Recent research has provided some support for the concurrent validity of two-subtest short forms for estimating Canadian WAIS-III Index scores in the standardization sample (Lange & Iverson, in press). The purpose of this study was to examine the efficacy of using various two-subtest short forms to estimate Canadian WAIS-III Index scores in a clinical population. Participants were 100 inpatients from two large psychiatric hospitals in British Columbia, Canada. Using all possible two-subtest combinations, estimated VCI, POI, and WMI scores were generated by prorating subtest scaled scores and using the Canadian normative data (Wechsler, 2001). The agreement rate between full form and short form index scores was very high for all subtest combinations (range = 90-98%). Two-subtest short forms were useful for estimating VCI, POI, and WMI scores in this population.
This study developed regression algorithms for estimating IQ scores using the Canadian WAIS-III norms. Participants were the Canadian WAIS-III standardization sample (n = 1,105). The sample was randomly divided into two groups (Development and Validation groups). The Development group was used to generate 12 regression algorithms for FSIQ and three algorithms each for VIQ and PIQ. Algorithms combined demographic variables with WAIS-III subtest raw scores. The algorithms accounted for 48-78% of the variance in FSIQ, 70-71% in VIQ, and 45-55% in PIQ. In the Validation group, the majority of the sample had predicted IQs that fell within a 95% CI band (FSIQ=92-94%; VIQ=93-95%; PIQ=94-94%). These algorithms yielded reasonably accurate estimates of FSIQ, VIQ, and PIQ in this healthy adult population. It is anticipated that these algorithms will be useful as a means for estimating premorbid IQ scores in a clinical population. However, prior to clinical use, these algorithms must be validated for this purpose.
In an acute care setting, evaluation of traumatic brain injury (TBI) is often complicated by alcohol intoxication. The purpose of this study is to evaluate the clinical utility of the protein S100B as a biochemical marker for identifying brain injury in patients who are intoxicated at the time of injury.
The study participants were 160 patients who presented to a large urban Level I Trauma Centre in Vancouver, Canada. Patients were classified into four clinical groups (medical controls, trauma controls, mild TBI, and definite TBI) and two day-of-injury alcohol intoxication groups (i.e., sober and intoxicated). Blood samples were collected via venipuncture in heparinized tubes within 8 hours of injury. Measures of S100B concentration were obtained using a commercially available assay kit (Sangtec 100 Elisa).
For those patients who were sober at the time of injury, higher S100B levels were associated with TBI when compared with other physical injuries and general medical complaints. However, for patients who were intoxicated at the time of injury, there were uniformly low S100B levels across all clinical groups.
Although there seems to be a strong association between S100B levels and TBI, further research is required to establish the clinical role of S100B in patients with suspected TBI, particularly in patients whose clinical presentation is complicated by alcohol intoxication.
To examine the relation between diffusion tensor imaging (DTI) of the corpus callosum and postconcussion symptom reporting following mild traumatic brain injury (MTBI).
Sixty patients with MTBI and 34 patients with orthopedic/soft-tissue injuries (Trauma Controls) prospectively enrolled from consecutive admissions to a level 1 trauma center.
Diffusion tensor imaging of the corpus callosum was undertaken using a Phillips 3T scanner at 6 to 8 weeks postinjury. Participants also completed a postconcussion symptom checklist. The MTBI group was divided into 2 subgroups based on the International Classification of Diseases, Tenth Revision symptom criteria for postconcussion disorder (PCD): PCD Present (n = 21), PCD Absent (n = 39).
Measures of fractional anisotropy and mean diffusivity for the genu, body, and splenium of the corpus callosum. Participants also completed the British Columbia Post-Concussion Symptom Inventory.
The MTBI group reported more postconcussion symptoms than the trauma controls. There were no significant differences between MTBI and trauma control groups on all DTI measures. In the MTBI sample, there were no significant differences on all DTI measures between those who did and did not meet the International Classification of Diseases, Tenth Revision research criteria for postconcussion disorder.
These data do not support an association between white matter integrity in the corpus callosum and self-reported postconcussion syndrome 6 to 8 weeks post-MTBI.
Widespread negative attitudes toward electroconvulsive therapy (ECT) are present in the general public and among heath care professionals. However, there is evidence to suggest that clinical experience and knowledge of ECT positively improve attitudes toward this treatment. The purpose of this study was to evaluate the effects of an ECT education training program on attitudes toward ECT. Participants were 73 student nurses (91.8% women) and 21 care aid students (81.0% women) undertaking a 6-week rotation in psychiatry at a large provincial psychiatric hospital in British Columbia, Canada. The ECT education training program consisted of a brief lecture, viewing of an educational videotape, familiarization with the ECT equipment, and observation of an ECT treatment. Participants completed a short questionnaire pretraining and posttraining program. Attitudes toward ECT did not substantially differ between the 2 groups. For the entire sample, only 8.5% reported that they were well informed about ECT before the training session. More favorable attitudes were reported upon completion of the ECT education program compared with attitudes reported before training. These findings suggest that attitudes toward ECT increase favorably when individuals are provided with training and experience.
Since the release of the Canadian WAIS-III normative data in 2001 (Wechsler, 2001), the clinical application of these norms has been limited by the absence of a method to estimate premorbid functioning. However, Lange, Schoenberg, Woodward, and Brickell (2005) recently developed regression algorithms that estimate premorbid FSIQ, VIQ and PIQ scores for use with the Canadian WAIS-III norms. The purpose of this study was to expand work by Lange and colleagues by developing regression algorithms to estimate premorbid GAI (Saklofske et al., 2005), VCI, and POI scores. Participants were the Canadian WAIS-III standardization sample (n = 1,105). The sample was randomly divided into two groups (Development and Validation group). Using the Development group, a total of 14 regression algorithms were generated to estimate GAI, VCI, and POI scores by combining subtest performance (i.e., Vocabulary, Information, Matrix Reasoning, and Picture Completion) with demographic variables (i.e., age, education, ethnicity, region of the country, and gender). The algorithms accounted for a maximum of 77% of the variance in GAI, 78% of the variance in VCI, and 63% of the variance in POI. In the Validation Group, correlations between predicted and obtained scores were high (GAI = .70 to .88; VCI = .87 to .88; POI = .71 to .80). Evaluation of prediction errors revealed that the majority of estimated GAI, VCI, and POI scores fell within a 95% CI band (93.5% to 97.0%) and within 10 points of obtained index scores (72.3% to 85.6%) depending on the subtests used. These algorithms provide a promising means for estimating premorbid GAI, VCI, and POI scores using the Canadian WAIS-III norms.
A small percentage of people with a mild traumatic brain injury (MTBI) report persistent symptoms and problems many months or even years following injury. Preliminary research suggests that people who sustain an injury often underestimate past problems (i.e., "good old days" bias), which can impact their perceived level of current problems and recovery. The purpose of this study was to examine the influence of the good old bays bias on symptom reporting following MTBI. The MTBI sample consisted of 90 referrals to a concussion clinic (mean time from injury to evaluation = 2.1 months, SD = 1.5, range = 0.8-8.1). All were considered temporarily fully disabled from an MTBI and they were receiving financial compensation through the Worker's Compensation system. Patients provided post-injury and pre-injury retrospective ratings on the 16-item British Columbia Post-concussion Symptom Inventory (BC-PSI). Ratings were compared to 177 healthy controls recruited from the community and a local university. Consistent with the good old bays bias, MTBI patients retrospectively endorsed the presence of fewer pre-injury symptoms compared to the control group. Individuals who failed effort testing tended to retrospectively report fewer symptoms pre-injury compared to those patients who passed effort testing. Many MTBI patients report their pre-injury functioning as better than the average person. This can negatively impact their perception of current problems, recovery from injury, and return to work.
The aim of the present study was to investigate trajectories of suicide attempt risks before and after granting of disability pension in young people.
The analytic sample consisted of all persons 16-30 years old and living in Sweden who were granted a disability pension in the years 1995-1997; 2000-2002 as well as 2005-2006 (n = 26,624). Crude risks and adjusted odds ratios for suicide attempt were computed for the 9-year window around the year of disability pension receipt by repeated-measures logistic regressions.
The risk of suicide attempt was found to increase continuously up to the year preceding the granting of disability pension in young people, after which the risk declined. These trajectories were similar for women and men and for disability pension due to mental and somatic diagnoses. Still, the multivariate odds ratios for suicide attempts for women and for disability pension due to mental disorders were 2.5- and 3.8-fold increased compared with the odds ratios for men and disability pension due to somatic disorders, respectively. Trajectories of suicide attempts differed for young individuals granted a disability pension during 2005-2006 compared with those granted during 1995-1997 and 2000-2002.
We found an increasing risk of suicide attempt up until the granting of a disability pension in young individuals, after which the risk decreased. It is of clinical importance to monitor suicide attempt risk among young people waiting for the granting of a disability pension.
The safety of metformin in heart failure has been questioned because of a perceived risk of life-threatening lactic acidosis, though recent studies have not supported this concern. We investigated the risk of all-cause mortality associated with individual glucose-lowering treatment regimens used in current clinical practice in Denmark.
All patients aged = 30 years hospitalised for the first time for heart failure in 1997-2006 were identified and followed until the end of 2006. Patients who received treatment with metformin, a sulfonylurea and/or insulin were included and assigned to mono-, bi- or triple therapy groups. Multivariable Cox proportional hazard regression models were used to assess the risk of all-cause mortality.
A total of 10,920 patients were included. The median observational time was 844 days (interquartile range 365-1,395 days). In total, 6,187 (57%) patients died. With sulfonylurea monotherapy used as the reference, adjusted hazard ratios for all-cause mortality associated with the different treatment groups were as follows: metformin 0.85 (95% CI 0.75-0.98, p = 0.02), metformin + sulfonylurea 0.89 (95% CI 0.82-0.96, p = 0.003), metformin + insulin 0.96 (95% CI 0.82-1.13, p = 0.6), metformin + insulin + sulfonylurea 0.94 (95% CI 0.77-1.15, p = 0.5), sulfonylurea + insulin 0.97 (95% CI 0.86-1.08, p = 0.5) and insulin 1.14 (95% CI 1.06-1.20, p = 0.0001).
Treatment with metformin is associated with a low risk of mortality in diabetic patients with heart failure compared with treatment with a sulfonylurea or insulin.
