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Donney JF, Ghandour RM, Kogan MD, Lewin A. Family-Centered Care and Flourishing in Early Childhood. Am J Prev Med 2022; 63:743-750. [PMID: 35945092 DOI: 10.1016/j.amepre.2022.06.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Flourishing reflects a child's ability to cope with stress and have positive relationships, which are critical to health and well-being. Pediatricians may increase flourishing in children through family-centered care, which is perceived as sensitive and responsive to specific child needs and family circumstances. The purpose of this study was to examine the relationship between family-centered care and flourishing in young children. METHODS Data from the 2019-2020 National Survey of Children's Health were used to examine the relationship among children aged 1-5 years (n=17,826). The relationship was explored using chi-square tests and sequential logistic regression modeling, controlling for family socioeconomics and adversity, race/ethnicity, child health, and other measures of healthcare quality. Analyses were conducted in January 2022. RESULTS Approximately 82% of young children were flourishing. After adjusting for all variables, receipt of family-centered care was the only measure of quality health care associated with an increased likelihood of flourishing in young children (adjusted prevalence rate ratio=1.14; 95% CI=1.01, 1.29; p=0.02). Disparities in flourishing by child sex, race/ethnicity, parental education, income, and insurance type were mitigated after adjustment. However, a decreased likelihood of flourishing continued to be associated with having a special healthcare need (adjusted prevalence rate ratio=0.74; 95% CI=0.68, 0.82) and experiencing multiple adverse childhood experiences (adjusted prevalence rate ratio=0.78; 95% CI=0.66, 0.92). CONCLUSIONS Expanding receipt of family-centered care may support flourishing and help to reduce disparities in flourishing during early childhood. Future research should evaluate the strategies to overcome barriers to delivering and receiving family-centered care, especially among children with special healthcare needs and children who experienced multiple adverse childhood experiences.
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Affiliation(s)
- Julie Fife Donney
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Reem M Ghandour
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland
| | - Michael D Kogan
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland
| | - Amy Lewin
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
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Conway CA, Lewin A. Development and psychometric properties of the ACE-I: Measuring adverse childhood experiences among Latino immigrant youth. Psychol Trauma 2022; 14:1247-1255. [PMID: 35113626 DOI: 10.1037/tra0001223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Despite the well-established relationship between Adverse Childhood Experiences (ACEs) and health and well-being across the life course, there is a limited understanding of ACEs among diverse populations. The purpose of this study was to develop a new measure, the ACE-I, which consists of adversities that may be more relevant among immigrant populations, and to compare these rates to those of traditionally studied ACEs. METHOD Data for this study comes from a community sample of 338 Latino immigrant adolescents who completed an 11-item measure of traditional ACEs and a novel 13-item measure of immigrant-specific ACEs (ACE-I) as part of the intake process for a positive youth development program. RESULTS While the scores of the two ACEs measure were correlated (r = .16), immigrant youth, on average, reported more adversities on the ACE-I measure than the traditional ACEs measure (3.6 vs. 1.6). Overall, individual ACE-I items were more likely to be endorsed than traditional ACE items. Fit indexes from a confirmatory factor analysis suggested that the ACE-I hypothesized three-factor structure (experiences of violence/unrest in one's home country, danger encountered on the migration journey, and instability of life as an immigrant) represents a satisfactory solution. CONCLUSIONS These findings suggest that there are essential early adverse experiences for immigrants that have not previously been considered in ACEs research. Broadening our conceptualization and measurement of ACEs among immigrant populations could provide valuable insight into social determinants of health and avenues for intervention for immigrant youth and families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- C Andrew Conway
- Department of Family Science, School of Public Health, University of Maryland
| | - Amy Lewin
- Department of Family Science, School of Public Health, University of Maryland
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Caffrey N, Goldman M, Lewin A, Grégoire Y, Yi QL, O'Brien SF. Removing the men who have sex with men blood donation deferral: Informing risk models using Canadian public health surveillance data. Transfus Clin Biol 2022; 29:198-204. [PMID: 35987531 DOI: 10.1016/j.tracli.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Gay, bisexual and other men who have sex with men (gbMSM) were ineligible to donate blood in most countries since the 1980's. In Canada the deferral period has been incrementally decreased from lifetime to male-to-male sex in the last 3 months. Now a few countries have removed the deferral altogether. Risk models have been utilised to estimate the probability of an HIV positive donation being released into the blood supply and to inform incremental changes to the length of the deferral period. Here we use public health data to estimate the risk of HIV if the gbMSM deferral criteria were removed in Canada. MATERIAL AND METHODS We calculate the risk reduction among heterosexuals based on responses to standard risk questions routinely asked of donors. We assume gbMSM will donate at the same rate as heterosexual males. We apply the same risk reduction principle to HIV incidence and prevalence among gbMSM in the general population to evaluate the HIV risk without gbMSM time deferral. We model three scenarios where risk reduction is varied by assumptions about incidence and compliance with deferral criteria. RESULTS The estimates for all scenarios were not significantly different to the currently observed scenario which predicts a residual risk of 0.02 HIV positive per million donations (95% CI: 0.000006-0.09). CONCLUSION The models predict that removing the gbMSM deferral criteria would result in HIV residual risk similar to currently observed.
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Affiliation(s)
- N Caffrey
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada.
| | - M Goldman
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, K1H 8M5 Ottawa, Ontario, Canada.
| | - A Lewin
- Medical Affairs & Innovation, Héma-Québec 4045, boulevard de la Côte-Vertu, H4R 2W7 Saint-Laurent, QC, Canada.
| | - Y Grégoire
- Medical Affairs & Innovation, Héma-Québec 4045, boulevard de la Côte-Vertu, H4R 2W7 Saint-Laurent, QC, Canada.
| | - Q-L Yi
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada.
| | - S F O'Brien
- Donation Policy & Studies, Canadian Blood Services, K1G 4J5 Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, K1G 5Z3 Ottawa, Ontario, Canada.
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CLARK K, Joslin J, Gill C, Martin H, Lewin A, Tarft H, Smith P, Bramham K. POS-183 NEPHROCHECK AKI RISK SCORES IN PREGNANT AND NON-PREGNANT HEALTHY WOMEN. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Keogh R, Cosgriff R, Andrinopoulou ER, Brownlee K, Carr S, Diaz-Ordaz K, Granger E, Jewell N, Lewin A, Leyrat C, Schluter D, van Smeden M, Szczesniak R, Connett. G. WS08.6 Impact of triple therapy on IVantibiotic requirements in cystic fibrosis: combining evidence from a patient Registry and randomised trials. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Conway CA, Roy K, Hurtado Choque GA, Lewin A. Family separation and parent–child relationships among Latinx immigrant youth. Journal of Latinx Psychology 2020. [DOI: 10.1037/lat0000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wong A, Frøslev T, Dearing L, Forbes H, Mulick A, Mansfield K, Silverwood R, Kjærsgaard A, Sørensen H, Smeeth L, Lewin A, Schmidt S, Langan S. The association between partner bereavement and melanoma: cohort studies in the U.K. and Denmark. Br J Dermatol 2020; 183:673-683. [PMID: 32128788 PMCID: PMC7587014 DOI: 10.1111/bjd.18889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychological stress is commonly cited as a risk factor for melanoma, but clinical evidence is limited. OBJECTIVES This study aimed to evaluate the association between partner bereavement and (i) first-time melanoma diagnosis and (ii) mortality in patients with melanoma. METHODS We conducted two cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). In study 1, we compared the risk of first melanoma diagnosis in bereaved vs. matched nonbereaved people using stratified Cox regression. In study 2 we estimated hazard ratios (HRs) for death from melanoma in bereaved compared with nonbereaved individuals with melanoma using Cox regression. We estimated HRs separately for the U.K. and for Denmark, and then pooled the data to perform a random-effects meta-analysis. RESULTS In study 1, the pooled adjusted HR for the association between partner bereavement and melanoma diagnosis was 0·88 [95% confidence interval (CI) 0·84-0·92] across the entire follow-up period. In study 2, we observed increased melanoma-specific mortality in people experiencing partner bereavement across the entire follow-up period (HR 1·17, 95% CI 1·06-1·30), with the peak occurring during the first year of follow-up (HR 1·31, 95% CI 1·07-1·60). CONCLUSIONS We found decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement. These findings may be partly explained by delayed detection resulting from the loss of a partner who could notice skin changes. Stress may play a role in melanoma progression. Our findings indicate the need for a low threshold for skin examination in individuals whose partners have died. What is already known about this topic? Psychological stress has been proposed as a risk factor for the development and progression of cancer, including melanoma, but evidence is conflicting. Clinical evidence is limited by small sample sizes, potential recall bias associated with self-report, and heterogeneous stress definitions. What does this study add? We found a decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement. While stress might play a role in the progression of melanoma, an alternative explanation is that bereaved people no longer have a close person to help notice skin changes, leading to delayed melanoma detection. Linked Comment: Talaganis et al. Br J Dermatol 2020; 183:607-608.
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Affiliation(s)
- A.Y.S. Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - T. Frøslev
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Dearing
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - H.J. Forbes
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research UKLondonU.K
| | - A. Mulick
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - K.E. Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - R.J. Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Centre for Longitudinal StudiesDepartment of Social ScienceUniversity College LondonLondonU.K
| | - A. Kjærsgaard
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - H.T. Sørensen
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - L. Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research UKLondonU.K
| | - A. Lewin
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
| | - S.A.J. Schmidt
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of DermatologyAarhus University HospitalAarhusDenmark
| | - S.M. Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondonU.K
- Health Data Research UKLondonU.K
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Skracic I, Lewin A, Steinberg J. P77 Examining the association between experiences of reproductive coercion and current contraceptive use. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quinn DA, Lewin A. Family factors associated with emerging adults' human papillomavirus vaccine behavior. J Am Coll Health 2020; 68:528-535. [PMID: 30908148 DOI: 10.1080/07448481.2019.1583240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
Objective: The current study examined the role of family influences on the vaccine behavior of emerging adults. Participants: In Spring 2017, we conducted anonymous online surveys of undergraduate students (n = 608) at a large, public university in the mid-Atlantic. Methods: Logistic regression was used to examine associations between family factors and students' awareness of the HPV vaccine, vaccine receipt, and vaccine intentions. Family factors included sex communication, religiosity, parental monitoring, family structure, and parents' birthplace. Results: More comprehensive family sex communication is associated with less uncertainty regarding HPV vaccine receipt and greater likelihood of being already vaccinated. More frequent family religiosity and more parental monitoring are associated with greater likelihood of having decided against vaccination rather than already being vaccinated. Significant gender and racial disparities exist. Conclusion: Further research, policy, and programmatic intervention are needed to reduce disparities and to improve emerging adults' compliance with HPV vaccine recommendations.
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Affiliation(s)
- Deirdre A Quinn
- Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Amy Lewin
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, USA
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Abstract
This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.
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Affiliation(s)
- Julie Fife Donney
- Department of Family Science, School of Public Health, University of Maryland, College Park (Drs Donney and Lewin). Dr Mitchell is an Independent Research Consultant, Nashville, Tennessee
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Schwarz C, Lewin A, Schäfer H. WS02.4 Glycopeptidolipids of the Mycobacterium abscessus cell wall are immunodominant antigens and represent potential targets for a diagnostic assay. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Quinn DA, Mitchell SJ, Lewin A. The Role of Teen Mothers' Support Relationships in Maintenance of Contraceptive Use. J Pediatr Adolesc Gynecol 2017; 30:35-40. [PMID: 27565409 DOI: 10.1016/j.jpag.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 04/13/2016] [Revised: 07/29/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To explore interpersonal factors associated with maintaining contraceptive use over time among urban, African American teen mothers. DESIGN Longitudinal study, 2011-2015. SETTING Six pediatric primary care sites in the same city, all of which primarily serve urban, low-income, African American families. PARTICIPANTS Teen mothers accessing health services for their child at one of the six study sites. INTERVENTIONS The current study was a secondary data analysis of data that were collected as part of a patient-centered medical home model intervention, that compared a group of teen mothers and their children who were participants in the intervention with mother-child dyads who were enrolled in standard community-based pediatric primary care. Structured interviews were conducted with teen mothers at baseline/enrollment, when their children were, on average, 3 months old, and again 12 months later. MAIN OUTCOME MEASURES Maintenance of contraceptive use over time. RESULTS Teen mothers who perceived any tangible support from their own mothers were significantly less likely to maintain contraceptive use over time (adjusted odds ratio [AOR] = .27). However, teens who perceived any emotional support from their own mothers were nearly four times more likely to maintain contraceptive use (AOR = 3.74). Teens who lived with their own mothers were more than 5 times more likely to maintain contraceptive use over time (AOR = 5.49). CONCLUSION To better understand contraceptive discontinuation and thus to prevent repeat pregnancies among teen mothers, it might be necessary to further examine the role of support relationships in teen mothers' contraceptive decision-making. Secondary pregnancy prevention programs should include key support persons.
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Affiliation(s)
- Deirdre A Quinn
- University of Maryland School of Public Health, College Park, Maryland.
| | | | - Amy Lewin
- University of Maryland School of Public Health, College Park, Maryland
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Hodgkinson S, Godoy L, Beers LS, Lewin A. Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting. Pediatrics 2017; 139:peds.2015-1175. [PMID: 27965378 PMCID: PMC5192088 DOI: 10.1542/peds.2015-1175] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
Poverty is a common experience for many children and families in the United States. Children <18 years old are disproportionately affected by poverty, making up 33% of all people in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.
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Affiliation(s)
- Stacy Hodgkinson
- Children's National Health System, Washington, District of Columbia; and
| | - Leandra Godoy
- Children’s National Health System, Washington, District of Columbia; and
| | - Lee Savio Beers
- Children’s National Health System, Washington, District of Columbia; and
| | - Amy Lewin
- University of Maryland School of Public Health, College Park, Maryland
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Baral J, Schön MR, Ruppert R, Ptok H, Strassburg J, Brosi P, Kreis ME, Lewin A, Sauer J, Sawicki S, Schiffmann L, Winde G, Junginger T, Merkel S, Hermanek P. [Spincter preservation after selective chemoradiotherapy of rectal cancer. Interim results of the OCUM study]. Chirurg 2016; 86:1138-44. [PMID: 26347011 DOI: 10.1007/s00104-015-0083-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/12/2022]
Abstract
BACKGROUND In a prospective multicenter observational study (OCUM) neoadjuvant chemoradiotherapy (nRCT) was selectively administered depending on the risk of local recurrence and based on the distance between tumor and mesorectal fascia in pretherapeutic high-resolution magnetic resonance imaging (MRI). OBJECTIVE Frequency and quality of abdominoperineal excision (APE) and sphincter preserving operations. PATIENTS AND METHODS Of 642 patients treated in 13 hospitals 389 received surgery alone and 253 nRCT followed by surgery. By univariate and multivariate analysis risk factors for APE were determined. Quality parameters were the quality grade of mesorectal excision, the pathohistological involvement of the circumferential resection margin and intraoperative local dissemination of tumor cells. RESULTS AND DISCUSSION In 12.8 % of the patients APE was performed. Independent risk factors for APE were tumor location in the lower third of the rectum and the individual hospitals, where APE varied between 0 and 32 %. This variation was chiefly caused by the different case mix. Hospitals with a high APE rate (> 30 %) treated significantly more patients with very low lying carcinomas (< 3 cm above the anal verge) and more advanced tumors. The median height of the tumor in cases of APE was nearly equal in all participating hospitals. Independent on the number of cases the quality of rectal surgery was high. Within the patient groups of primary surgery and nRCT the oncological quality parameter did not significantly differ between sphincter preservation and APE. As far as sphincter preservation is concerned the results justify a selective application of nRCT in patients with rectal carcinoma. The long-term results still have to be awaited.
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Affiliation(s)
- J Baral
- Chirurgische Klinik, Städtisches Klinikum, Karlsruhe, Deutschland
| | - M R Schön
- Chirurgische Klinik, Städtisches Klinikum, Karlsruhe, Deutschland
| | - R Ruppert
- Klinik Neuperlach, Klinik für Allgemein- und Viszeralchirurgie, Endokrine Chirurgie und Coloproktologie, Städtische Kliniken München, München, Deutschland
| | - H Ptok
- Klinik für Chirurgie, Carl-Thiem-Klinik, Cottbus, Deutschland
| | - J Strassburg
- Abteilung für Allgemein- und Viszeralchirurgie, Vivantes-Klinik im Friedrichshain, Berlin, Deutschland
| | - P Brosi
- Chirurgische Klinik, Kantonspital Liestal, Liestal, Schweiz
| | - M E Kreis
- Chirurgische Klinik I, Charité Campus Benjamin Franklin, Berlin, Deutschland
| | - A Lewin
- Allgemein- und Viszeralchirurgie, Sanaklinikum Berlin Lichtenberg, Berlin, Deutschland
| | - J Sauer
- Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Klinikum Arnsberg, Arnsberg, Deutschland
| | - S Sawicki
- Franziskus Hospital Bielefeld, Bielefeld, Deutschland
| | - L Schiffmann
- Klinik für Allgemein-, Unfall- Viszeral- und Plastische Chirurgie, Ev. Krankenhaus Lippstadt, Lippstadt, Deutschland
| | - G Winde
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie und Proktologie, Klinikum Herford, Herford, Deutschland
| | - T Junginger
- Klinik für Allgemein- und Abdominalchirurgie, Universitätsmedizin Mainz, Langenbeckstr.1, 55131, Mainz, Deutschland.
| | - S Merkel
- Chirurgische Klinik, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Deutschland
| | - P Hermanek
- Chirurgische Klinik, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Deutschland
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Lewin A, Mitchell S, Beers L, Schmitz K, Boudreaux M. Improved Contraceptive Use Among Teen Mothers in a Patient-Centered Medical Home. J Adolesc Health 2016; 59:171-6. [PMID: 27448947 DOI: 10.1016/j.jadohealth.2016.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE The Generations program, a patient-centered medical home, providing primary medical care, social work, and mental health services to teen mothers and their children, offers a promising approach to pregnancy prevention for teen mothers. This study tested whether the Generations intervention was associated with improved rates of contraceptive and condom use among participants 12 months after program entry. METHODS This study compared teen mothers enrolled in Generations to those receiving standard community-based pediatric primary care over 12 months. Participants included African-American mothers ages 19 and younger, with infants under 6 months, living in Washington DC. A total of 83% of the baseline sample (150 mother-child dyads) was retained at follow-up. RESULTS Generations participants had over three times the odds of contraceptive use, with an odds ratio (OR) of 3.35, and twice the odds of condom use (OR = 2.29) after 12 months, compared to participants receiving standard pediatric care. The odds remained comparable and significant when adjusting for differences in baseline use. Once additional covariates were entered into the model, the association was reduced to OR = 2.59 because being in a relationship with the baby's father was significantly associated with reduced contraceptive use. The same pattern was evident for condom use. Mothers in Generations had steady use of contraceptives over time, but there was a decline in use among comparison mothers, indicating that Generations prevented contraceptive discontinuation. CONCLUSIONS Findings from this study suggest that the Generations program is an effective intervention for improving contraceptive use among teen mothers, a group at especially high risk for pregnancy.
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Affiliation(s)
- Amy Lewin
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.
| | - Stephanie Mitchell
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland
| | - Lee Beers
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | - Kristine Schmitz
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | - Michel Boudreaux
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland
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Patel S, De Fronzo R, Lewin A, Kaste R, Kohler S, Woerle HJ, Broedl UC. Safety and tolerability of combinations of empagliflozin/linagliptin for 52 weeks in patients with type 2 diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lewin A, Mitchell SJ, Waters D, Hodgkinson S, Southammakosane C, Gilmore J. The protective effects of father involvement for infants of teen mothers with depressive symptoms. Matern Child Health J 2016; 19:1016-23. [PMID: 25102809 DOI: 10.1007/s10995-014-1600-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/26/2022]
Abstract
The purpose of this study is to examine the role of father involvement on infant distress among children born to teen mothers, particularly those who are depressed. 119 teen mothers (<20 years) and their infants (<6 months) enrolled in a quasi-experimental trial of a comprehensive pediatric primary care program. Data were drawn from mother-reported questionnaires administered at baseline, before participation in the intervention or comparison conditions. 29 % of teen mothers screened positive for depression. Mothers reported that 78 % of fathers were engaged with their children, typically seeing them a few times per month, and 71 % took financial responsibility for their children. In a multiple linear regression, father responsibility predicted lower infant distress, maternal depression predicted higher infant distress, and there was a significant interaction in which father engagement buffered the effect of maternal depression on infant distress. Fathers may be a protective resource for children born to teen mothers, even as early as the first 6 months of life, potentially mitigating the heightened risk associated with maternal depression in the postpartum period.
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Affiliation(s)
- Amy Lewin
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, 301-405-4008, USA,
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Kreis ME, Ruppert R, Ptok H, Strassburg J, Brosi P, Lewin A, Schön MR, Sauer J, Junginger T, Merkel S, Hermanek P. Use of Preoperative Magnetic Resonance Imaging to Select Patients with Rectal Cancer for Neoadjuvant Chemoradiation--Interim Analysis of the German OCUM Trial (NCT01325649). J Gastrointest Surg 2016; 20:25-32; discussion 32-3. [PMID: 26556476 DOI: 10.1007/s11605-015-3011-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/24/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Introduction of total mesorectal excision (TME) surgery for rectal cancer decreased local recurrence dramatically. Additional neoadjuvant chemoradiation (nCR) is frequently given in UICC II and III tumors based on TNM staging which is of limited accuracy. We aimed to evaluate determination of circumferential margin by magnetic resonance imaging (mrCRM) as an alternative criterium for nCR. METHODS Multicenter prospective cohort study which enrolled 642 patients in 13 centers with non-metastasized rectal adenocarcinoma. Patients with T4 tumors or patients with a mrCRM of 1 mm or less were treated by neoadjuvant chemoradiation. All others proceeded directly to surgery when inclusion criteria and no exclusion criteria were met. Quality of TME and accuracy of mrCRM determination were assessed during pathology workup. RESULTS TME was complete in 381 of 389 patients after surgery without nCR (97.9%) and in 245 of 253 patients (96.8%) after nCR. Negative pathology circumferential margins (pCRM) were seen in 97.4% without nCR and in 89% of patients after nCR. Negative pCRM was predicted by negative mrCRM in 98.3% of rectal cancers. NCR was given to 253 of 642 patients (39.5%). Lymph node count was 23 (range 7-79; median/range) for surgery without nCR and 19 (range 2-56) for surgery after nCR. CONCLUSIONS Surgical quality determined by pathology workup of specimen was very good in this study. Magnetic resonance imaging guided indication for nCR allows to achieve superb results concerning surrogate parameters for good oncological outcome. Thus, use of neoadjuvant chemoradiation with its potential detrimental side effects may be substantially reduced in selected patients.
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Affiliation(s)
- Martin E Kreis
- Department of Surgery, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany.
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - R Ruppert
- Department of Surgery, Klinikum Neuperlach, Munich, Germany
| | - H Ptok
- Department of Surgery, Carl-Thiem-Klinikum, Cottbus, Germany
| | - J Strassburg
- Department of Surgery, Vivantes Klinikum Friedrichshain, Berlin, Germany
| | - P Brosi
- Kantonsspital Liestal, Chirurgische Klinik, Liestal, Switzerland
| | - A Lewin
- Allgemein- und Viszeralchirurgie, Sanaklinikum Lichtenberg, Berlin, Germany
| | - M R Schön
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum, Karlsruhe, Germany
| | - J Sauer
- Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Klinikum Arnsberg, Arnsberg, Germany
| | - T Junginger
- Chirurgische Klinik Universitätsklinikum Mainz, Mainz, Germany
| | - S Merkel
- Chirurgische Klinik Friedrich-Alexander-Universität Erlangen, Erlangen, Germany
| | - P Hermanek
- Chirurgische Klinik Friedrich-Alexander-Universität Erlangen, Erlangen, Germany
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Davies M, Bode B, Kushner R, Lewin A, Vang Skjøth T, Jensen CB, De Fronzo R, Kienhöfer J, Pfeiffer A. Liraglutide 3.0 mg for weight management in obese/overweight adults with Type 2 Diabetes: Results from the SCALE diabetes 56-week randomized, double-blind, placebo-controlled trial. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1556576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schwarz C, Hatzler L, Schäfer H, Lewin A. 50 A prospective study on non-tuberculous mycobacteria (NTM) in patients with CF. J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30227-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lewin A, Mitchell SJ, Hodgkinson S, Gilmore J, Beers LS. Pregnancy intentions among expectant adolescent couples. J Pediatr Adolesc Gynecol 2014; 27:172-6. [PMID: 24629716 DOI: 10.1016/j.jpag.2013.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/27/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To examine the self-reported pregnancy intentions of the male partners of expectant adolescent mothers, the accuracy of adolescent mothers' perceptions of their partner's pregnancy intentions, and the concordance between young mothers' and fathers' pregnancy intentions. DESIGN This cross-sectional pilot study collected interview data from expectant adolescent mothers and their male partners. SETTING Data were collected in participants' homes. PARTICIPANTS 35 expectant couples were interviewed separately. Most participants were African American (89% of mothers, 74% of fathers). 69% of mothers were 17-18 years old, and half of the fathers were ≥19. MAIN OUTCOME MEASURES Parents responded to survey questions adapted from the Center for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System Questionnaire. RESULTS 44% of fathers reported wanting their partner to get pregnant. Another 15% were ambivalent. A kappa statistic of 0.12 (P = .33) indicated very little "accuracy" of mothers' perceptions of their partners' pregnancy intentions. Further, there was low concordance between the pregnancy intentions of mothers and fathers. Young fathers who wanted or were ambivalent about pregnancy were significantly more likely to use no contraception or withdrawal. CONCLUSION For a notable number of minority couples, adolescent mothers do not have an accurate perception of their partners' pregnancy intentions and use contraceptive methods that are not within their control. These findings indicate that teen pregnancy prevention interventions must target young males in addition to females and sexually active adolescents should be encouraged to discuss pregnancy intentions with each other.
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Affiliation(s)
- Amy Lewin
- Center for Translational Science, Children's National Medical Center, Washington, DC.
| | - Stephanie J Mitchell
- Center for Translational Science, Children's National Medical Center, Washington, DC
| | - Stacy Hodgkinson
- Goldberg Center for Community Pediatrics, Children's National Medical Center, Washington, DC
| | - Jasmine Gilmore
- Goldberg Center for Community Pediatrics, Children's National Medical Center, Washington, DC
| | - Lee S Beers
- Goldberg Center for Community Pediatrics, Children's National Medical Center, Washington, DC
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Lahiri A, Kneisel J, Kloster I, Kamal E, Lewin A. Abundance of Mycobacterium avium ssp. hominissuis in soil and dust in Germany - implications for the infection route. Lett Appl Microbiol 2014; 59:65-70. [PMID: 24612016 DOI: 10.1111/lam.12243] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The nontuberculous mycobacteria (NTM) are a heterogeneous group of bacteria found in soil, water and dust. The spread of NTM infection depends on the exposure to reservoirs with high proportions of mycobacteria, the virulence of the NTM strains, the enhanced sensitivity to infections such as those of immune-compromised hosts and patient risk factors such as Cystic Fibrosis. Since several decades, NTM lung disease has been increasingly observed in slender postmenopausal women. The most important NTM in Germany is Mycobacterium avium ssp. hominissuis (MAH). The routes of MAH infection are in almost all cases unknown, but water is often suspected as source of infection. We wanted to examine this hypothesis by determining the frequency of MAH in environmental samples of water, biofilms, soil and dust originating from Germany. We found MAH in 33% of the dust samples and 20% of the soil samples. No MAH could be isolated from water and biofilm. Dust and soil clearly presented more abundance of MAH in comparison with water and biofilms. Therefore, more attention should be paid to soil and dust in Germany as an important source of Myco. avium infections. SIGNIFICANCE AND IMPACT OF THE STUDY This study was conducted to investigate the ecological abundance of the most prominent clinical nontuberculous mycobacteria (NTM) in Germany, the Mycobacterium avium ssp. hominissuis (MAH). Examination of soil, water, dust and biofilm samples revealed that MAH in Germany was predominant in soil and dust. No MAH was identified in water and biofilms. Our finding contributes to the identification of the environmental niche of this opportunistic pathogen and proposes soil and dust as sources of MAH infection in Germany.
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Affiliation(s)
- A Lahiri
- Division 16 Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
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Abstract
Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents' engagement in mental health treatment.
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Affiliation(s)
- Stacy Hodgkinson
- Diana L. and Stephen A. Goldberg Center for Community Pediatric Health, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010.
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Hodgkinson S, Lewin A, Chang B, Beers L, Silber T. Informed consent and the implications for statutory rape reporting in research with adolescents. Am J Bioeth 2014; 14:54-55. [PMID: 25229591 DOI: 10.1080/15265161.2014.947818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Lewin A, Jöbges M, Werheid K. The influence of self-efficacy, pre-stroke depression and perceived social support on self-reported depressive symptoms during stroke rehabilitation. Neuropsychol Rehabil 2013; 23:546-62. [DOI: 10.1080/09602011.2013.794742] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lewin A, Mitchell SJ, Ronzio CR. Developmental Differences in Parenting Behavior: Comparing Adolescent, Emerging Adult, and Adult Mothers. ACTA ACUST UNITED AC 2013. [DOI: 10.1353/mpq.2013.0003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Asian-American children are considered to be at low risk of obesity, but previous estimates have not distinguished between children from different Asian countries. We estimate the prevalence of obesity among Asian-American children by mother's country of origin, generational status, and family socioeconomic factors using a secondary analysis of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) wave III (children ∼4 years old) dataset. METHODS The ECLS-B is a nationally representative study of children born in 2001 that oversampled births to Asian mothers. Asian ethnic categories included Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese, and Other Asian/Pacific Islander. The primary outcome variable was weight status; overweight = BMI ≥85(th) and obese = BMI ≥95(th) percentile for age and gender. RESULTS Twenty-six percent [95% confidence interval (CI) 23.6-29.1] of Asian-American 4 year olds were overweight or obese, and 13% (95% CI 10.2-15.2) were obese. Chinese-American children were at lower risk of overweight or obesity (23.5%, 95% CI 18.4-29.5 ) compared to whites (36%, 95% CI 34.3-37.7); Asian-Indian 4 year olds had the lowest rates of overweight or obesity (15.6%, 95% CI 8.0-28.2) and were most likely to be underweight (10%, 95% CI 4.9-19.4). Among Asians,Vietnamese-American children had the highest rate of overweight or obesity (34.7%, 95% CI 0.6-52.3). CONCLUSIONS Vietnamese-American children are at elevated risk of obesity and overweight, whereas Chinese and Asian-Indian children are at low risk. After controlling for Asian ethnicity, maternal education, and household poverty status, Asian-American children whose mothers were born outside the United States were less likely to be obese [odds ratio = 0.55 (0.32-0.95), p = 0.03].
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Affiliation(s)
- Anjali Jain
- Lewin Group, 3130 Fairview Park Drive, Falls Church, VA 22042, USA.
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Abdel-Wahab M, Abitbol A, Elattar I, Mahmoud O, Troner M, Lewin A. Does Radiation Technique Influence Peg Dependence? A Comparison Between Intensity Modulated Radiation Therapy and 3- dimensional Conformal Techniques. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitchell SJ, Lewin A, Rasmussen A, Horn IB, Joseph JG. Maternal distress explains the relationship of young African American mothers' violence exposure with their preschoolers' behavior. J Interpers Violence 2011; 26:580-603. [PMID: 20448236 PMCID: PMC3104723 DOI: 10.1177/0886260510363423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Adolescent mothers and their children are particularly susceptible to witnessing or directly experiencing violence. Such violence exposure predicts maternal distress, parenting, and child behavior problems. The current study examined how mothers' depressive symptoms, aggression, harsh disciplinary practices, and home environment independently explain the association between mothers' violence exposure and children's externalizing and internalizing behavior, controlling for their children's violence exposure. Data were collected from 230 African American mothers living in Washington, DC who gave birth as adolescents and whose children were 3 to 5 years old. Path analysis revealed that the effect of mothers' experienced violence on children's externalizing and internalizing behavior was mediated by mothers' depressive symptoms and aggression. However, neither harsh discipline nor stimulation in the home environment acted as significant mediators, and there were no direct or indirect effects of mothers' witnessed violence on child behavior. This study builds on previous work by identifying an association between maternal violence exposure and children's behavior, independent of children's own violence exposure that is explained by mothers' increased distress but not their parenting. These findings suggest that a potential means of preventing behavior problems in minority children born to adolescent mothers is to identify mothers who have been directly exposed to violence and treat their depressive symptoms and aggressive behaviors.
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Huang ZJ, Lewin A, Mitchell SJ, Zhang J. Variations in the Relationship Between Maternal Depression, Maternal Sensitivity, and Child Attachment by Race/Ethnicity and Nativity: Findings from a Nationally Representative Cohort Study. Matern Child Health J 2010; 16:40-50. [DOI: 10.1007/s10995-010-0716-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lewin A. 29 THE IMPACT OF ULTRASOUND ON IVF SUCCESS IN 2010. Reprod Biomed Online 2010. [DOI: 10.1016/s1472-6483(10)62447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lewin A, Mitchell SJ, Rasmussen A, Sanders-Phillips K, Joseph JG. Do Human and Social Capital Protect Young African American Mothers From Depression Associated With Ethnic Discrimination and Violence Exposure? Journal of Black Psychology 2010. [DOI: 10.1177/0095798410381242] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young minority mothers are particularly vulnerable to depression associated with community-level or contextual stressors such as violence exposure and ethnic discrimination. This study explores whether human and social capital act as buffers of the associations between such stressors and maternal depression. Among a sample of 230 urban, African American mothers, who were teenagers when their preschool-age children were born, both being a victim of violence and experiencing ethnic discrimination predicted increased depressive symptoms, and higher educational attainment predicted fewer symptoms. Ethnic identity moderated the association between witnessed violence and maternal depression, and community cohesion moderated the association between ethnic discrimination and depression. Social support protected against depressive symptoms associated with witnessed violence but seemingly exacerbated depression associated with victimization. The specific roles that forms of human and social capital play in moderating the effects of contextual stressors suggest the need for nuanced programmatic efforts to reduce maternal depression among young African American mothers living in violence-prone, urban neighborhoods.
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Affiliation(s)
- Amy Lewin
- Children's National Medical Center, Washington, DC, USA,
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Mitchell SJ, Lewin A, Joseph JG. Exploring gender differences in the association between young African American mothers' reports of preschoolers' violence exposure and problem behavior. J Clin Child Adolesc Psychol 2010; 38:576-81. [PMID: 20183643 DOI: 10.1080/15374410902976346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prevalence of children's violence exposure, particularly among ethnic minorities living in urban areas, is troubling. Gender differences in the rates and effects of violence exposure on behavior have been found for older children, and the current study extends this research to preschool-age children. We draw on data collected from a sample of 3- to 5-year-olds born to 230 adolescent African American mothers living in Washington, DC. Girls and boys were exposed to comparable levels of witnessed and directly experienced violence. In contrast to findings from studies of older children, preschool-age boys' and girls' externalizing and internalizing behavior were comparably associated with directly experienced and witnessed violence. These findings highlight the importance of further developmental research to differentiate the effects of violence exposure as children grow older.
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Affiliation(s)
- Stephanie J Mitchell
- Center for Clinical and Community Research, Children's National Medical Center, USA.
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Mitchell SJ, Lewin A, Horn IB, Valentine D, Sanders-Phillips K, Joseph JG. How does violence exposure affect the psychological health and parenting of young African-American mothers? Soc Sci Med 2010; 70:526-33. [PMID: 19932932 PMCID: PMC2853478 DOI: 10.1016/j.socscimed.2009.10.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [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: 03/18/2009] [Indexed: 11/27/2022]
Abstract
Urban, minority, adolescent mothers are particularly vulnerable to violence exposure, which may increase their children's developmental risk through maternal depression and negative parenting. The current study tests a conceptual model of the effects of community and contextual violence exposure on the mental health and parenting of young, African-American mothers living in Washington, DC. A path analysis revealed significant direct effects of witnessed and experienced violence on mothers' depressive symptoms and general aggression. Experiences of discrimination were also associated with increased depressive symptoms. Moreover, there were significant indirect effects of mothers' violence exposure on disciplinary practices through depression and aggression. These findings highlight the range of violence young African-American mothers are exposed to and how these experiences affect their mental health, particularly depressive symptoms, and thus disciplinary practices.
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Raskin P, Lewin A, Reinhardt R, Lyness W. Twice-daily and three-times-daily dosing of a repaglinide/metformin fixed-dose combination tablet provide similar glycaemic control. Diabetes Obes Metab 2009; 11:947-52. [PMID: 19531054 DOI: 10.1111/j.1463-1326.2009.01069.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/30/2022]
Abstract
AIM To assess the efficacy and safety of a new repaglinide/metformin fixed-dose combination (FDC) tablet administered either twice a day (BID) or three times a day (TID) for the management of type 2 diabetes. METHODS This was a 26-week, multicentre, open-label parallel trial in which subjects poorly controlled with mono- or dual-oral antidiabetic therapy were randomized 1 : 1 : 1 to instead receive repaglinide/metformin FDC either BID or TID or a rosiglitazone/metformin FDC BID. Two primary hypotheses were tested in a hierarchical manner: (i) treatment with the repaglinide/metformin FDC BID is non-inferior to that of the rosiglitazone/metformin FDC BID as measured by changes in haemoglobin A1c (HbA1c) (results presented in companion paper) and (ii) repaglinide/metformin BID is non-inferior to repaglinide/metformin TID (as measured by changes in HbA1c). Additional efficacy and safety end-points were also assessed. RESULTS A total of 561 subjects were randomized; 383 completed the study. Repaglinide/metformin FDC BID was non-inferior to repaglinide/metformin FDC TID with respect to HbA1c. Additionally, changes in mean fasting plasma glucose values from baseline to end of study were not significantly different between the BID and the TID dose groups. There were no major hypoglycaemic episodes reported in either group during the trial, and overall adverse event profiles were similar. CONCLUSION The efficacy of twice-daily dosing of a repaglinide/metformin FDC tablet was non-inferior to that of three-times-daily dosing.
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Affiliation(s)
- P Raskin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8858, USA.
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Raskin P, Lewin A, Reinhardt R, Lyness W. Twice-daily dosing of a repaglinide/metformin fixed-dose combination tablet provides glycaemic control comparable to rosiglitazone/metformin tablet. Diabetes Obes Metab 2009; 11:865-73. [PMID: 19476470 DOI: 10.1111/j.1463-1326.2009.01062.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 11/28/2022]
Abstract
AIM To assess the use of a new repaglinide/metformin fixed-dose combination (FDC) tablet for the treatment of type 2 diabetes. METHODS In this 26-week, multicentre, open-label, parallel-group trial, subjects poorly controlled with mono- or dual-oral antidiabetic therapy were randomized 1 : 1 : 1 to receive a repaglinide/metformin FDC tablet either two times daily (BID) or three times daily (TID) or a rosiglitazone/metformin FDC tablet BID. The primary objective comprised two hypotheses tested in a hierarchical order: (i) that treatment with the repaglinide/metformin FDC BID is non-inferior to that of a rosiglitazone/metformin FDC tablet BID as measured by changes in haemoglobin A1c (HbA1c) (results presented here) and (ii) if true, that treatment with the repaglinide/metformin FDC BID was non-inferior to that of the repaglinide/metformin FDC TID as measured by changes in HbA1c (results presented in a companion paper). Additional efficacy and safety end-points were also assessed. RESULTS Of the 561 subjects randomized, 383 completed the study. Reductions in HbA1c values became apparent at earlier times for repaglinide/metformin FDC BID treatment than rosiglitazone/metformin FDC BID, and final changes in HbA1c were not significantly different between treatment arms (p = 0.8186); thus, the predefined statistical criterion for non-inferiority was met. Overall adverse event profiles were comparable between treatment groups, and no major hypoglycaemic episodes were reported during the study. CONCLUSIONS The repaglinide/metformin FDC BID regimen showed efficacy that was non-inferior to that of the rosiglitazone/metformin FDC BID regimen currently in clinical use and a more rapid reduction of HbA1c values. Thus, repaglinide/metformin FDC BID is a clinically feasible alternative to rosiglitazone/metformin FDC BID.
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Affiliation(s)
- P Raskin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8858, USA.
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Zinman B, Gerich JE, Buse JB, Lewin A, Schwartz SL, Raskin P, Hale PM, Zdravkovic M, Blonde L. Die Wirksamkeit des GLP-1 Analogons Liraglutid hinsichtlich von Blutzuckereinstellung und Gewichtsreduktion bei Patienten, die gleichzeitig mit Metformin und Rosiglitazon behandelt wurden: Eine randomisierte, doppelblinde, plazebokontrollierte Studie. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mitchell SJ, Lewin A, Horn IB, Rasmussen A, Sanders-Phillips K, Valentine D, Joseph JG. Violence exposure and the association between young African American mothers' discipline and child problem behavior. Acad Pediatr 2009; 9:157-63. [PMID: 19450775 PMCID: PMC2730742 DOI: 10.1016/j.acap.2009.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 01/21/2009] [Accepted: 02/02/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Children of adolescent mothers are at increased risk of violence exposure and behavior problems, which have been linked to mothers' disciplinary practices. This study examines how the effect of young African American mothers' discipline on their preschool-age children's externalizing and internalizing behavior varies by mother and child violence exposure. METHODS A sample of 230 African American mothers who gave birth as adolescents and their 3- to 6-year-old children were recruited from community-based day care and primary health care sites in the Washington, DC, metropolitan region. In-person interviews were conducted by trained research assistants who administered standard survey instruments. RESULTS Hierarchical regression models revealed an interaction effect such that adolescent mothers' harsh disciplinary practices, specifically physical discipline strategies, were positively associated with young children's internalizing and externalizing behavior in the context of high or moderate, but not low, maternal violence exposure. CONCLUSIONS Compared with less violence-exposed mothers, the harsh disciplinary practices of young African American mothers who have been exposed to high levels of violence are more strongly associated with their children's problem behavior. Practitioners should screen mothers for violence exposure in order to address potential issues of discipline and behavior problems.
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Affiliation(s)
- Stephanie J Mitchell
- Center for Clinical and Community Research, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, USA.
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Lewin A. Sonographic aspects in infertility treatment. Reprod Biomed Online 2008. [DOI: 10.1016/s1472-6483(11)60656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Goreau T, Fisher T, Perez F, Lockhart K, Hibbert M, Lewin A. Turks and Caicos Islands 2006 coral reef assessment: Large-scale environmental and ecological interactions and their management implications. REV BIOL TROP 2007. [DOI: 10.15517/rbt.v56i0.5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Older women comprise an increasing portion of patients entering assisted reproduction programmes. This study is a retrospective summary of the files of all patients aged 40 years and older at advent of IVF, between 1995 and 2004, in the authors' centre. In all, 381 women underwent 1217 initiated treatment cycles. Embryo transfer was performed in 62.6% of initiated cycles. Success rates declined with each year after age 40; pregnancy and delivery rates were 13.9 and 9.1% at age 40 and 2.8 and 0.7% at age 45. There were no deliveries at an older age. Logistic regression analysis showed the following factors were independently and significantly related to higher pregnancy rates: younger age, lower dose of gonadotrophins, greater number of mature follicles, endometrial thickness, and number of embryos transferred; prior pregnancy did not influence success. Retrieving more than four oocytes increased pregnancy rates in all women over 40. Transferring 3 embryos or more increased pregnancy rates in all ages, but reached statistical significance only in women aged 40-41 (P < 0.000). It is concluded that in women between 40 and 41 years of age, ovarian response is a major determinant of success, but not in women older than that. Unrealistic expectations may be avoided if accurate data are provided regarding delivery rates per year after age 40.
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Affiliation(s)
- A Tsafrir
- IVF Unit, Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Centres Ein-Kerem, PO Box 12000, Jerusalem 91120, Israel.
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Strassburg J, Lewin A, Ludwig K, Kilian L, Linke J, Loy V, Knuth P, Püttcher O, Ruehl U, Stöckmann F, Hackenthal M, Hopfenmüller W, Huppertz A. Optimised surgery (so-called TME surgery) and high-resolution MRI in the planning of treatment of rectal carcinoma. Langenbecks Arch Surg 2007; 392:179-88. [PMID: 17279430 DOI: 10.1007/s00423-007-0149-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 07/27/2006] [Accepted: 12/06/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since November 1998, we have applied the concept of total mesorectal excision (TME) to rectal carcinoma together with a standardised pathological quality assessment. Participation in the European MERCURY study [The MERCURY Study Group Radiology (in press), 2006] required us to establish the indication for neoadjuvant radiochemotherapy on the basis of an magnetic resonance imaging (MRI) scan. The aim of the present retrospective study is to evaluate the quality of the surgery, the efficacy of the MRI and the oncological outcomes achieved. MATERIALS AND METHODS Between November 2001 and October 2005, 68 out of 109 patients with carcinoma of the rectum were submitted to radical surgery in curative intent and 23/68 (34%) were given neoadjuvant therapy. In an interdisciplinary study group, each patient was evaluated pre-operatively and post-operatively using standardised MRI and histopathological methods. RESULTS The quality of surgery was established on the basis of the pathological examination of the surgical specimen. The rates of incomplete mesorectal excision, intra-operative tumour cell dissemination and positive circumferential margins were all low at 4%, 7% and 3%, respectively. The effectiveness of MRI proved to be greatest in predicting the tumour status at the circumferential resection margin: in the admittedly limited number of patients it proved possible to correctly predict the tumour status for every patient. The assessment of the anatomic extent of the primary tumour and of the regional lymph node metastasis according to the TNM system, in contrast, was considerably less successful at 73% and 75%, and 37% and 57%, respectively. CONCLUSION By applying the TME concept and MRI-based therapy planning, excellent results can be achieved and, at the same time, the number of patients requiring neoadjuvant treatment is considerably reduced.
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Affiliation(s)
- J Strassburg
- Klinik für Chirurgie/Visceralchirurgie, Vivantes-Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany.
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Horn IB, Lewin A, Turner-Musa J, Edwards MC, Joseph JG. The use of AAP-recommended disciplinary practice guidelines among African American caregivers of children in Head Start programs. Public Health Rep 2006; 121:324-30. [PMID: 16640157 PMCID: PMC1525287 DOI: 10.1177/003335490612100316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/17/2022] Open
Abstract
OBJECTIVE The American Academy of Pediatrics (AAP) recommends that parents not use harsh disciplinary practices. Previous studies have characterized the disciplinary practices of African American parents as harsh, with reliance on more aggressive techniques not currently recommended by the AAP. However, recent research has indicated more disciplinary practice diversity among African Americans. This study describes factors associated with the use of AAP-recommended disciplinary practices among lower-income African American caregivers of children in Head Start. METHODS Subjects were caregivers of children at three Head Start sites. Participants were eligible for inclusion if the biological mother, biological father, or target child was identified as African American. Using consensus methods, responses to the Parental Discipline Methods Interview (PDMI) were described as consistent or inconsistent with AAP guidelines regarding use of negative disciplinary practices (e.g., spanking, yelling). Caregivers avoiding any of these inconsistent methods were referred to as "adherent." RESULTS "Adherent" caregivers were older (32.5 years vs. 30.4 years) and had more education (86.0% vs. 75.4% high school graduates). They were also less likely to report that their child had behavioral problems (12.9% vs. 25.2%) or deficient social skills (1.7% vs. 8.0%). CONCLUSIONS Lower-income African American caregivers were more likely to use disciplinary practices consistent with AAP guidelines if they had higher levels of education and were living in an urban setting. Caregivers describing their child as having fewer behavior problems, better social skills, or themselves as less stressed were also more likely to be "adherent."
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Affiliation(s)
- Ivor B Horn
- Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, 2501 Good Hope Rd. SE, Washington, DC 20020, USA.
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Abstract
A characteristic feature of mycobacteria is their slow growth rate, which in addition strongly varies in different species of the genus. All highly pathogenic species such as M. tuberculosis and M. leprae causing tuberculosis and leprosy, respectively, belong to the slow growing mycobacteria, while the apathogenic and opportunistic species are members of the fast growing mycobacteria. This suggests that the question be posed whether there is causality between mycobacterial growth rate and virulence. We discuss possible reasons for the slow and variable growth rates of mycobacteria and the current state of knowledge concerning the significance of slow growth for mycobacterial pathogenicity.
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Affiliation(s)
- A Lewin
- Robert Koch-Institut, Berlin, Germany.
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Kliwinski C, Kukral D, Postelnek J, Krishnan B, Killar L, Lewin A, Nadler S, Townsend R. Prophylactic administration of abatacept prevents disease and bone destruction in a rat model of collagen-induced arthritis. J Autoimmun 2005; 25:165-71. [PMID: 16256307 DOI: 10.1016/j.jaut.2005.09.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [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: 06/09/2005] [Revised: 06/09/2005] [Accepted: 09/07/2005] [Indexed: 11/23/2022]
Abstract
Abatacept is the first in a new class of agents that selectively modulates T-cell activation by attenuating CD28-mediated co-stimulation. This study examined the effects of abatacept on disease development in a rat model of collagen-induced arthritis (CIA). The rats were treated with either abatacept (1mg/kg) or control IgG beginning at the time of induction of CIA. By day 16, significant paw swelling was observed in IgG-treated control animals that continued to increase, reaching a plateau on day 21. Prophylactic treatment with abatacept completely abrogated paw swelling throughout the study. Histopathology demonstrated a significant reduction in inflammation, cartilage destruction, bone resorption and pannus formation. Abatacept treatment resulted in 90% inhibition of circulating collagen-specific antibodies and decreased the serum expression of many cytokines and chemokines that were upregulated in diseased animals. Immunohistochemical analysis of the ankle joints demonstrated that interleukin-6 production was reduced in the tissues and the numbers of osteoclasts present in the joints were also decreased. Ankle microcomputer tomography (micro-CT) analyses dramatically demonstrated the protective effects of abatacept on bone destruction in these animals. Data presented here demonstrate that prophylactic administration of abatacept significantly inhibits the onset and progression of disease in a rat CIA model, with reductions in inflammation, inflammatory mediators, and bone and joint destruction.
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Affiliation(s)
- C Kliwinski
- Discovery Biology, Bristol-Myers Squibb, P.O. Box 4000, Princeton, NJ 08543, USA
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Gaudiani LM, Lewin A, Meneghini L, Perevozskaya I, Plotkin D, Mitchel Y, Shah S. Efficacy and safety of ezetimibe co-administered with simvastatin in thiazolidinedione-treated type 2 diabetic patients. Diabetes Obes Metab 2005; 7:88-97. [PMID: 15642080 DOI: 10.1111/j.1463-1326.2004.00420.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [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: 11/30/2022]
Abstract
AIM In patients with type 2 diabetes mellitus (T2DM), combination therapy is usually required to optimize glucose metabolism as well as to help patients achieve aggressive targets for low-density lipoprotein cholesterol (LDL-C) and other lipid parameters associated with cardiovascular risk. The thiazolidinediones (TZDs) are increasingly being used for both their blood glucose-lowering properties and their modest beneficial effects on triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Ezetimibe, an intestinal cholesterol absorption inhibitor, has a mechanism of action that differs from that of statins, which inhibit hepatic cholesterol synthesis. We compared the lipid-modifying efficacy and safety of adding ezetimibe to simvastatin, vs. doubling the dose of simvastatin, in TZD-treated T2DM patients. METHODS This was a randomized, double-blind, parallel group, multicentre study in T2DM patients, 30-75 years of age, who had been on a stable dose of a TZD for at least 3 months and had LDL-C > 2.6 mmol/l (100 mg/dl) prior to study entry. Other antidiabetic medications were also allowed. Following 6 weeks of open-label simvastatin 20 mg/day, patients were randomized to the addition of either blinded ezetimibe 10 mg/day (n = 104) or an additional blinded simvastatin 20 mg/day (total simvastatin 40 mg/day; n = 110) for 24 weeks. Patients were stratified according to TZD type and dose (pioglitazone 15-30 vs. 45 mg/day; rosiglitazone 2-4 vs. 8 mg/day). RESULTS LDL-C was reduced more (p < 0.001) by adding ezetimibe 10 mg to simvastatin 20 mg (-20.8%) than by doubling the dose of simvastatin to 40 mg (-0.3%). Ezetimibe plus simvastatin 20 mg also produced significant incremental reductions in non-HDL-C (p < 0.001), very low-density lipoprotein cholesterol (p < 0.05) and apolipoprotein B (p < 0.001) relative to simvastatin 40 mg. There were no differences between the groups with respect to changes in TG and HDL-C levels, and both treatments were well tolerated. CONCLUSIONS Co-administration of ezetimibe with simvastatin, a dual inhibition treatment strategy targeting both cholesterol synthesis and absorption, is well tolerated and provides greater LDL-C-lowering efficacy than increasing the dose of simvastatin in T2DM patients taking TZDs.
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Affiliation(s)
- L M Gaudiani
- Marin Endocrine Associates, Greenbrae, CA 94904, USA.
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Abstract
It is uncertain how long IVF units can keep frozen embryos. Few data exist on success of embryo transfer for embryos that have been cryopreserved for many years. We report the delivery of healthy twins following the transfer of embryos cryopreserved for 12 years. To the best of our knowledge, this is the longest reported successful human embryo freezing.
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Affiliation(s)
- A Revel
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein Kerem, PO Box 12000, Jerusalem 91120, Israel.
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