human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To investigate the frequency and risk factors of major depressive disorder ( MDD )  after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the  intervention group ( n = 88 ) or the  control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls  , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and  pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries .  Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes . The relationship between access to compensation and health outcomes is complex , and more high-level research is required PURPOSE To examine change in resilience in people with spinal cord injury ( SCI ) when  group cognitive behavior therapy ( GCBT ) was added to routine psychosocial rehabilitation ( RPR ) . RESEARCH METHOD / DESIGN A prospect i ve repeated- measures cohort design was used to determine the efficacy of the addition of  GCBT ( n = 50 ) . The control group consisted of individuals receiving RPR  , which included access to individual CBT ( ICBT ) when required  ( n = 38 ) . Groups were assessed on 3 occasions : soon after admission , within 2 weeks of discharge , and 6-months postdischarge . Measures included sociodemographic , injury , and psychosocial factors . The outcome variable was resilience , considered an important outcome measure for recovery . To adjust for baseline differences in self-efficacy , depressive mood and anxiety between the 2 groups , these factors were entered into a repeated measures multivariate analysis of covariance ( MANCOVA ) as covariates . Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups . RESULTS The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group . Trajectory data indicated over 60 % were demonstrating acceptable resilience irrespective of group . CONCLUSION / IMPLICATION S Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes . Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration . Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to underst and complex trajectories . Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience Importance : Each year , millions of 
    Output:
    
agent
Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To investigate the frequency and risk factors of major depressive disorder ( MDD )  after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the  intervention group ( n = 88 ) or the  control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls  , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and  pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries .  Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes . The relationship between access to compensation and health outcomes is complex , and more high-level research is required PURPOSE To examine change in resilience in people with spinal cord injury ( SCI ) when  group cognitive behavior therapy ( GCBT ) was added to routine psychosocial rehabilitation ( RPR ) . RESEARCH METHOD / DESIGN A prospect i ve repeated- measures cohort design was used to determine the efficacy of the addition of  GCBT ( n = 50 ) . The control group consisted of individuals receiving RPR  , which included access to individual CBT ( ICBT ) when required  ( n = 38 ) . Groups were assessed on 3 occasions : soon after admission , within 2 weeks of discharge , and 6-months postdischarge . Measures included sociodemographic , injury , and psychosocial factors . The outcome variable was resilience , considered an important outcome measure for recovery . To adjust for baseline differences in self-efficacy , depressive mood and anxiety between the 2 groups , these factors were entered into a repeated measures multivariate analysis of covariance ( MANCOVA ) as covariates . Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups . RESULTS The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group . Trajectory data indicated over 60 % were demonstrating acceptable resilience irrespective of group . CONCLUSION / IMPLICATION S Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes . Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration . Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to underst and complex trajectories . Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience Importance : Each year , millions of 
    Output:
    