leme de Moura-Ribeiro, Silvia Maria Ciasca / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T12:07:58Z (GMT). No. of bitstreams: 1 Riechi_TatianaIzabeleJarorskideSa_D.pdf: 7337748 bytes, checksum: 0efb01b99750b80257e9ddb8bcd6d435 (MD5) Previous issue date: 2008 / Resumo: O objetivo deste estudo foi avaliar o impacto do nascimento pré-termo e com baixo peso (PT-BPN) no neurodesenvolvimento, na formação das funções mentais superiores e conseqüentemente na aprendizagem acadêmica, de crianças e adolescentes em idade escolar. A intensificação dos cuidados pré e peri natais e a evolução técnico-profissional das Unidades de Terapia Intensiva Neonatal melhorou as condições de sobrevivência dos bebês PT-BPN, gerando o aumento progressivo das taxas de sobrevivência neonatal e com elas, novas expectativas quanto às morbidades resultantes ao longo da infância, juventude e até, a fase adulta. Questões relativas a quais alterações longitudinais, cognitivo-comportamentais, poderiam ser assinaladas como possíveis efeitos da interrupção abrupta e precoce do processo gestacional. Mediante a vulnerabilidade do Sistema Nervoso Central (SNC), alterações estruturais e funcionais podem ocorrer, gerando circuitos cerebrais alternativos e/ou compensatórios, que resultam em Transtornos do Desenvolvimento como, o Distúrbio de Aprendizagem. Foi desenvolvido um estudo transversal caso controle em 120 escolares com idades entre 06 anos e 15 anos e 11 meses, regularmente matriculados no Ensino Fundamental e pareados sócio-economicamente. Todos foram submetidos ao protocolo de Avaliação Neuropsicológica, Neurológica e Escolar. O Grupo Propósito (GP) foi formado por 60 escolares nascidos no CAISM-FCM/UNICAMP com idade gestacional < 37 semanas e peso < 2.500 g. O Grupo Controle (GC) foi composto de 24 escolares irmãos dos sujeitos GP e, 36 escolares vizinhos colegas dos sujeitos GP, ambos nascidos com peso = 2.500g e idade gestacional = 37 semanas. Entre os instrumentos utilizados estão: WISC III, Teste Guestáltico Visomotor Bender, Trail Making Test, Figura Complexa de Rey, Teste Neuropsicológico Luria Nebraska-C, Escala Comportamental A2 de Rutter, Lista de Verificação Comportamental para Crianças e Adolescentes (CBCL) e Teste de Desempenho Escolar. Foram encontradas diferenças estatisticamente significativas entre GP e GC, com resultados inferiores para GP indicando comprometimento de: Coordenação Viso-Motora (86,7%), Desenvolvimento Psicomotor Geral (75,0%), Habilidade Viso-Construtiva (73,3%), Raciocínio Matemático (66,1%), Habilidade Tátil-Cinestésica (65,0%) e Memória Visual (60,0%), todos com p-valor=0,001. O QI dos sujeitos do GP mostrou-se na média, em geral, 10 pontos abaixo do GC. Observou-se prevalência no GP de: Distúrbios de Aprendizagem (33,3%), Dificuldade Escolar (35,0%), Lateralidade Cruzada (46,6%) e problemas Psicológicos e/ou Psiquiátricos (61,7%). Os escolares brasileiros PT-BPN desta pesquisa apresentaram alterações funcionais cerebrais específicas, associadas a transtornos cognitivo-comportamentais e de aprendizagem, mais expressivos do que os sujeitos do GC e também dos resultados descritos na literatura internacional / Abstract: The objective of this study was to evaluate the impact of preterm birth and low birth weight (PT-LBW) on neurodevelopment, on the formation of high mental functions, and, consequently, on the academic learning of school-age children and teenagers. The intensification of pre- and peri-natal cares and the technical-professional evolution of Newborn Intensive Care Units have improved the survival conditions of PT-LBW babies, therefore generating a progressive increase of newborn survival rates and, with that, new expectations regarding the resultant morbidities through childhood, youth and even the adult phase. Issues regarding which longitudinal, cognitive-behavioral alteration could be branded as possible effects of the abrupt and premature interruption of the gestational process. Through the vulnerability of the Central Nervous System (CNS), structural and functional alterations might occur, generating alternative and/or compensational brain circuits, which result on Development Derangements such as the Learning Disorder. A cross-sectional case-control study was conducted on 120 school-age children with ages between 06 years-old and 15 years-old and 11 months, regularly enrolled at Elementary Schools and socio-economically paired. All were submitted to the Neuropsychological, Neurological and Academic Assessment protocol. The Purpose Group (PG) was formed by 60 school-age children born at the CAISM-FCM/UNICAMP having gestational ages lower than 37 weeks and birth weight lower than 2,500 g. The Control Group (CG) was composed by 24 school-age children siblings of the PG subjects and 36 school-age children neighbors and colleagues of the PG subjects, all born with weights higher or equal 2,500 g and gestational ages higher or equal 37 weeks. Among the research instruments used we find: WISC III, Bender Visual-Motor Gestalt Test, Trail Making Test, Rey Complex Figure, Luria Nebraska-C Neuropsychological Test, Rutter¿s Behavioral Scale A2, the Child Behavior Checklist (CBCL) and Test of School Performance. Statistically significant differences were found between PG and CG, PG having lower results that indicate impairments of: Visual-Motor Coordination (86,7%), General Psychomotor Development (75,0%), Visual-Constructive Skill (73,3%), Mathematical Thinking (66,1%), Tactile-Kinesthetic Skill (65,0%) and Visual Memory (60,0%), all with a p-value = 0,001. The IQ of the PG subjects was, generally, in an average of 10 points lower than CG¿s. On the PG the prevalence of the following was observed: Learning Disorders (33,3%), School Learning Problem (35,0%), Crossed Laterality (46,6%) and Psychological and/or Psychiatric Problems (61,7%). The Brazilian PT-LBW school-age subjects of this research displayed specific brain functional alterations, associated to cognitive-behavioral and learning disorders, which are more outstanding than those of the CG subjects, and also than results described on international literature about the matter / Doutorado / Neurologia / Doutor em Ciências Médicas

The present study is a cross-validation of the Validity-10 embedded symptom validity indicator from the Neurobehavioral Symptom Inventory (NSI) for the detection of questionable response validity during evaluation for mild traumatic brain injury (TBI). The sample and data derived from a three-site Veterans Affairs (VA) parent study to validate the TBI Clinical Reminder, a routine set of questions asked of all recently returned veterans at VA facilities to screen for history of TBI. In the parent study, veterans recently returned from Iraq and Afghanistan underwent an evaluation for TBI with a physician and completed an assessment battery including neuropsychological tests of cognitive performance and indicators of symptom and performance validity, psychiatric assessment measures, a structured interview for post-traumatic stress disorder (PTSD), and various behavioral health questionnaires. The present study estimated the test operating characteristics of Validity-10, using NSI results gathered during the physician evaluation to compute Validity-10 scores, and using results on several other measures of symptom and performance validity from the assessment battery as criteria for questionable response validity. Only individuals who had positive screen results for TBI on the TBI Clinical Reminder prior to full evaluation were included in the present sample. Sensitivity of Validity-10 to questionable validity was moderately high (.60 - .70) to excellent (.90 - 1.00) at high levels of specificity (> .80). Effects of different base rates of and different criteria for questionable validity on the utility of Validity-10 were explored as well. Chi-square analyses to determine the effect of PTSD symptoms on the utility of Validity-10 demonstrated overall classification accuracy in general, and false positive rate in particular, were relatively poorer when used with individuals who reported significant PTSD symptoms. Overall, these findings support the use of Validity-10 (at cut score Validity-10 ≥ 19) to identify those veterans being evaluation for mild TBI in the VA system who should be referred for comprehensive secondary evaluation by a clinical neuropsychologist using multiple forms of symptom and performance validity testing. Further studies of the effects of PTSD symptoms on the accuracy of Validity-10 for this purpose are recommended.

Abstract Traumatic brain injury (TBI) is often the leading cause of death and the most common cause of permanent disability in children and young adults. The hospital admission rates as well as the incidence and mortality rates of TBI vary enormously in different countries and populations. Even though alcohol misuse is a well-known modifiable risk factor for TBI and other injuries, few studies have been carried out on drinking patterns in relation to TBI, alcohol's role in recurrent brain injuries as well as TBI in relation to alcohol use in children and adolescents. The Northern Finland 1966 Birth Cohort was used to study the epidemiology and recurrence of TBI as well as alcohol use by children with TBI by the age of 14 years and those who sustained TBI later in life. The role of parents' alcohol misuse on children's TBI was also studied. The incidence of TBI in the whole study population was 118/100 000 person-years (PY), and the pediatric incidence of TBI (children aged under 16 years) was 130/100 000 PY. Up to the age of 10 years, the occurrence of TBI did not differ by gender, but after that age, boys and men had a higher incidence compared to girls and women. Mortality from TBI in the whole study population was 14/100 000 PY. Parental alcohol misuse and male gender were significant risk factors for the occurrence of TBI in childhood. Drinking to intoxication at the age of 14 years was a more common habit of TBI subjects than controls, especially among girls. Frequent alcohol drinking and drunkenness reported at the age of 14 years as well as male gender were independent predictors of TBI later in life. An alcohol-related first TBI and urban place of birth were found to be significant risk factors for recurrent TBI. A significant positive correlation between first and recurrent TBIs with respect to alcohol involvement was observed. Alcohol drinking and parental alcohol misuse should be recognized among children and adolescents with acute TBI. Because alcohol drinking predicts the recurrence of TBI, a brief intervention focused on drinking habits is needed as an immediate preventive measure.

Concussion is an injury that disproportionately affects children and adolescents and has the potential to negatively impact school performance. Currently, a significant proportion of youth with concussion go unreported due to a lack of effective concussion surveillance procedures. Additionally, many individuals who have daily contact with youth (e.g., parents, teachers) lack training in how to assess or manage a concussion. Schools may be the ideal setting to address both of these problems as they have a high level of access to students and employ personnel (e.g., school psychologists, nurses, social workers, counselors) with experience in assessment and intervention. What is not known is how to best design a school-based concussion management (SBCM) procedure in order to facilitate concussion surveillance and management. Accordingly, the overall purpose of this study was to identify and describe factors (i.e., provider implementation characteristics, concussion referral communication) which may inform the design and implementation of SBCM programming. Examining the relationship between relevant SBCM outcomes and factors associated with strong school programming may help build the foundation for future SBCM procedures. Factors that influence program fidelity and outcomes are called school programming implementation characteristics and they reside at multiple levels (i.e., community, school, climate, program, provider) and are positively related to successful outcomes across varied programming. This exploratory study which utilized secondary analysis of existing data focused on the provider level with the primary aim of identifying and describing student services personnel (SSP; n = 144) implementation characteristics. Indicators of provider implementation characteristics consisted of their beliefs, training, and experiences in order to quantify how these characteristics predict perceptions of the impact of concussion on academics, perception of current informal procedures, and the number of students with concussions served. The independent variables primarily under investigation in this study (role, career experience, recent concussion experience, and training subscale) align with empirically supported personnel implementation characteristics. The second aim of this study was to explore pre-existing communication patterns between SSP utilizing the independent variable referral source. It is of note that the school district from which the data were collected had no formal SBCM programming; therefore, all SSP implementation characteristics examined were viewed as baseline characteristics. Results indicated that as all SSP groups (i.e., school psychologists, nurses, counselors, social workers) perceive a need for SBCM as indicated by dissatisfaction with current procedures and agreement that concussion can negatively impact student performance. Although all groups indicated that they did not believe current concussion procedures to be effective, school psychologists and nurses reported the highest levels of dissatisfaction Additionally, nurses were found to have the highest levels of training in concussion assessment and management, and received significantly more concussion referrals per year when compare to the other SSP. These findings suggest that nurses may be effective in delivering concussion related service and establishing effective concussion surveillance procedures. Although more research is needed, this study represents the first step in bridging the gap between experimental concussion research and the successful delivery of these innovations through SBCM programming in order to help students recover from a concussion.