Symptom Cluster Profiles Following Traumatic Orthopaedic Injuries

项目总结 每年，创伤伤害影响数百万美国人，导致6710亿美元的医疗费用和 失去了生产力。它们也是导致47岁以前死亡和潜在寿命损失的主要原因。 在75岁之前。除了社会成本外，疼痛、睡眠障碍、焦虑、抑郁等症状， 创伤骨科损伤(TOI)后，应激相关障碍非常普遍，可能 会导致负面的长期健康后果。 识别TOI后的症状群特征可能会导致识别那些阴性风险最高的人 结果。尽管症状群分布的机制并不完全清楚，但它们可能共享一种 常见病因学。使用通过整合美国国立卫生研究院创建的理论框架 症状科学模型和不良症状理论，拟议的研究将利用交叉 分段设计，描述症状群谱中的成员关系，检查 人口统计学和临床因素以及症状群特征中的成员，并测量 血清脑源性神经营养因子与Val66Met的单核苷酸多态性 BDNF基因(Rs6265)与不同类型的 在大型城市一级创伤中，在受伤后24小时内招募的TOI幸存者样本 中间。将使用多项Logistic回归的潜在轮廓分析来描述集团成员 症状群特征及其与人口学、临床因素和生物标记物数据的关系。 这项研究的目的是1)描述TOI幸存者的症状群特征，表明 由于疼痛、睡眠障碍以及焦虑、抑郁和压力相关障碍的症状，立即 遵循TOI；以及2)检查人口统计学和临床因素与症状群之间的关系 TOI幸存者的个人资料。3)检验以下假设：低浓度的BDNF 与TOI之后的症状群特征之间的成员关系相关联；以及4)检验假设 在BDNF基因的一个或两个等位基因上存在Val66Met SNP与 TOI后的症状群特征。 这项研究的结果将提供必要的初步数据，以支持未来的研究检查自我和 TOI后的症状处理。培训计划包括旨在促进 广泛了解TOI后个体的生物行为反应，以及筛查和 伤后症状的处理。与NINR促进精准健康的战略计划保持一致 通过研究生物标志物在症状科学中的作用，拟议的工作将提供必要的 为从事护理研究奠定基础，专注于研究生物行为机制 对TOI幸存者症状群特征的干预。

PROJECT SUMMARY Each year, traumatic injuries affect millions of Americans, resulting in $671 billion in healthcare costs and lost productivity. They are also the leading cause of death before age 47 and of years of potential life lost before age 75. In addition to societal costs, symptoms, such as pain, sleep disturbance, anxiety, depression, and stress related disorders are highly prevalent following traumatic orthopaedic injuries (TOI) and may contribute to negative long-term health outcomes. Identifying symptom cluster profiles following TOI may lead to recognizing those at highest risk for negative outcomes. Although the mechanisms for symptom cluster profiles are not completely known, they may share a common etiology. Using a theoretical framework created by incorporating the National Institutes of Health Symptom Science Model and the Theory of Unpleasant Symptoms, the proposed study will utilize a cross- sectional design to describe membership in symptom cluster profiles, examine the associations between demographic and clinical factors and membership in symptom cluster profiles, and measure the extent to which serum brain-derived neurotrophic factor (BDNF) and the val66met single nucleotide polymorphism (rs6265) of the BDNF gene are associated with membership in symptom cluster profiles among a diverse sample of TOI survivors recruited within the first 24 hours of their injury in a large, urban level one trauma center. Latent profile analysis with multinomial logistic regression will be used to describe group membership in the symptom cluster profiles and their associations with demographic and clinical factors and biomarker data. The aims of this study are to 1) describe TOI survivors' membership in symptom cluster profiles, indicated by pain, sleep disturbance, and symptoms of anxiety, depression, and stress related disorders, immediately following a TOI; and 2) examine associations between demographic and clinical factors and symptom cluster profile membership among TOI survivors. 3) test the hypothesis that low serum concentrations of BDNF are associated with membership among symptom cluster profiles following TOI; and 4) test the hypothesis that the presence of the val66met SNP on one or both alleles of the BDNF gene is associated membership among symptom cluster profiles following TOI. The results of this study will provide essential preliminary data to support future studies examining self- and symptom management following TOI. The training plan includes specific experiences designed to promote extensive knowledge of the biobehavioral responses of individuals following TOI, and the screening and management of post-injury symptoms. Aligned with the NINR's strategic plan to promote precision health through research of the role of biomarkers in symptom science, the proposed work will provide an essential foundation for a career in nursing research focused on investigating biobehavioral mechanisms of, and interventions for, symptom cluster profiles in TOI survivors.