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BACKGROUND: Individuals with moderate to severe traumatic brain injury (msTBI) have reported a lack of motivation, lack of time, and fatigue as perceived barriers to exercise. OBJECTIVE: To evaluate the effects of an exercise program on self-reported health-related symptoms and quality of life in persons 45-years and older with msTBI. METHODS: Post-hoc analysis of a prospective community-based 12-week exercise program of 20 adults, age 45–80 years, with msTBI. Ten were in aerobic exercise training (AET) program and 10 in a stretching and toning (SAT) program. The AET group was instructed to exercise based on their estimated maximal heart rate (HR) for 150 minutes weekly. The SAT group was to stretch for the same target time without significantly increasing HR or level of exertion. Outcome measures were Traumatic Brain Injury Quality of Life (TBI-QOL) for global, cognitive, emotional, and social health, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Pittsburgh Sleep Quality Index (PSQI) for sleep quality. RESULTS: AET was associated with improved self-reported cognitive health and sleep compared to SAT. Moderate to large, positive effect sizes were also observed in the AET group in the QOL categories of global, emotional, and social health, and depressive symptoms. CONCLUSIONS: This study offers preliminary evidence that AET may improve health-related QOL, especially for cognition and sleep, in middle-aged and older adults with msTBI. [ABSTRACT FROM AUTHOR]

With mobile health technologies serving as an alternative means of providing healthcare, evaluating patients' abilities to navigate digital infrastructures is becoming increasingly relevant. The goal of this study is to investigate smartphone use patterns among individuals with history of moderate-to-severe traumatic brain injury (TBI). An anonymous survey was delivered via e-mail or text message to eligible participants who had a history of moderate-to-severe TBI and were prospectively followed at one of the eight participating Traumatic Brain Injury Model Systems centers for at least 1-year post-injury. The survey captured demographic data and included a questionnaire to evaluate smartphone use (calling, texting, web browsing, etc.). A total of 2665 eligible individuals were contacted to complete the survey, 472 of which responded. 441 of them reported smartphone use. Individuals ages 45 and older were significantly less likely to use their phones for functions other than calling and texting when compared to individuals ages 18–44 (p < 0.05). Most individuals with moderate-to-severe TBI in this cohort demonstrated intentional smartphone use, suggesting that mobile health technologies may be feasible as a cost-effective healthcare alternative. However, doing so will require additional interventions to provide further technological education especially in older individuals with TBI. [ABSTRACT FROM AUTHOR]

Background: Hexabromocyclododecane (HBCD) is a brominated flame retardant used in polystyrene foams in thermal insulation and electrical equipment. The HBCD commercial mixture consists mainly of α, β, and γ stereoisomers. Health concerns of HBCD exposure include alterations in immune and reproductive systems, neurotoxic effects, and endocrine disruption. Stereoisomer-specific levels of HBCD have not been measured previously in U.S. food. Objectives: We measured HBCD stereoisomer levels in U.S. foods from Dallas, Texas, supermarkets. Methods: Convenience samples of commonly consumed foods were purchased from supermarkets in Dallas in 2009-2010. Food samples included a wide variety of lipid-rich foods: fish, peanut butter, poultry, pork, and beef. Thirty-six individual food samples were collected in 2010 and analyzed for α-, β-, and γ-HBCD stereoisomers using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Ten pooled food samples previously collected in 2009 for a study of total HBCD levels using gas chromatography-mass spectrometry (GC-MS), were reanalyzed for α-, β-, and γ-HBCD stereoisomers using LC-MS/MS. Results: Of the 36 measured individual foods, 15 (42%) had detectable levels of HBCD. Median (ranges) of α- and γ-HBCD concentrations were 0.003 (< 0.005-1.307) and 0.005 (< 0.010-0.143) ng/g wet weight (ww), respectively; β-HBCD was present in three samples with a median (range) of 0.003 (< 0.005-0.019) ng/g ww. Median levels (range) for α-, γ-, and γ-HBCD, in pooled samples were 0.077 (0.010-0.310), 0.008 (< 0.002-0.070), and 0.024 (0.012-0.170) ng/g ww, respectively. Conclusions: α-HBCD was detected most frequently and at highest concentrations, followed by γ-, and then β-HBCD, in food samples from Dallas, Texas. Food may be a substantial contributor to the elevated α-HBCD levels observed in humans. These data suggest that larger and more representative sampling should be conducted. [ABSTRACT FROM AUTHOR]

Skin-sparing mastectomy (SSM) is an accepted surgical option for breast cancer treatment. SSM allows for preservation of the skin envelope and improved cosmesis. Despite initial concerns, large series have not revealed higher recurrence rates. There is, however, a paucity of data regarding the rates of residual breast tissue (RBT) left behind after SSM, what factors influence this, and the oncologic implications of RBT. Retrospective review identified 288 total mastectomies. Patients who had undergone SSM with excision of additional skin for reconstructive purposes, either at the initial oncologic surgery or at subsequent revision, were included in the final study group. Pathologic analysis was performed to evaluate excised skin. Data regarding demographics, tumor type, and treatment were collected. Comparison between patients who had pathologically confirmed RBT in the excised skin and those who did not was performed. Of 288 total mastectomies, 92 were SSM's, and 66 had skin specimens removed for nononcologic reasons, of these, 4 (6%) had RBT. Age at diagnosis (p = 0.806), BMI (p = 0.531), tumor size (p = 0.922), and estrogen receptor status (p > 0.999) did not contribute to increased RBT risk. At median follow-up of 33.5 months, there have been no recurrences. In addition, cost analysis reveals it is likely not cost-effective to perform pathologic evaluation of these specimens. SSM, performed at an academic medical center by fellowship-trained surgeons, has a very low rate of RBT, and does not compromise oncologic outcomes. Routine pathologic assessment of these skin specimens, removed for nononcologic reasons, may not be required. [ABSTRACT FROM AUTHOR]

Background: For > 50 years, polyfluoroalkyl compounds (PFCs) have been used worldwide, mainly as surfactants and emulsifiers, and human exposure to some PFCs is widespread. Objectives: Our goal was to report PFC serum concentrations from a convenience sample of Dallas, Texas, children from birth to < 13 years of age, and to examine age and sex differences in PFC concentrations. Methods: We analyzed 300 serum samples collected in 2009 for eight PFCs by online solid phase extraction-high performance liquid chromatography-isotope dilution-tandem mass spectrometry. Results: Perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA) were detected in > 92% of participants; the other PFCs measured were detected less frequently. Overall median concentrations of PFOS (4.1 ng/mL) were higher than those for PFOA (2.85 ng/mL), PFNA (1.2 ng/mL), and PFHxS (1.2 ng/mL). For PFOS, PFOA, PFNA, and PFHxS, we found no significant differences (p < 0.05) by sex, significantly increasing concentrations for all four chemicals by age, and significantly positive correlations between all four compounds. Conclusions: We found no significant differences in the serum concentrations of PFOS, PFOA, PFNA, and PFHxS by sex, but increasing concentrations with age. Our results suggest that these 300 Texas children from birth through 12 years of age continued to be exposed to several PFCs in late 2009, years after changes in production of some PFCs in the United States. [ABSTRACT FROM AUTHOR]