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Colson-Fearon D, Antoine DG, Peirce JM, Kidorf M, Hammond AS. The Impact of Child Protective Services Involvement on Pregnant and Postpartum Women in Substance Use Disorder Treatment. Subst Use Misuse 2023; 58:1110-1114. [PMID: 37165975 DOI: 10.1080/10826084.2023.2212074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Background: Pregnant women with substance use disorder often fail to complete treatment. Treatment retention can be influenced by many factors, including CPS involvement. This study evaluates the relationship, if any, between active CPS involvement while in treatment and treatment outcomes. Methods: This study is a retrospective analysis of data from 127 patients from the Center for Addiction and Pregnancy at the Johns Hopkins Bayview Medical Center in Baltimore, MD. The sample included 92 women with active CPS cases and 35 individuals without current CPS involvement. A log binomial regression with robust variance was used to estimate the relative risks of treatment completion and time spent in treatment (≥90 days vs. <90 days) between the active CPS-involved and uninvolved groups. Statistical significance was noted at a level of p < 0.05. Results: Women with active CPS involvement during their admission were significantly more likely to spend at least 90 days in treatment (OR = 1.78, CI = [1.09, 2.93]). The active CPS group also trended toward higher rates of treatment completion (RR = 1.41, CI = [0.78, 2.57]), although this finding was not statistically significant. Conclusions: In this real-world clinical sample, active CPS involvement was not associated with early SUD treatment discontinuation, however this did not translate to significant differences in rates of treatment completion. Additionally, prospective research to evaluate how the potential for CPS involvement may affect enrollment in SUD treatment would also help direct patient counseling.
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Affiliation(s)
- Darien Colson-Fearon
- Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Denis G Antoine
- Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica M Peirce
- Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Huhn AS, Finan PH, Gamaldo CE, Hammond AS, Umbricht A, Bergeria CL, Strain EC, Dunn KE. Suvorexant ameliorated sleep disturbance, opioid withdrawal, and craving during a buprenorphine taper. Sci Transl Med 2022; 14:eabn8238. [PMID: 35731889 DOI: 10.1126/scitranslmed.abn8238] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Increased orexin/hypocretin signaling is implicated in opioid withdrawal, sleep disturbances, and drug-seeking behaviors. This study examined whether a dual-orexin receptor antagonist would improve sleep and withdrawal outcomes when compared with placebo during a buprenorphine/naloxone taper. Thirty-eight participants with opioid use disorder were recruited to a clinical research unit and maintained on 8/2 to 16/4 mg of buprenorphine/naloxone treatment for 3 days before being randomized to 20 mg of suvorexant (n = 14), 40 mg of suvorexant (n = 12), or placebo (n = 12); 26 individuals completed the study. After randomization, participants underwent a 4-day buprenorphine/naloxone taper and 4-day post-taper observation period. Total sleep time (TST) was collected nightly with a wireless electroencephalography device and wrist-worn actigraphy; opioid withdrawal symptoms were assessed via the Subjective Opiate Withdrawal Scale (SOWS); and abuse potential was assessed on a 0- to 100-point visual analog scale of "High" every morning. A priori outcomes included two-group (collapsing suvorexant doses versus placebo) and three-group comparisons of area-under-the-curve (AUC) scores for TST, SOWS, and High. In two-group comparisons, participants receiving suvorexant displayed increased TST during the buprenorphine/naloxone taper and decreased SOWS during the post-taper period. In three-group comparisons, participants receiving 20 mg of suvorexant versus placebo displayed increased AUC for TST during the buprenorphine/naloxone taper, but there was no difference in SOWS among groups. There was no evidence of abuse potential in two- or three-group analyses. The results suggest that suvorexant might be a promising treatment for sleep and opioid withdrawal in individuals undergoing a buprenorphine/naloxone taper.
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Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Charlene E Gamaldo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Annie Umbricht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Hammond AS, Sweeney MM, Chikosi TU, Stitzer ML. Digital delivery of a contingency management intervention for substance use disorder: A feasibility study with DynamiCare Health. J Subst Abuse Treat 2021; 126:108425. [PMID: 34116816 PMCID: PMC8197772 DOI: 10.1016/j.jsat.2021.108425] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Digital health tools can provide convenient delivery of evidence-based treatments. The DynamiCare Health smartphone app delivers a contingency management intervention for substance use disorder consisting of remote self-testing for alcohol (breath) and drugs (saliva) with remote test validation and delivery of financial incentives for negative test results. This study examined feasibility, engagement (duration and consistency of app utilization), and impact on usual care treatment participation when a community substance use treatment program implemented this digital therapy among its patients. The study randomly assigned patients with alcohol use disorder (N = 61) to receive either DynamiCare along with treatment-as-usual (TAU; N = 29) or TAU only (N = 32) during a 90-day evaluation period. Mean duration between first and last app use was 64 (±35) days, with mean earnings of $248 (±$209, out of $600 maximum). Among those with any app use (n = 25), compliance was 68% and 74%, respectively for requested breath and saliva samples. Overall, two thirds of patients (66%) assigned to the app used it for at least 57 days and with high rates of self-testing compliance. Those completing the assessment (n = 13; 45% of sample) endorsed high satisfaction ratings. DynamiCare versus TAU participants were more likely to be retained in usual care treatment at 90 days (24% vs 3%; (χ2 (1, 61) = 5.9, p < 0.05), but sustained app utilization was associated with a wide range of usual care treatment participation. These data suggest that DynamiCare Health is feasible and potentially beneficial as a complement to community substance use treatment programs.
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Affiliation(s)
| | | | | | - Maxine L Stitzer
- Johns Hopkins University School of Medicine, USA; Friends Research Institute, USA
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Abstract
OBJECTIVES There has been advocacy for legalization of abusable substances, but systematic data on societal beliefs regarding such legalization are limited. People who use substances may have unique beliefs about legalization, and this study assessed whether they would be in favor of drug legalization/decriminalization. It was hypothesized that those who use particular drugs (especially marijuana) would support its legalization/decriminalization, but that this would not be the case across all classes (especially opioids and stimulants). METHODS A nationwide sample of 506 adults were surveyed online to assess demographic characteristics, substance misuse, and beliefs regarding drug legalization/decriminalization. Legalization/decriminalization beliefs for specific drugs were assessed on an 11-point scale (0, strongly disagree; 10, strongly agree). RESULTS For persons with opioid misuse (15.4%), when asked about their agreement with: "heroin should be legalized," the mean score was 4.6 (SEE = 0.4; neutral). For persons with stimulant misuse (12.1%), when asked about their agreement with: "cocaine should be legalized," the score was 4.2 (0.5). However, for persons with marijuana misuse (34.0%), when asked about their agreement with: "medical marijuana should be legalized" the score was 8.2 (0.3; indicating agreement), and for "recreational marijuana" the score was also 8.2 (0.3). CONCLUSIONS These results suggest that persons who used marijuana strongly support the legalization of both recreational and medical marijuana, whereas persons who primarily have opioid or stimulant misuse have less strongly held beliefs about legalization of substances within those respective categories. By including those who misuse drugs, these data assist in framing discussions of drug legalization and have the potential to inform drug policy considerations.
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Affiliation(s)
- Alexis S Hammond
- Behavioral Pharmacology Research Unit (BPRU), Department of Psychiatry and Behavioral Sciences, the Johns Hopkins University School of Medicine, Baltimore, MD
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Huhn AS, Brooner RK, Sweeney MM, Antoine D, Hammond AS, Ayaz H, Dunn KE. The association of prefrontal cortex response during a natural reward cue-reactivity paradigm, anhedonia, and demoralization in persons maintained on methadone. Addict Behav 2021; 113:106673. [PMID: 33022538 PMCID: PMC7736228 DOI: 10.1016/j.addbeh.2020.106673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022]
Abstract
Persons with opioid use disorder (OUD) often experience anhedonia and demoralization, yet there is relatively little research on the pathophysiology of anhedonia and demoralization in OUD treatment and recovery. In the current study, persons maintained on methadone (N = 29) underwent a natural reward-cue paradigm during functional near-infrared spectroscopy (fNIRS) imaging. Natural reward cues included highly palatable food, positive social interactions (e.g., a happy family at the dinner table), and emotional intimacy (e.g. couples embracing or kissing, but no erotic images). Participants also self-reported symptoms of anhedonia on the Snaith-Hamilton Pleasure Scale (SHPS) and demoralization on the Demoralization Scale II (DS-II). Participants who reported clinically-significant anhedonia on the SHPS displayed decreased neural activity in the right prefrontal cortex (PFC) in response to natural reward cues (F(1,25) = 3.612, p = 0.027, ηp2 = 0.302). In linear regression models of positive social cues, decreased neural activity in the right VMPFC was associated with increased SHPS total score (F(1,27) = 7.131, R2 = 0.209, p = .013), and decreased neural activity in an area encompassing the right lateral VMPFC and DLPFC was associated with increased DS-II total score (F(1,27) = 10.641, R2 = 0.283, p = 0.003). This study provides initial evidence that the prefrontal cortex is involved in the pathophysiology of anhedonia and demoralization in persons in recovery from OUD. Anhedonia and demoralization are important treatment outcomes that should be queried along with a constellation of physical and mental health outcomes, to assess areas of needed improvement in methadone maintenance and other OUD treatment modalities.
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Affiliation(s)
- Andrew S Huhn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Mary M Sweeney
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Denis Antoine
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Alexis S Hammond
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, United States; Drexel University, College of Arts and Sciences, Department of Psychology, United States; University of Pennsylvania, Department of Family and Community Health, United States; Children's Hospital of Philadelphia, Center for Injury Research and Prevention, United States
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
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Hammond AS, Antoine DG, Stitzer ML, Strain EC. A Randomized and Controlled Acceptability Trial of an Internet-based Therapy among Inpatients with Co-occurring Substance Use and Other Psychiatric Disorders. J Dual Diagn 2020; 16:447-454. [PMID: 32701419 DOI: 10.1080/15504263.2020.1794094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Technology-assisted treatment (TAT) holds promise for innovative assessment, prevention, and treatment of substance use disorders (SUD). The widespread access to TAT makes it a potentially cost-effective and inventive option available for delivery in multiple settings. This study assessed acceptability of the web-based Therapeutic Education System (TES) in hospitalized dual diagnosis patients with SUDs and other psychiatric disorders. Methods: Eligible participants were nonpsychotic, voluntary patients with self-reported drug or alcohol use in the 30 days prior to admission. They were randomly assigned to treatment as usual (TAU, n = 47) or TAU + TES (n = 48). Acceptability of this Internet-based intervention was assessed by observed utilization and self-report. Results: The TAU + TES group (# analyzed = 41) completed a mean total of 5.5 (SEM = 0.8) modules with about one module per day while hospitalized and rated TES highly on several constructs of acceptability, including novelty, usefulness and ease of understanding. Conclusions: These findings support further exploration of TAT for treatment expansion in a high acuity, dual diagnosis population and indicate the value of future research on efficacy. ClinicalTrials.gov Identifier: NCT02674477.
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Affiliation(s)
- Alexis S Hammond
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Denis G Antoine
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maxine L Stitzer
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Friends Research Institute, Baltimore, Maryland, USA
| | - Eric C Strain
- Behavioral Pharmacology Research Unit, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Antoine D, Huhn AS, Strain EC, Turner G, Jardot J, Hammond AS, Dunn KE. Method for Successfully Inducting Individuals Who Use Illicit Fentanyl Onto Buprenorphine/Naloxone. Am J Addict 2020; 30:83-87. [PMID: 32572978 DOI: 10.1111/ajad.13069] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/25/2020] [Accepted: 06/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals exposed to fentanyl are at risk of precipitated withdrawal using typical buprenorphine/naloxone induction procedures. METHODS This case series describes buprenorphine/naloxone inductions of four individuals who tested positive for fentanyl. RESULTS Buprenorphine-precipitated withdrawal was observed in two individuals who completed a conventional buprenorphine/naloxone induction strategy. Two more individuals completed a revised buprenorphine/naloxone induction strategy that did not precipitate withdrawal. DISCUSSION AND CONCLUSION Using multiple 2 mg doses of buprenorphine/naloxone in patients already in mild/moderate withdrawal improved outcomes. SCIENTIFIC SIGNIFICANCE Persons who use illicit fentanyl might be less likely to experience precipitated withdrawal from this revised buprenorphine/naloxone induction strategy. (Am J Addict 2021;30:83-87).
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Affiliation(s)
- Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gavin Turner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jasmyne Jardot
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hammond AS, Paul MJ, Hobelmann J, Koratana AR, Dredze M, Chisolm MS. Perceived Attitudes About Substance Use in Anonymous Social Media Posts Near College Campuses: Observational Study. JMIR Ment Health 2018; 5:e52. [PMID: 30072359 PMCID: PMC6096169 DOI: 10.2196/mental.9903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/01/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use is a major issue for adolescents and young adults, particularly college students. With the importance of peer influence and the ubiquitous use of social media among these age groups, it is important to assess what is discussed on various social media sites regarding substance use. One particular mobile app (Yik Yak) allowed users to post any message anonymously to nearby persons, often in areas with close proximity to major colleges and universities. OBJECTIVE This study describes the content, including attitude toward substances, of social media discussions that occurred near college campuses and involved substances. METHODS A total of 493 posts about drugs and alcohol on Yik Yak were reviewed and coded for their content, as well as the poster's attitude toward the substance(s) mentioned. RESULTS Alcohol (226/493, 45.8%), marijuana (206/493, 41.8%), and tobacco (67/493, 13%) were the most frequently mentioned substances. Posts about use (442/493) were generally positive toward the substance mentioned (262/442, 59.3%), unless the post was about abstinence from the substance. Additionally, posts that commented on the substance use of others tended to be less positive (18/92, 19.6% positive) compared to posts about one's own use (132/202, 65.3% positive). CONCLUSIONS This study provides a description of anonymous discussions on or near college campuses about drugs and alcohol, which serves as an example of data that can be examined from social media sites for further research and prevention campaigns.
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Affiliation(s)
- Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Paul
- Department of Information Science, University of Colorado, Boulder, Boulder, CO, United States
| | - Joseph Hobelmann
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD, United States
| | - Animesh R Koratana
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Mark Dredze
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD, United States
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD, United States
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Stitzer ML, Hammond AS, Matheson T, Sorensen JL, Feaster DJ, Duan R, Gooden L, del Rio C, Metsch LR. Enhancing Patient Navigation with Contingent Incentives to Improve Healthcare Behaviors and Viral Load Suppression of Persons with HIV and Substance Use. AIDS Patient Care STDS 2018; 32:288-296. [PMID: 29883190 DOI: 10.1089/apc.2018.0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This secondary analysis compares health behavior outcomes for two groups of HIV+ substance users randomized in a 3-arm trial [1] to receive Patient Navigation with (PN+CM) or without (PN) contingent financial incentives (CM). Mean age of participants was 45 years; the majority was male (67%), African American (78%), unemployed (35%), or disabled (50%). Behaviors incentivized for PN+CM were (1) attendance at HIV care visits and (2) verification of an active HIV medication prescription. Incentives were associated with shorter time to treatment initiation and higher rates of behaviors during the 6-month intervention with exception of month 6 HIV care visits. Median HIV care visits were 3 (IQR 2-4) for PN+CM versus 1.5 (IQR 0-3) for PN (Wilcoxon p < 0.001); median validated medication checks were 4 (IQR 2-6) for PN+CM versus 1 (IQR 0-3) for PN (Wilcoxon p < 0.001). Viral suppression rates at end of treatment were not significantly different for the two groups but were directly related to the number of behaviors completed for both care visits (χ2(1) = 7.69, p = 0.006) and validated medication (χ2(1) = 8.49, p = 0.004). Results support use of incentives to increase performance of key healthcare behaviors. Adjustments to the incentive program may be needed to achieve greater rates of sustained health behavior change that result in improved viral load outcomes.
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Affiliation(s)
- Maxine L. Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Alexis S. Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - James L. Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Lauren Gooden
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University, New York, New York
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Lisa R. Metsch
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University, New York, New York
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Stitzer M, Matheson T, Cunningham C, Sorensen JL, Feaster DJ, Gooden L, Hammond AS, Fitzsimons H, Metsch LR. Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use: a secondary post hoc analysis of the Project HOPE study. Addict Sci Clin Pract 2017. [PMID: 28651612 PMCID: PMC5485550 DOI: 10.1186/s13722-017-0081-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Interventions are needed to improve viral suppression rates among persons with HIV
and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156–70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression. Aims This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention. Methods Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN + CM a total of $220 could be earned for attendance at 11 PN sessions over the 6-month intervention with payments ranging from $10 to $30 under an escalating schedule. Results The majority (74%) of PN-only participants attended 6 or more sessions but only 28% attended 10 or more and 16% attended all eleven sessions. In contrast, 90% of PN + CM attended 6 or more visits, 69% attended 10 or more and 57% attended all eleven sessions (attendance distribution χ2[11] = 105.81; p < .0001). Overall (PN and PN + CM participants combined) percent with viral load suppression at 6-months was 15, 38 and 54% among those who attended 0–5, 6–9 and 10–11 visits, respectively (χ2(2) = 39.07, p < .001). Conclusion In this secondary post hoc analysis, contact with patient navigators was increased by attendance incentives. Higher rates of attendance at patient navigation sessions was associated with viral suppression at the 6-month follow-up assessment. Study results support use of attendance incentives to improve rates of contact between service providers and patients, particularly patients who are difficult to engage in care. Trial Registration clinicaltrials.govIdentifier: NCT01612169.
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Affiliation(s)
- Maxine Stitzer
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Tim Matheson
- San Francisco Department of Public Health, 25 Van Ness Avenue Suite 500, San Francisco, CA, 94102, USA
| | - Colin Cunningham
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - James L Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue SFGH Building 20, Rm. 2117, San Francisco, CA, 94110, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, CRB 1059, Miami, FL, 33136, USA
| | - Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032, USA
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Heather Fitzsimons
- Department of Psychiatry and Behavioral Sciences, Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032, USA
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Gregory KJ, Herman EJ, Ramsey AJ, Hammond AS, Byun NE, Stauffer SR, Manka JT, Jadhav S, Bridges TM, Weaver CD, Niswender CM, Steckler T, Drinkenburg WH, Ahnaou A, Lavreysen H, Macdonald GJ, Bartolomé JM, Mackie C, Hrupka BJ, Caron MG, Daigle TL, Lindsley CW, Conn PJ, Jones CK. N-aryl piperazine metabotropic glutamate receptor 5 positive allosteric modulators possess efficacy in preclinical models of NMDA hypofunction and cognitive enhancement. J Pharmacol Exp Ther 2013; 347:438-57. [PMID: 23965381 DOI: 10.1124/jpet.113.206623] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Impaired transmission through glutamatergic circuits has been postulated to play a role in the underlying pathophysiology of schizophrenia. Furthermore, inhibition of the N-methyl-d-aspartate (NMDA) subtype of ionotropic glutamate receptors (NMDAR) induces a syndrome that recapitulates many of the symptoms observed in patients with schizophrenia. Selective activation of metabotropic glutamate receptor subtype 5 (mGlu5) may provide a novel therapeutic approach for treatment of symptoms associated with schizophrenia through facilitation of transmission through central glutamatergic circuits. Here, we describe the characterization of two novel N-aryl piperazine mGlu5 positive allosteric modulators (PAMs): 2-(4-(2-(benzyloxy)acetyl)piperazin-1-yl)benzonitrile (VU0364289) and 1-(4-(2,4-difluorophenyl)piperazin-1-yl)-2-((4-fluorobenzyl)oxy)ethanone (DPFE). VU0364289 and DPFE induced robust leftward shifts in the glutamate concentration-response curves for Ca(2+) mobilization and extracellular signal-regulated kinases 1 and 2 phosphorylation. Both PAMs displayed micromolar affinity for the common mGlu5 allosteric binding site and high selectivity for mGlu5. VU0364289 and DPFE possessed suitable pharmacokinetic properties for dosing in vivo and produced robust dose-related effects in reversing amphetamine-induced hyperlocomotion, a preclinical model predictive of antipsychotic-like activity. In addition, DPFE enhanced acquisition of contextual fear conditioning in rats and reversed behavioral deficits in a mouse model of NMDAR hypofunction. In contrast, DPFE had no effect on reversing apomorphine-induced disruptions of prepulse inhibition of the acoustic startle reflex. These mGlu5 PAMs also increased monoamine levels in the prefrontal cortex, enhanced performance in a hippocampal-mediated memory task, and elicited changes in electroencephalogram dynamics commensurate with procognitive effects. Collectively, these data support and extend the role for the development of novel mGlu5 PAMs for the treatment of psychosis and cognitive deficits observed in individuals with schizophrenia.
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Affiliation(s)
- K J Gregory
- Department of Pharmacology and Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee (K.J.G., E.J.H., A.S.H., N.E.B., S.R.S., J.T.M., S.J., T.M.B., C.D.W., C.M.N., C.W.L., P.J.C., C.K.J.); Drug Discovery Biology, MIPS, Monash University, Parkville, Victoria, Australia (K.J.G.); Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada (A.J.R.); Institute of Imaging and Science, Vanderbilt University (N.E.B.); Janssen Research & Development, Beerse, Belgium (T.S., W.H.D., A.A., H.L., G.J.M., C.M., B.J.H.); Janssen Research & Development, Toledo, Spain (J.M.B.); Department of Cell Biology, Duke University, Durham, North Carolina (M.G.C., T.L.D.); Department of Chemistry, Vanderbilt University Medical Center, Nashville, Tennessee (C.W.L.); and U.S. Department of Veterans Affairs, Nashville, Tennessee (C.K.J.)
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12
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Traore B, Diarra B, Dembele BPP, Somboro AM, Hammond AS, Siddiqui S, Maiga M, Kone B, Sarro YS, Washington J, Parta M, Coulibaly N, M'baye O, Diallo S, Koita O, Tounkara A, Polis MA. Molecular strain typing of Mycobacterium tuberculosis complex in Bamako, Mali. Int J Tuberc Lung Dis 2012; 16:911-6. [PMID: 22508197 DOI: 10.5588/ijtld.11.0397] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and to examine the relationship between the strains and their drug susceptibility profiles. METHODS Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali. RESULT Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1; 38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than MTB T1 (respectively OR 0.1, 95%CI 0.03-0.4 and OR 0.1, 95%CI 0.01-0.8). Age ≥ 32 years (OR 1.4, 95%CI 0.4-3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1-2.5) and male sex (OR 4, 95%CI 0.9-16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%). CONCLUSION This study indicates a low level of primary drug resistance in Bamako, affirms the importance of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.
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Affiliation(s)
- B Traore
- Project SEREFO-NIAID (Centre de Recherche et de Formation sur VIH/Sida et Tuberculose-Institut National des Maladies Infectieuses et Allergiques)/University of Bamako Research Collaboration on HIV-TB, Bamako, Mali
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13
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Hammond AS, Rodriguez AL, Townsend SD, Niswender CM, Gregory KJ, Lindsley CW, Conn PJ. Discovery of a Novel Chemical Class of mGlu(5) Allosteric Ligands with Distinct Modes of Pharmacology. ACS Chem Neurosci 2010; 1:702-716. [PMID: 20981342 PMCID: PMC2957851 DOI: 10.1021/cn100051m] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/12/2010] [Indexed: 11/29/2022] Open
Abstract
We previously discovered a positive allosteric modulator (PAM) of the metabotropic glutamate receptor subtype 5 (mGlu(5)) termed 4 N-{4-chloro-2-[(1,3-dioxo-1,3-dihydro-2H-isoindol-2-yl)methyl]phenyl}-2-hydroxybenzamide (CPPHA) that elicits receptor activation through a novel allosteric site on mGlu(5), distinct from the classical mGlu(5) negative allosteric modulator (NAM) MPEP allosteric site. However, a shallow structure-activity relationship (SAR), poor physiochemical properties, and weak PAM activity at rat mGlu(5) limited the utility of CPPHA to explore allosteric activation of mGlu(5) at a non-MPEP site. Thus, we performed a functional high-throughput screen (HTS) and identified a novel mGlu(5) PAM benzamide scaffold, exemplified by VU0001850 (EC(50) = 1.3 μM, 106% Glu(max)) and VU0040237 (EC(50) = 350 nM, 84% Glu Max). An iterative parallel synthesis approach delivered 22 analogues, optimized mGlu(5) PAM activity to afford VU0357121 (EC(50) = 33 nM, 92% Glu(max)), and also revealed the first non-MPEP site neutral allosteric ligand (VU0365396). Like CPPHA, PAMs within this class do not appear to bind at the MPEP allosteric site based on radioligand binding studies. Moreover, mutagenesis studies indicate that VU0357121 and related analogues bind to a yet uncharacterized allosteric site on mGlu(5), distinct from CPPHA, yet share a functional interaction with the MPEP site.
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Affiliation(s)
- Alexis S. Hammond
- Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee 37208
- Department of Pharmacology
| | | | | | | | | | - Craig W. Lindsley
- Department of Pharmacology
- Department of Chemistry
- Vanderbilt Program in Drug Discovery
| | - P. Jeffrey Conn
- Department of Pharmacology
- Department of Chemistry
- Vanderbilt Program in Drug Discovery
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Engers DW, Rodriguez AL, Williams R, Hammond AS, Venable D, Oluwatola O, Sulikowski GA, Conn PJ, Lindsley CW. Synthesis, SAR and unanticipated pharmacological profiles of analogues of the mGluR5 ago-potentiator ADX-47273. ChemMedChem 2009; 4:505-11. [PMID: 19197923 DOI: 10.1002/cmdc.200800357] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An iterative analogue library synthesis strategy rapidly developed comprehensive SAR for the mGluR5 ago-potentiator ADX-47273. This effort identified key substituents in the 3-position of oxadiazole that engendered either mGluR5 ago-potentiation or pure mGluR5 positive allosteric modulation. The mGluR5 positive allosteric modulators identified possessed the largest fold shifts (up to 27.9-fold) of the glutamate CRC reported to date as well as providing improved physiochemical properties.
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Affiliation(s)
- Darren W Engers
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232-6600, USA
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Hammond AS, Klein MR, Corrah T, Fox A, Jaye A, McAdam KP, Brookes RH. Mycobacterium tuberculosis genome-wide screen exposes multiple CD8 T cell epitopes. Clin Exp Immunol 2005; 140:109-16. [PMID: 15762882 PMCID: PMC1809330 DOI: 10.1111/j.1365-2249.2005.02751.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Mounting evidence suggests human leucocyte antigen (HLA) class I-restricted CD8(+) T cells play a role in protective immunity against tuberculosis yet relatively few epitopes specific for the causative organism, Mycobacterium tuberculosis, are reported. Here a total genome-wide screen of M. tuberculosis was used to identify putative HLA-B*3501 T cell epitopes. Of 479 predicted epitopes, 13 with the highest score were synthesized and used to restimulate lymphocytes from naturally exposed HLA-B*3501 healthy individuals in cultured and ex vivo enzyme-linked immunospot (ELISPOT) assays for interferon (IFN)-gamma. All 13 peptides elicited a response that varied considerably between individuals. For three peptides CD8(+) T cell lines were expanded and four of the 13 were recognized permissively through the HLA-B7 supertype family. Although further testing is required we show the genome-wide screen to be feasible for the identification of unknown mycobacterial antigens involved in immunity against natural infection. While the mechanisms of protective immunity against M. tuberculosis infection remain unclear, conventional class I-restricted CD8(+) T cell responses appear to be widespread throughout the genome.
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Affiliation(s)
- A S Hammond
- Bacterial Diseases Programme, Tuberculosis Division, Medical Research Council (MRC) Laboratories, Fajara, The Gambia
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Klein MR, Smith SM, Hammond AS, Ogg GS, King AS, Vekemans J, Jaye A, Lukey PT, McAdam KP. HLA-B*35-restricted CD8 T cell epitopes in the antigen 85 complex of Mycobacterium tuberculosis. J Infect Dis 2001; 183:928-34. [PMID: 11237810 DOI: 10.1086/319267] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2000] [Revised: 12/08/2000] [Indexed: 11/03/2022] Open
Abstract
Few target epitopes have been described for human CD8 T lymphocytes in antigens of Mycobacterium tuberculosis. By use of a reverse immunogenetics approach, 23 motif-bearing peptides of the Ag85 complex were tested for binding to HLA-B*35, one of the common B-types in West Africa. Three 9-mer peptides bound with high affinity to HLA-B*3501 and displayed low dissociation rates of peptide-major histocompatibility complexes (MHCs). IC(50) and half-life values of peptide-MHC class I complexes were in the same range as reported earlier for other immunogenic peptides. Immune responses against peptide Ag85C (aa 204-212) WPTLIGLAM were characterized in detail. Peptide-stimulated effector cells were able to kill macrophages infected with M. tuberculosis or bacille Calmette-Guérin. Peptide-specific CD8 T cells could be visualized by using HLA-B*3501 tetramers and were shown to produce interferon-gamma and tumor necrosis factor-alpha. Together with other published epitopes, these peptides can be used to study more closely the role of CD8 T cells in mycobacterial infection and tuberculosis.
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Affiliation(s)
- M R Klein
- Tuberculosis Research Programme, Medical Research Council Laboratories, Fajara, BANJUL, Gambia, West Africa.
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Benjamin JB, Szivek JA, Hammond AS, Kubchandhani Z, Matthews AI, Anderson P. Contact areas and pressures between native patellas and prosthetic femoral components. J Arthroplasty 1998; 13:693-8. [PMID: 9741448 DOI: 10.1016/s0883-5403(98)80015-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Contact areas and pressures between native patellas and a prosthetic condylar design femoral component were measured at flexion angles of 30 degrees, 60 degrees, and 90 degrees. These were compared to measurements obtained with a domed all-polyethylene patellar component. Mean native patellar contact areas were found to be fourfold greater than seen with the prosthetic patellar component. Contact stresses in the native patellas were below the yield strength of articular cartilage in 80% of the contact area. By contrast, stresses measured in the prosthetic patella exceeded the yield strength of ultrahigh molecular weight polyethylene in 64% of the measured contact area. Contact areas and stresses were not significantly effected by flexion angle. Although contact areas and stresses reflect only a part of the dynamics of the patellofemoral articulation this information would support the selective retention of the native patella in total knee arthroplasty.
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Affiliation(s)
- J B Benjamin
- Department of Surgery, The University of Arizona Health Sciences Center, Tucson, 85724-5064, USA
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Johnston MH, Hammond AS, Laskin W, Jones DM. The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy. Am J Gastroenterol 1996; 91:1507-11. [PMID: 8759651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To prospectively determine the prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus. Short segment is defined as extending less than 2 cm proximal to the esophagogastric junction. This has been referred to by some investigators as "short segment Barrett's esophagus." METHODS One hundred and seventy two patients undergoing elective esophagogastroduodenoscopy were consecutively enrolled. Patients with known Barrett's esophagus were excluded. All study patients completed a symptom questionnaire. At endoscopy, the presence of esophagitis and locations of the diaphragmatic hiatus, esophagogastric junction, and the squamocolumnar junction were recorded. Biopsy specimens were obtained at the squamocolumnar junction to identify specialized intestinal metaplasia and 2 cm above the squamocolumnar junction to evaluate for histological esophagitis. RESULTS Two patients (1.2%) had at least 2 cm of columnar-lined esophagus. Of the 170 patients without 2 cm of columnar-lined esophagus, 16 (9.4%) patients had short segments of specialized intestinal metaplasia. Twelve (7.0%) of these patients had specialized intestinal metaplasia limited to the esophagogastric junction. All patients with specialized intestinal metaplasia were Caucasian, and there was a slight male predominance. Patients without specialized intestinal metaplasia (n = 154, 90.6%) did not differ statistically with respect to age, gender, use of acid-suppressing drugs, alcohol, or smoking history. Pyrosis and regurgitation were significantly more common in patients with specialized intestinal metaplasia involving the distal 2 cm of the esophagus or the esophagogastric junction. Cough was more common in the group with specialized intestinal metaplasia limited to the esophagogastric junction. The groups were similar in frequency of dysphagia, globus sensation, nocturnal pyrosis, eructation, early satiety, nausea, and abdominal pain. CONCLUSIONS Specialized intestinal metaplasia less than 2 cm proximal to the esophagogastric junction is common in Caucasian patients undergoing routine esophagogastroduodenoscopy. Pyrosis and regurgitation are significantly more common in patients with short segments of specialized intestinal metaplasia, whether involving the distal 2 cm of the esophagus or the esophagogastric junction alone. Alcohol and tobacco use are no more common in patients with specialized intestinal metaplasia than in those without metaplasia. The presence of specialized intestinal metaplasia did not correlate with either endoscopic or histological esophagitis.
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Affiliation(s)
- M H Johnston
- Division of Gastroenterology, National Naval Medical Center, Bethesda, Maryland, USA
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