ABSTRACT
PRIMARY OBJECTIVE: Traumatic brain injury (TBI) is a signature wound of recent Unites States military conflicts. The National Intrepid Center of Excellence (NICoE) has demonstrated that interdisciplinary care is effective for active-duty military personnel with TBI and related psychological health conditions. This paper details how the Marcus Institute for Brain Health (MIBH), established in 2017 as an Integrated Practice Unit (IPU), is founded on the NICoE model and is dedicated to interdisciplinary care for Veterans with persistent symptoms due to TBI and psychological comorbidities. RESEARCH DESIGN: A highly integrated group of clinicians from diverse disciplines combine their expertise to offer comprehensive evaluation, intensive outpatient treatment, and program outcomes evaluation. METHODS AND PROCEDURES: The role of each discipline in the provision of care, and the regular interaction of all clinicians, are delineated. A strong connection to academic medicine is maintained so that clinical research and education complement patient care. MAIN OUTCOMES AND RESULTS: Over three hundred veterans and family members have received treatment at the MIBH. Program evaluation is underway. CONCLUSIONS: As the understanding of TBI and related psychological conditions continues its rapid evolution, the expert interdisciplinary care at the MIBH has great promise as a Veteran counterpart of the NICoE.
Subject(s)
Brain Injuries, Traumatic , Military Personnel , Stress Disorders, Post-Traumatic , Veterans , Brain , Brain Injuries, Traumatic/psychology , Brain Injuries, Traumatic/therapy , Comorbidity , Humans , Military Personnel/psychology , Stress Disorders, Post-Traumatic/therapy , Veterans/psychologyABSTRACT
OBJECTIVE: The present study examined self-efficacy and self-esteem as basic aspects of the self that influence self-care and physiological outcomes among young adults with Type I diabetes. The two aims of this study were 1) to examine the cross-sectional and longitudinal role of the self-variables as they predict self-care and HbA1c and 2) to test whether self-care mediates the association between the self variables and HbA1c using cross-sectional and longitudinal data. METHODS: One hundred ten participants were recruited from a regional diabetes outpatient clinic. Inclusion criteria were age (18-35 years) and duration of diabetes (>1 year before recruitment). Participants were 61% female and 88% white. In addition, the sample had an average annual income between $24,999 and $34,999, and 85% had completed some or all of college. The average duration of diabetes was 15 years. RESULTS: Using multiple regression analyses we found that, compared with self-esteem, self-efficacy was a better predictor of all aspects of self-care and HbA1c in cross-sectional analyses, in addition to diet and exercise self-care, and a better predictor of HbA1c in longitudinal analyses. The data also supported the cross-sectional and longitudinal mediational model in which better self-care helped account for the association between greater self-efficacy and better HbA1c. CONCLUSIONS: Self-efficacy is an important factor for management of self-care practices and physiological outcomes among young adults with Type I diabetes, and self-care may be an important mechanism by which self-efficacy influences HbA1c levels.
