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中度至重度创伤性脑损伤后长达10年的就业概率轨迹

Employment Probability Trajectories Up To 10 Years After Moderate-To-Severe Traumatic Brain Injury.

作者信息

Howe Emilie I, Andelic Nada, Perrin Paul B, Røe Cecilie, Sigurdardottir Solrun, Arango-Lasprilla Juan Carlos, Lu Juan, Løvstad Marianne, Forslund Marit Vindal

机构信息

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

出版信息

Front Neurol. 2018 Dec 5;9:1051. doi: 10.3389/fneur.2018.01051. eCollection 2018.

Abstract

To examine trajectories of employment probability up to 10 years following moderate-to-severe traumatic brain injury (TBI) and identify significant predictors from baseline socio-demographic and injury characteristics. A longitudinal observational study followed 97 individuals with moderate-to-severe TBI for their employment status up to 10 years post injury. Participants were enrolled at the Trauma Referral Center in South-Eastern Norway between 2005 and 2007. Socio-demographic and injury characteristics were recorded at baseline. Employment outcomes were assessed at 1, 2, 5, and 10 years. Hierarchical linear modeling (HLM) was used to examine employment status over time and assess the predictors of time, gender, age, relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale (GCS) score, duration of post-traumatic amnesia (PTA), CT findings, and injury severity score, as well as the interaction terms between significant predictors and time. The linear trajectory of employment probabilities for the full sample remained at ~50% across 1, 2, 5, and 10-years post-injury. Gender ( = 0.016), relationship status ( = 0.002), employment ( < 0.001) and occupational status at injury ( = 0.005), and GCS ( = 0.006) yielded statistically significant effects on employment probability trajectories. Male gender, those in a partnered relationship at the time of injury, individuals who had been employed at the time of injury, those in a white-collar profession, and participants with a higher acute GCS score had significantly higher overall employment probability trajectories across the four time points. The timegender interaction term was statistically significant ( = 0.002), suggesting that employment probabilities remained fairly stable over time for men, but showed a downward trend for women. The timeemployment at injury interaction term was statistically significant ( = 0.003), suggesting that employment probabilities were fairly level over time for those who were employed at injury, but showed an upward trend over time for those who had been unemployed at injury. Overall employment probability trajectories remained relatively stable between 1 and 10 years. Baseline socio-demographic and injury characteristics were predictive of employment trajectories. Regular follow-up is recommended for patients at risk of long-term unemployment.

摘要

研究中度至重度创伤性脑损伤(TBI)后长达10年的就业概率轨迹,并从基线社会人口统计学和损伤特征中识别出显著的预测因素。一项纵向观察性研究对97名中度至重度TBI患者伤后长达10年的就业状况进行了跟踪。参与者于2005年至2007年在挪威东南部的创伤转诊中心登记入组。在基线时记录社会人口统计学和损伤特征。在1年、2年、5年和10年时评估就业结果。采用分层线性模型(HLM)来研究随时间变化的就业状况,并评估时间、性别、年龄、恋爱状况、教育程度、伤前就业情况、职业、损伤原因、急性格拉斯哥昏迷量表(GCS)评分、创伤后遗忘症(PTA)持续时间、CT检查结果和损伤严重程度评分等预测因素,以及显著预测因素与时间之间的交互项。整个样本在伤后1年、2年、5年和10年的就业概率线性轨迹保持在约50%。性别(P = 0.016)、恋爱状况(P = 0.002)、伤前就业情况(P < 0.001)和损伤时的职业状况(P = 0.005)以及GCS评分(P = 0.006)对就业概率轨迹产生了统计学上的显著影响。男性、伤时处于恋爱关系中的人、伤时已就业的人、从事白领职业的人以及急性GCS评分较高的参与者在这四个时间点的总体就业概率轨迹显著更高。时间-性别交互项具有统计学意义(P = 0.002), 表明男性的就业概率随时间保持相当稳定,但女性呈下降趋势;时间-伤前就业情况交互项具有统计学意义(P = 0.003),表明伤时已就业者的就业概率随时间相当平稳,但伤时失业者的就业概率随时间呈上升趋势。总体就业概率轨迹在1年至10年之间保持相对稳定。基线社会人口统计学和损伤特征可预测就业轨迹。建议对有长期失业风险的患者进行定期随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4c9/6289969/c4620e5aac0a/fneur-09-01051-g0001.jpg

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