Monica M. Bennett Ph.D.

Reynolds, M., S. Driver, M. Bennett, S. Patel, E. Rainey and A. M. Warren (2018). “Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre.” Clin Obes Jul 31. [Epub ahead of print].

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The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service >/=24 h, medically stable, spoke English or Spanish and >/=18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients’ height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 +/- 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.

Ramsey, J., S. Driver, C. Swank, M. Bennett and R. Dubiel (2018). “Physical activity intensity of patient’s with traumatic brain injury during inpatient rehabilitation.” Brain Inj Jul 23. [Epub ahead of print]: 1-7.

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OBJECTIVE: Use actigraphy to (1) describe the intensity of physical activity completed by patients with traumatic brain injury (TBI) during inpatient rehabilitation, and (2) examine the association between physical activity intensity and demographic, injury, and programmatic characteristics. DESIGN: Observational. METHOD: Fifty individuals with TBI undergoing inpatient rehabilitation wore accelerometers for an average of 8.7 +/- 1.8 days to capture physical activity intensity that was summarized using activity counts (ACs). Intensity of activity was described for categories of the participant’s day including physical and occupational therapy, non-active therapy, recreation, and sleep. Descriptive statistics, Pearson’s correlations, and general linear regression were computed. RESULTS: Participants average physical activity intensity was considered “inactive” during physical (M = 242.7.7 +/- 105.2 AC/min) and occupational therapy (M = 244 +/- 105), non-active therapy (M = 142.2 +/- 74.1), and recreation (M = 112.8 +/- 59.5), and “sedentary” during sleep (M = 26.7 +/- 14.8). Significant positive associations were identified between physical activity intensity and categories of the participant’s day suggesting that participants who complete more intense activity in therapy also complete more intense activity during non-active therapy and recreation time. General linear regression indicated that age significantly predicted physical activity intensity. CONCLUSIONS: Findings demonstrate that patients with TBI undergoing inpatient rehabilitation are largely inactive or sedentary. Strategies to promote a safe increase in physical activity intensity are required if cardiovascular conditioning is to be improved during inpatient rehabilitation.

McLaughlin, C. M., J. Gonzalez-Hernandez, M. Bennett and H. G. Piper (2018). “Pediatric breast masses: an argument for observation.” J Surg Res 228: 247-252.

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BACKGROUND: Pediatric breast masses can be a diagnostic challenge. Nearly all are benign, but there is no consensus on which should be removed. We hypothesized that children with asymptomatic breast lesions can be safely managed nonoperatively. METHODS: We performed a single-institution retrospective review of children (less-than-or-equal-to 18 y) who underwent breast mass excision from 2008 to 2016. Male patients with gynecomastia and those who had needle biopsy without formal excision were excluded. Pearson correlation was used to compare ultrasound and pathologic size. Kruskal-Wallis test was used to compare size and final diagnosis. RESULTS: One hundred ninety-six patients were included (96% female). Mean age was 15 +/- 3 y. Most patients (71%) presented with a painless mass. Preoperative ultrasound was obtained in 70%. Pathology included fibroadenoma (81.5%), tubular adenoma (5%), benign phyllodes tumor (3%), benign fibroepithelial neoplasm (0.5%), and other benign lesions (10%). There were no malignant lesions. Ultrasound size had a Pearson correlation of 0.84 with pathologic size (P < 0.0001). There was no association between the size and final diagnosis. CONCLUSIONS: Over 9 y, all pediatric breast masses removed at a single center were benign, most commonly fibroadenoma. Ultrasound was an accurate predictor of size, but large lesions did not necessarily confer a high malignancy risk. Observation is appropriate for asymptomatic breast masses in children. Decision for surgery should be individualized and not based on size alone.

Roden-Foreman, K., R. Robinson, M. Bennett, K. Roaten, L. Petrey, M. B. Powers and A. M. Warren (2018). “Posttraumatic growth in a heterogeneous sample of traumatically injured patients 1 year post injury.” J Clin Psychol 74(6): 989-1003.

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OBJECTIVE: Posttraumatic growth (PTG) describes positive change resulting from challenging life events. The current study examined factors associated with PTG in traumatically injured patients 1 year post injury. METHOD: Participants (N = 221) in this prospective cohort study included adults admitted to a Level I trauma center. Over half the participants (60%) were male, with a mean age of 47. Participants completed baseline measures during hospitalization. PTG was assessed at 12-month follow-up. RESULTS: Greater PTG was associated with minority race/ethnicity, lower income, automotive collision, and premorbid psychological disorder other than depression or posttraumatic stress (PTS). These variables are also known to predict PTS in trauma patients. Analysis confirmed that greater PTS at follow-up was associated with more growth. CONCLUSION: Participants with the most growth also experienced the most distress. This finding demonstrates the importance of implementing psychological screening and intervention for trauma patients in the acute care setting to reduce PTS and facilitate growth.

McLaughlin, C. M., M. Bennett, N. Channabasappa, J. Journeycake and H. G. Piper (2018). “Anticoagulation results in increased line salvage for children with intestinal failure and central venous thrombosis.” J Pediatr Surg. Feb 7. [Epub ahead of print].

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PURPOSE: The purpose of this study was to investigate whether anticoagulation (AC) results in thrombus resolution and increased line longevity in children with intestinal failure (IF) and catheter-associated central venous thrombosis (CVT). METHODS: A retrospective, single institution review was performed of children with IF who were dependent on parenteral nutrition with known CVT between 2006 and 2017. Frequency of catheter-related complications including infection, occlusion, and breakage were compared 18months prior to and after starting AC. Thrombus resolution during anticoagulation was also determined. Data were analyzed using Poisson regression. p-Values <0.05 were considered significant. RESULTS: Eighteen children had >/=1 CVT, with the subclavian vein most commonly thrombosed (44%). All children were treated with low molecular weight heparin, and 6 patients (33%) had clot resolution on re-imaging while receiving AC. Bloodstream infections decreased from 7.9 to 4.4 per 1000 catheter days during AC (p=0.01), and the number of infections requiring catheter replacement decreased from 3.0 to 1.0 per 1000 catheter days (p=0.01). There were no significant differences in line occlusions or breakages. CONCLUSION: Anticoagulation for children with intestinal failure and central venous thrombosis may prevent thrombus propagation, and decrease blood stream infections and line replacements. Further research is needed to determine optimal dosing and duration of therapy. LEVEL OF EVIDENCE: III; Retrospective Comparative Study.