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Strouphauer E, Valenzuela-Flores C, Minhajuddin A, Slater H, Riddle DB, Pinciotti CM, Guzick AG, Hettema JM, Tonarelli S, Soutullo CA, Elmore JS, Gushanas K, Wakefield S, Goodman WK, Trivedi MH, Storch EA, Cervin M. The clinical presentation of major depressive disorder in youth with co-occurring obsessive-compulsive disorder. J Affect Disord 2024; 349:349-357. [PMID: 38199393 DOI: 10.1016/j.jad.2024.01.070] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth. METHODS A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis. RESULTS Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged. LIMITATIONS Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis. CONCLUSIONS Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD.
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Affiliation(s)
| | | | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA; Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David B Riddle
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Andrew G Guzick
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - John M Hettema
- Department of Psychiatry and Behavioral Sciences, Texas A&M Health Sciences Center, Bryan, TX, USA
| | - Silvina Tonarelli
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Cesar A Soutullo
- UT Health Houston, Louis A. Faillace MD Department of Psychiatry and Behavioral Sciences, Houston, TX, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kimberly Gushanas
- Department of Psychiatry, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Sarah Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wayne K Goodman
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Eric A Storch
- College of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Matti Cervin
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Minhajuddin A, Jha MK, Slater H, Mayes TL, Storch EA, Shotwell J, Soutullo C, Wakefield SM, Trivedi MH. Data-driven subgrouping of youths with depression reveals that resilience is associated with higher physical functioning despite high symptom burden in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). J Affect Disord 2024; 348:353-361. [PMID: 38110157 DOI: 10.1016/j.jad.2023.12.031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) measure, which assesses past week status of seven domains (physical function mobility, anxiety, depressive symptoms, fatigue, peer relationships, pain interference, and pain intensity), represents a new paradigm using patient-reported outcomes. We used a data-driven approach with PROMIS to identify subgroups of youths receiving depression treatment. METHODS Youths (n = 721) enrolled in the Texas Youth Depression and Suicide Research Network who completed the PROMIS were analyzed. Latent class analyses (LCAs) identified subgroups and compared their baseline clinical/sociodemographic features. RESULTS Compared to population norms, our sample had worse than average physical function, anxiety, depression, fatigue, and pain interference. Using LCA, four subgroups were identified: 1) lower symptom severity and higher physical functioning (14.6 %); 2) higher symptom burden, higher pain interference/intensity, and lower physical functioning (52.7 %); 3) higher symptom burden, higher pain interference/intensity, but with higher physical functioning (9.2 %); and 4) higher symptom burden, but lower physical functioning and pain interference/intensity (23.6 %). Group 3 demonstrated higher resilience than Group 2. In contrast, Group 2 had higher anxiety than Group 4. LIMITATIONS Individuals may have different symptom profiles due to the observational nature of the study. Replication of these subgroups may be difficult, as future samples may differ in these characteristics. Further work may demonstrate the stability of these groups. CONCLUSIONS A data-driven analysis identified a small but significant subgroup with high physical functioning despite high symptom burden and pain, and this group reported higher resilience. Resilience-enhancing interventions may help improve functional outcomes in depressed youth.
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Affiliation(s)
- Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish K Jha
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Cesar Soutullo
- Louise A. Faillace Department of Psychiatry and Behavioral Health, The University of Texas (UT Health) at Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Slater H, AlZubi Y, Rezaeizadeh A, Hughes JL, Gorman A, Mayes TL, Elmore JS, Storch EA, Wakefield SM, Trivedi MH. Characterizing Measurement-Based Care in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01653-3. [PMID: 38340213 DOI: 10.1007/s10578-023-01653-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/12/2024]
Abstract
Integration of measurement-based care (MBC) into clinical practice has shown promise in improving treatment outcomes for depression. Yet, without a gold standard measure of MBC, assessing fidelity to the MBC model across various clinical settings is difficult. A central goal of the Texas Youth Depression and Suicide Research Network (TX-YDSRN) was to characterize MBC across the state of Texas through the development of a standardized tool to assess the use of MBC strategies when assessing depression, anxiety, side effects, and treatment adherence. A chart review of clinical visits indicated standardized depression measures (71.2%) and anxiety measures (64%) were being utilized across sites. The use of standardized measures to assess medication adherence and side effects was limited to less than six percent for both, with the majority utilizing clinical interviews to assess adherence and side effects; yet medication was changed in nearly half. Rates of utilization of standardized measures for participants with multiple MBC forms were similar to those who only provided one form.
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Affiliation(s)
- Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Yasmin AlZubi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Afsaneh Rezaeizadeh
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - April Gorman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA.
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Goodman LC, Elmore JS, Mayes TL, Minhajuddin A, Slater H, Blader JC, Liberzon I, Baronia RB, Bivins EJ, LaGrone JM, Jackson S, Martin SL, Brown R, Soares JC, Wakefield SM, Trivedi MH. Linking trauma to mental health in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN). Psychiatry Res 2024; 331:115620. [PMID: 38091894 DOI: 10.1016/j.psychres.2023.115620] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/10/2023] [Accepted: 11/18/2023] [Indexed: 01/02/2024]
Abstract
Rates of youth depression and suicide are rising worldwide and represent public health crises. The present study examined the relationship between trauma history and symptoms of depression, suicidal ideation, and anxiety among suicidal and depressed youth. A diverse group of 1000 8-20-year-olds enrolled in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN) reported their trauma history (Traumatic Events Screening Inventory for Children) and symptoms of depression (Patient Health Questionnaire for adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder scale; GAD-7), and suicidality (Concise Health Risk Tracking scale; CHRT-SR). Nearly half of the sample reported exposure to multiple categories of traumatic experiences. Number of trauma exposure categories significantly predicted PHQ-A and GAD-7 scores. Exposure to interpersonal trauma and to sexual trauma were significantly associated with PHQ-A, GAD-7, and CHRT-SR scores. The number of trauma exposure categories was associated with increased levels of anxiety and depression; however, only exposure to interpersonal or sexual trauma was associated with more suicidality. Clinicians should assess trauma exposure in patients seeking psychiatric care, especially for interpersonal and sexual trauma, which may be predictive of increased risk for suicidality in depressed youth. Future work should disentangle the effects of specific trauma types from multiple trauma exposure.
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Affiliation(s)
- Lynnel C Goodman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Joseph C Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Regina B Baronia
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Emily J Bivins
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Sierra Jackson
- Office of Clinical Research, JPS Health Network, Fort Worth, TX, USA
| | - Sarah L Martin
- Department of Psychiatry, Texas Tech University Health Science Center El Paso, El Paso, USA
| | - Ryan Brown
- Department of Psychiatry & Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, UT Health Center of Excellence on Mood Disorders, UT Houston Medical School, Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Nandy K, Rush AJ, Carmody T, Kennard BD, Emslie GJ, Slater H, Mayes TL, DeFilippis M, Garza C, Storch EA, Wakefield SM, Trivedi MH. A Comparison of Depressive Symptom Self-Reported Measures in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). J Clin Psychiatry 2023; 85:23m14861. [PMID: 38127311 DOI: 10.4088/jcp.23m14861] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To evaluate psychometrically and provide crosswalks between 3 self-report measures of depressive symptomatology in youth in psychiatric care settings. Ratings included the Patient Health Questionnaire for Adolescents (PHQ-A), a widely used 9-item self-report; the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16); and the 5-item Very Quick Inventory of Depressive Symptomatology-Self-Report (VQIDS-SR5), a recent effort to create a bridge from the QIDS-SR16 to clinical practice. Methods: Data from the Texas Youth Depression and Suicide Research Network Registry (August 26, 2020-May 11, 2022) were included in this work. At first visit, 795 depressed or suicidal adolescent (12-20 years of age) psychiatric outpatients completed the PHQ-A, QIDS-SR16, and VQIDS-SR5. Classical test theory and item-response theory (IRT) analyses were conducted. Crosswalks among total scales were created. Sensitivity to change over 1-month follow-up was assessed for all 3 scales (n = 682). Results: Cronbach alphas were 0.86 (PHQ-A), 0.80 (QIDS-SR16), and 0.76 (VQIDS-SR5). Item total correlations were 0.49-0.72, 0.29-0.64, and 0.43-0.61, respectively. All 3 scales were unidimensional and sensitive to change over a 1-month period. IRT analyses revealed satisfactory item performance. Modest but significant associations were found between baseline to 1-month changes in PHQ-A and VQIDS-SR5 total scores (r = 0.50, P < .0001) and between PHQ-A and QIDS-SR16 total scores (r = 0.56; P < .0001). Categorical thresholds of severity (ie, mild, moderate, severe, and very severe) were comparable between PHQ-A and QIDS-SR16. Conclusions: The PHQ-A, QIDS-SR16, and VQIDS-SR5 are unidimensional, psychometrically acceptable self-reports of depressive prevalence or severity in adolescents and young adults in this sample. Total scale scores on any measure can be converted reliably to those on any other.
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Affiliation(s)
- Karabi Nandy
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - A John Rush
- Curbstone Consultant LLC, Santa Fe, New Mexico
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-National University of Singapore, Singapore
| | - Thomas Carmody
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Beth D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
- Children's Medical Center, Dallas, Texas
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
- Children's Medical Center, Dallas, Texas
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | | | - Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, School of Medicine, Edinburg
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine Houston Texas
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
- Corresponding Author: Madhukar H. Trivedi, MD, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119
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Trivedi MH, Minhajuddin A, Slater H, Baronia R, Blader JC, Blood J, Brown R, Claassen C, DeFilippis M, Farmer D, Garza C, Hughes JL, Kennard BD, Liberzon I, Martin S, Mayes TL, Soares JC, Soutullo CA, Storch EA, Wakefield SM. Texas Youth Depression and Suicide Research Network (TX-YDSRN) research registry and learning healthcare network: Rationale, design, and baseline characteristics. J Affect Disord 2023; 340:88-99. [PMID: 37459975 DOI: 10.1016/j.jad.2023.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/30/2022] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND American youth are seriously impacted by depression and suicide. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) Participant Registry Study was initiated in 2020 to develop predictive models for treatment outcomes in youth with depression and/or suicidality. This report presents the study rationale, design and baseline characteristics of the first 1000 participants. METHODS TX-YDSRN consists of the Network Hub (coordinating center), 12 medical school "Nodes" (manage/implement study), each with 1-5 primary care, inpatient, and/or outpatient Sub-Sites (recruitment, data collection). Participants are 8-20-year-olds who receive treatment or screen positive for depression and/or suicidality. Baseline data include mood and suicidality symptoms, associated comorbidities, treatment history, services used, and social determinants of health. Subsequent assessments occur every two months for 24 months. RESULTS Among 1000 participants, 68.7 % were 12-17 years, 24.6 % were ≥ 18 years, and 6.7 % were < 12. Overall, 36.8 % were non-Hispanic Caucasian, 73.4 % were female, and 79.9 % had a primary depressive disorder. Nearly half of the sample reported ≥1 suicide attempt, with rates similar in youth 12-17 years old (49.9 %) and those 18 years and older (45.5 %); 29.9 % of children <12 reported at least one suicide attempt. Depression and anxiety scores were in the moderate-severe range for all age groups (Patient Health Questionnaire for Adolescents [PHQ-A]: 12.9 ± 6.4; Generalized Anxiety Disorder [GAD-7]: 11.3 ± 5.9). LIMITATIONS The sample includes youth who are receiving depression care at enrollment and may not be representative of non-diagnosed, non-treatment seeking youth. CONCLUSIONS The TX-YDSRN is one of the largest prospective longitudinal cohort registries designed to develop predictive models for outcome trajectories based on disorder heterogeneity, social determinants of health, and treatment availability.
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Affiliation(s)
- Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Regina Baronia
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Joseph C Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jamon Blood
- University of Texas Health Science Center, Tyler, TX, USA
| | - Ryan Brown
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | | | - David Farmer
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Beth D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA
| | | | - Sarah Martin
- Texas Tech University Health Science Center, El Paso, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jair C Soares
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
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Kennard BD, Hughes JL, Minhajuddin A, Slater H, Blader JC, Mayes TL, Kirk C, Wakefield SM, Trivedi MH. Suicidal thoughts and behaviors in youth seeking mental health treatment in Texas: Youth Depression and Suicide Network research registry. Suicide Life Threat Behav 2023; 53:748-763. [PMID: 37530468 DOI: 10.1111/sltb.12980] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Suicidality in youth is a serious public health problem. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was initiated in 2020 to create a research registry for youth with depression and/or suicidality in Texas. This report presents baseline clinical/demographic characteristics of the first 1000 participants, focusing on suicidal thoughts and behaviors. METHODS The registry includes 8-20-year-old youth receiving treatment for depression, or who screen positive for depression and/or suicidal ideation/behavior. Baseline data include diagnosis, depression/anxiety severity, suicidal ideation/behavior, trauma history, and measures of resilience. RESULTS We present baseline data on the first 1000 participants. Most (79.6%) of the sample had a primary depressive disorder. The sample had moderate to severe depression (Patient Health Questionnaire for Adolescents, PHQ-A; 12.9 ± 6.4) and anxiety (Generalized Anxiety Disorder, GAD-7; 11.3 ± 5.9). Nearly half reported ≥1 lifetime suicide attempts and 90% reported lifetime or current suicidal ideation. Participants with past/current suicidality (attempts and/or ideation) had greater illness severity (depression, anxiety, and suicidal thoughts/behaviors), lower resilience, and higher rates of trauma exposure than those without suicidality. CONCLUSIONS Baseline data indicate moderate levels of depression, anxiety, and suicidality and their correlates in this cohort. Future reports will determine trajectories of outcomes and predictors, moderators, and social determinants related to these outcomes.
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Affiliation(s)
- Beth D Kennard
- The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph C Blader
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Kirk
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sarah M Wakefield
- The Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Riddle DB, Guzick A, Minhajuddin A, Smárason O, Armstrong GM, Slater H, Mayes TL, Goodman LC, Baughn DL, Martin SL, Wakefield SM, Blader J, Brown R, Goodman WK, Trivedi MH, Storch EA. Obsessive-compulsive disorder in youth and young adults with depression: Clinical characteristics of comorbid presentations. J Obsessive Compuls Relat Disord 2023; 38:100820. [PMID: 37521713 PMCID: PMC10373162 DOI: 10.1016/j.jocrd.2023.100820] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Obsessive-compulsive disorder (OCD), anxiety disorders, and depressive disorders are highly comorbid, and each contribute to significant functional impairment for affected youth. Comorbid anxiety disorders in depressed youth have been associated with greater depressive symptom severity and impairment, but the impact of comorbid OCD in this population remains unclear. Accordingly, the present study examined the differential clinical characteristics of youth with depression and comorbid OCD relative to age/gender matched depressed youth with no such comorbidity and to those with depression and a comorbid (non-OCD) anxiety disorder. A sample of 797 youth and young adults ages 8-20 years who met diagnostic criteria for depression alone, depression with co-occurring OCD or any anxiety disorder were included in the present study. Rates of comorbid anxiety and OCD were very high (60.5% and 15.5%, respectively). Relative to youth with only depression, depressed youth with comorbid OCD or anxiety had greater severity of depression, suicidality, and overall impairment in social, physical, and emotional functioning. These results highlight the contribution of OCD or anxiety comorbidity in more complex clinical presentations for depressed youth.
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Affiliation(s)
- David B Riddle
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Orri Smárason
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabrielle M Armstrong
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Holli Slater
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lynnel C Goodman
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Denise L Baughn
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Sarah L Martin
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Joseph Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Brown
- Department of Psychiatry and Behavioral Sciences, University of Texas, Austin, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Madhukar H Trivedi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Hughes JL, Trombello JM, Kennard BD, Slater H, Rezaeizadeh A, Claassen C, Wakefield SM, Trivedi MH. Suicide risk assessment and suicide risk management protocol for the Texas Youth Depression and Suicide Research Network. Contemp Clin Trials Commun 2023; 33:101151. [PMID: 37288070 PMCID: PMC10241872 DOI: 10.1016/j.conctc.2023.101151] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Suicide prevention research is a national priority, and national guidance includes the development of suicide risk management protocols (SRMPs) for the assessment and management of suicidal ideation and behavior in research trials. Few published studies describe how researchers develop and implement SRMPs or articulate what constitutes an acceptable and effective SRMP. Methods The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was developed with the goal of evaluating screening and measurement-based care in Texas youth with depression or suicidality (i.e., suicidal ideation and/or suicidal behavior). The SRMP was developed for TX-YDSRN through a collaborative, iterative process, consistent with a Learning Healthcare System model. Results The final SMRP included training, educational resources for research staff, educational resources for research participants, risk assessment and management strategies, and clinical and research oversight. Conclusion The TX-YDSRN SRMP is one methodology for addressing youth participant suicide risk. The development and testing of standard methodologies with a focus on participant safety is an important next step to further the field of suicide prevention research.
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Affiliation(s)
- Jennifer L. Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Joseph M. Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - Betsy D. Kennard
- The Peter O’Donnell Jr. Brain Institute, Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Afsaneh Rezaeizadeh
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Sarah M. Wakefield
- The Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
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Nandy K, Rush AJ, Slater H, Mayes TL, Minhajuddin A, Jha M, Blader JC, Brown R, Emslie G, Fuselier MN, Garza C, Gushanas K, Kennard B, Storch EA, Wakefield SM, Trivedi MH. Psychometric evaluation of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR 9) (a measure of suicidal risk) in adolescent psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN). J Affect Disord 2023; 329:548-556. [PMID: 36806661 DOI: 10.1016/j.jad.2023.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/30/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND This study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), a measure of suicidality, in adolescent psychiatric outpatients. METHODS Altogether, 933 depressed or suicidal adolescents (12-20 years of age), receiving treatment at psychiatric outpatient clinics in Texas, completed the 16-item CHRT-SR at baseline and one month later. CHRT-SR9 was extracted from CHRT-SR16 using multigroup confirmatory factor analysis. Sex and age measurement invariance, classical test theory, item response theory (IRT), and concurrent validity analyses (against the suicidal ideation Item 9 of Patient Health Questionnaire-Adolescent (PHQ-A)) were conducted. RESULTS The CHRT-SR9 demonstrated excellent model fit with four factors (pessimism, helplessness, despair, and suicidal thoughts). Measurement invariance was upheld. Acceptable item-total correlations (0.56-0.80) and internal consistency (Spearman-Brown 0.78-0.89) were revealed. IRT analyses showed a unidimensional instrument with excellent item performance. Using the CHRT-SR9 total score as a measure of overall suicidality and comparing it against levels of PHQ-A Item 9, the mean (standard deviation) of CHRT-SR9 total score was 8.64 (SD = 5.97) for no-risk (0 on Item 9), 17.05 (SD = 5.00) for mild, 23.16 (SD = 5.05) for moderate, and 26.96 (SD = 5.24) for severe-risk (3 on Item 9). Significant differences (p-value<0.0001) indicated that CHRT-SR9 total score distinguished between levels of suicidal risk. Furthermore, CHRT-SR9 was sensitive to change over a one-month period. LIMITATIONS Whether CHRT-SR9 predicts actual suicidal attempts in adolescents is not well defined. CONCLUSION The CHRT-SR9 is an easy-to-administer, user-friendly self-report with good psychometric qualities which makes it an excellent screening measure of suicidal risk in adolescent psychiatric outpatients.
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Affiliation(s)
- Karabi Nandy
- Division of Biostatistics, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - A John Rush
- Curbstone Consultant LLC, Santa Fe, NM, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Duke-National University of Singapore, Singapore
| | - Holli Slater
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Division of Biostatistics, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manish Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph C Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Brown
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Graham Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA
| | - Madeleine N Fuselier
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA
| | - Kim Gushanas
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, TX, USA
| | - Beth Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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11
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Jha MK, Minhajuddin A, Slater H, Mayes TL, Blader J, Brown R, Garza C, Kennard BD, Riddle D, Storch EA, Shotwell J, Soutullo CA, Wakefield SM, Trivedi MH. Psychometric properties of Concise Associated Symptom Tracking (CAST) scale in youths and young adults: Findings from the Texas youth depression and suicide research network (TX-YDSRN). J Psychiatr Res 2023; 161:179-187. [PMID: 36933444 DOI: 10.1016/j.jpsychires.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/03/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
Symptoms of irritability, anxiety, panic, and insomnia are common in patients with depression, and their worsening after antidepressant treatment initiation is associated with poorer long-term outcomes. The Concise Associated Symptom Tracking (CAST) scale was developed to measure these symptoms in adults with major depressive disorder (MDD). Here, we evaluate the psychometric properties of CAST in an ongoing community-based observational study involving children, adolescents, and young adults. Individuals from the ongoing Texas Youth Depression and Suicide Research Network (TX-YDSRN; N = 952) with CAST data available were included. Fit statistics [Goodness of Fit Index (GFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA)] from confirmatory factor analyses were used to evaluate the five- and four-domain structure of CAST. Item response theory (IRT) analyses were also used. Individuals were grouped based on age (in years) as youths (8-17) and young adults (18-20). Correlations with other clinical measures were used to inform construct validity. Four-domain (irritability, anxiety, panic, and insomnia) 12-item structure of CAST (CAST-12) was optimal for youths (N = 709, GFI = 0.906, CFI = 0.919, RMSEA = 0.095) and young adults (N = 243, GFI = 0.921, CFI = 0.938, RMSEA = 0.0797) with Cronbach's alpha of 0.87 and 0.88, respectively. Slope of each item exceeded 1.0 on IRT analyses suggesting adequate discrimination for each item. Scores on irritability, anxiety, panic, and insomnia were significantly correlated with similar items on other scales. Together these findings suggest that CAST-12 is a valid self-report measure of irritability, anxiety, insomnia, and panic in youths and young adults.
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Affiliation(s)
- Manish K Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA
| | - Joseph Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Brown
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA
| | - Beth D Kennard
- Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Riddle
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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12
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O’shea A, Drennan J, Littlewood C, Slater H, Sim J, Mcveigh J. POS0161-HPR BARRIERS AND FACILITATORS RELATED TO SELF-MANAGEMENT OF SHOULDER PAIN: A SYSTEMATIC REVIEW AND QUALITATIVE SYNTHESIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Shoulder pain is a significant cause of pain and disability in the general population.1 Current research suggests that shoulder pain can be resistant to treatment and is often recurrent.2 Systematic review-level evidence shows modest short-term benefits for most current treatments.3 Effective self-management strategies that equip patients with the necessary tools to self-manage their condition are urgently required. However, engagement with self-management is poor, potentially compromising treatment outcomes and contributing to ongoing disability.4Objectives:The objectives of this review were to:•Systematically identify and appraise relevant qualitative evidence on barriers and facilitators relating to self-management from the perspectives of people with shoulder pain and healthcare professionals.•Collate and synthesise this evidence, to gain an understanding of factors that influence self-management of shoulder pain.•Develop evidence-based recommendations to inform the implementation and delivery of self-management programmes for shoulder pain.Methods:A meta-aggregative approach to the synthesis of qualitative evidence was used. Twelve databases were searched, from inception to 13 July 2020, to identify studies exploring barriers and facilitators related to self-management of shoulder pain from the perspectives of people with shoulder pain and clinicians involved in the care of such patients. Two independent reviewers identified eligible articles, extracted the data and conducted critical appraisal. Two reviewers independently identified and developed categories, with validation by two further researchers. Categories were discussed among the wider research team and a comprehensive set of synthesized findings was derived.Results:Sixteen studies were included in the review, exploring several shoulder conditions: shoulder instability; rotator cuff-related pain; dysfunction post rotator cuff surgery; and degenerative rotator cuff tears. From the perspective of patients, three synthesized findings were identified that influenced self-management: (1) support for self-management, including subthemes related to patient-centred support, knowledge, time, access to equipment, and patient digital literacy; (2) personal factors, including patient beliefs, patient expectations, patient motivation, pain, and therapeutic response; and (3) external factors, including influence of the clinician and therapeutic approach. From the perspective of clinicians, two synthesized findings were identified that influenced adherence to self-management: (1) support for self-management, including education, patient-centred support, patient empowerment, time, and clinician digital literacy; and (2) preferred management approach, including clinician beliefs, expectations, motivation, therapeutic approach, and therapeutic response.Conclusion:Patients and clinicians identified several barriers and facilitators that influenced self-management of shoulder pain. Clinicians’ awareness of these factors could positively influence patient management, enhance patients’ ability to self-manage, and improve treatment outcomes.References:[1]Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis and Rheumatism. 2004;51(4): 642-651.[2]Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group. British Medical Journal. 1996;313(7057): 601-602.[3]Littlewood C, May S, Walters S. A review of systematic reviews of the effectiveness of conservative interventions for rotator cuff tendinopathy. Shoulder & Elbow. 2013;5(3): 151-167.[4]Littlewood C, Malliaras P, Mawson S, May S, Walters S. Patients with rotator cuff tendinopathy can successfully self-manage, but with certain caveats: a qualitative study. Physiotherapy. 2014;100(1): 80-85.Disclosure of Interests:Aidan O’Shea: None declared, Jonathan Drennan: None declared, Chris Littlewood: None declared, Helen Slater Speakers bureau: AbbVie PTY LTD 2018, Julius Sim: None declared, Joseph McVeigh: None declared
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, 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Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Abstract
BACKGROUND The painDETECT questionnaire (PD-Q) has been used widely for the identification of neuropathic pain (NeP); however, the reliability of the English version of the PD-Q has never been investigated. OBJECTIVE This study aimed to determine the reliability of the PD-Q pre- (T0) and immediately post- (T1) clinical consultation and at one-week follow-up (T2). METHODS We recruited 157 patients attending a Neurosurgery Spinal Clinic and Pain Management Department. Minor changes to PD-Q instructions were made to facilitate patient understanding; however, no changes to individual items or scoring were made. Intraclass correlation coefficients (ICCs) were used to assess the reliability of PD-Q total scores between T0-T1 and T0-T2; weighted kappa (κ) was used to assess the agreement of PD-Q classifications (unlikely NeP, ambiguous, likely NeP) between all time-points. To ensure stability of clinical pain, patients scoring ≤2 or ≥6 on the Patient Global Impression Scale (PGIC) at T2 were excluded from the T0-T2 analysis. RESULTS Accounting for missing data and exclusions (change in PGIC score), data for 136 individuals (mean [SD] age: 56.8 [15.2]; 54% male) was available, of whom n = 129 were included in the T0-T1 and n = 69 in the T0-T2 comparisons. There was almost perfect agreement between the PD-Q total scores at T0-T1 time-points (ICC 0.911; 95% CI: 0.882-0.941) and substantial agreement at T0-T2 (ICC 0.792; 95% CI: 0.703-0.880). PD-Q classifications demonstrated substantial agreement for T0-T1 (weighted κ: 0.771; 95% CI: 0.683-0.858) and for T0-T2 (weighted κ: 0.691; 95% CI: 0.553-0.830). Missing data was accounted in 13% of our cohort and over 42% of our patients drew multiple pain areas on the PD-Q body chart. CONCLUSION The English version of the PD-Q is reliable as a screening tool for NeP. The validity of the questionnaire is still in question and has to be investigated in future studies.
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Affiliation(s)
- B Tampin
- a Department of Physiotherapy , Sir Charles Gairdner Hospital , Perth , Western Australia
- b Department of Neurosurgery , Sir Charles Gairdner Hospital , Perth , Western Australia
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
- d Faculty of Business Management and Social Sciences , Hochschule Osnabrück, University of Applied Sciences , Osnabrück , Germany
| | - T Bohne
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - M Callan
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - M Kvia
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - A Melsom Myhre
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - E C Neoh
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
| | - C Bharat
- e Centre for Applied Statistics, University of Western Australia , Perth , Western Australia
- f Department of Research, Sir Charles Gairdner Hospital , Perth , Western Australia
| | - H Slater
- c School of Physiotherapy and Exercise Science, Faculty of Health Sciences , Curtin University , Perth , Western Australia
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15
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Tampin B, Lind C, Slater H. The Role of Sensory Parameters in Predicting Clinical Outcome after Lumbar Discectomy. physioscience 2016. [DOI: 10.1055/s-0035-1567074] [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: 10/22/2022]
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16
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Daly-Wolfe K, Moyer-Mileur L, Slater H, Browning S, Baserga M, Morrell G, Metos J, Jordan K. Subscapular Skinfold Thickness Is a Low-Cost Measure to Estimate Visceral Adiposity in Preterm Infants. J Acad Nutr Diet 2015. [DOI: 10.1016/j.jand.2015.06.052] [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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17
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Fary R, Slater H, Chua J, Ranelli S, Chan M, Briggs A. Workforce capacity building in management of rheumatoid arthritis: a randomised controlled trial and cohort study of web-based e-learning for physiotherapists. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.593] [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: 10/23/2022]
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18
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Gardner P, Slater H, Fary R, Jordan J, Chua J, Briggs A. Physiotherapy students’ perspectives of online learning for physiotherapy management of chronic health conditions. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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19
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Slater H, Davies S, Milne G, Kelso J, Slattery M, Briggs A. The painHEALTH website: a Western Australian policy-into-practice initiative to deliver holistic, consumer-focused best-evidence pain management for people with musculoskeletal pain. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1362] [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: 10/23/2022]
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21
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Loesch DZ, Bui MQ, Hammersley E, Schneider A, Storey E, Stimpson P, Burgess T, Francis D, Slater H, Tassone F, Hagerman RJ, Hessl D. Psychological status in female carriers of premutation FMR1 allele showing a complex relationship with the size of CGG expansion. Clin Genet 2015; 87:173-178. [PMID: 24428240 DOI: 10.111/cage12347] [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] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 05/24/2023]
Abstract
We utilized a sample of 299 adult females aged between 19 and 86 years, carrying fragile X mental retardation (FMR1) alleles with small CCG expansions ranging from 50 to 141 repeats to analyse the relationships between psychological symptoms as assessed by the Symptom Checklist-90-Revised (SCL-90-R) and the size of the CGG repeat in the FMR1 gene. There were highly significant (negative) correlations between the size of the CGG repeat and a great majority of SCL-90-R subscale scores and all the global indices, suggesting that carriers of premutations in the mid-size CGG repeat range may be at greatest risk for the development of psychiatric disorder.
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Affiliation(s)
- D Z Loesch
- School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia
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22
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Loesch DZ, Bui MQ, Hammersley E, Schneider A, Storey E, Stimpson P, Burgess T, Francis D, Slater H, Tassone F, Hagerman RJ, Hessl D. Psychological status in female carriers of premutation FMR1 allele showing a complex relationship with the size of CGG expansion. Clin Genet 2014; 87:173-8. [PMID: 24428240 DOI: 10.1111/cge.12347] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 11/28/2013] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 11/26/2022]
Abstract
We utilized a sample of 299 adult females aged between 19 and 86 years, carrying fragile X mental retardation (FMR1) alleles with small CCG expansions ranging from 50 to 141 repeats to analyse the relationships between psychological symptoms as assessed by the Symptom Checklist-90-Revised (SCL-90-R) and the size of the CGG repeat in the FMR1 gene. There were highly significant (negative) correlations between the size of the CGG repeat and a great majority of SCL-90-R subscale scores and all the global indices, suggesting that carriers of premutations in the mid-size CGG repeat range may be at greatest risk for the development of psychiatric disorder.
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Affiliation(s)
- D Z Loesch
- School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia
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23
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Martyn M, Anderson V, Archibald A, Carter R, Cohen J, Delatycki M, Donath S, Emery J, Halliday J, Hill M, Sheffield L, Slater H, Tassone F, Younie S, Metcalfe S. Offering fragile X syndrome carrier screening: a prospective mixed-methods observational study comparing carrier screening of pregnant and non-pregnant women in the general population. BMJ Open 2013; 3:e003660. [PMID: 24022395 PMCID: PMC3773647 DOI: 10.1136/bmjopen-2013-003660] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Fragile X syndrome (FXS) is the leading cause of inherited intellectual and developmental disability. Policy development relating to carrier screening programmes for FXS requires input from large studies examining not only test uptake but also psychosocial aspects. This study will compare carrier screening in pregnant and non-pregnant populations, examining informed decision-making, psychosocial issues and health economics. METHODS AND ANALYSIS Pregnant and non-pregnant women are being recruited from general practices and obstetric services. Women receive study information either in person or through clinic mail outs. Women are provided pretest counselling by a genetic counsellor and make a decision about testing in their own time. Data are being collected from two questionnaires: one completed at the time of making the decision about testing and the second 1 month later. Additional data are gathered through qualitative interviews conducted at several time points with a subset of participating women, including all women with a positive test result, and with staff from recruiting clinics. A minimum sample size of 500 women/group has been calculated to give us 88% power to detect a 10% difference in test uptake and 87% power to detect a 10% difference in informed choice between the pregnant and non-pregnant groups. Questionnaire data will be analysed using descriptive statistics and multivariate logistic regression models. Interview data will be thematically analysed. Willingness-to-pay and cost effectiveness analyses will also be performed. Recruitment started in July 2009 and data collection will be completed by December 2013. ETHICS AND DISSEMINATION Ethics approval has been granted by the Universities of Melbourne and Western Australia and by recruiting clinics, where required. Results will be reported in peer-reviewed publications, conference presentations and through a website http://www.fragilexscreening.net.au. The results of this study will make a significant contribution to discussions about the wider introduction of population carrier screening for FXS.
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Affiliation(s)
- M Martyn
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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24
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Abstract
OBJECTIVE To test the hypothesis that massage would improve autonomic nervous system (ANS) function as measured by heart rate variability (HRV) in preterm infants. STUDY DESIGN Medically stable, 29- to 32-week preterm infants (17 massage, 20 control) were enrolled in a masked, randomized longitudinal study. Licensed massage therapists provided the massage or control condition twice a day for 4 weeks. Weekly HRV, a measure of ANS development and function, was analyzed using SPSS generalized estimating equations. RESULTS Infant characteristics were similar between groups. HRV improved in massaged infants but not in the control infants (P<0.05). Massaged males had a greater improvement in HRV than females (P<0.05). HRV in massaged infants was on a trajectory comparable to term-born infants by study completion. CONCLUSION Massage-improved HRV in a homogeneous sample of hospitalized, medically stable, preterm male infants and may improve infant response to exogenous stressors. We speculate that massage improves ANS function in these infants.
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Affiliation(s)
- SL. Smith
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - R. Lux
- Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
| | - S. Haley
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - H. Slater
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - J. Beechy
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - LJ. Moyer-Mileur
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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25
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Briggs AM, Slater H, Smith AJ, Parkin-Smith GF, Watkins K, Chua J. Low back pain-related beliefs and likely practice behaviours among final-year cross-discipline health students. Eur J Pain 2012; 17:766-75. [PMID: 23139051 DOI: 10.1002/j.1532-2149.2012.00246.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Evidence points to clinicians' beliefs and practice behaviours related to low back pain (LBP), which are discordant with contemporary evidence. While interventions to align beliefs and behaviours with evidence among clinicians have demonstrated effectiveness, a more sustainable and cost-effective approach to positively developing workforce capacity in this area may be to target the emerging workforce. The aim of this study was to investigate beliefs and clinical recommendations for LBP, and their alignment to evidence, in Australian university allied health and medical students. METHODS Final-year students in chiropractic, medicine, occupational therapy, pharmacy and physiotherapy disciplines in three Western Australian universities responded to a survey. Demographic data, LBP-related beliefs data [modified Health Care Providers Pain and Impact Relationship Scale (HC-PAIRS) and the Back Pain Beliefs Questionnaire (BBQ)] and activity, rest and work clinical recommendations for an acute LBP clinical vignette were collected. RESULTS Six hundred two students completed the survey (response rate 74.6%). Cross-discipline differences in beliefs and clinical recommendations were observed (p > 0.001). Physiotherapy and chiropractic students reported significantly more helpful beliefs compared with the other disciplines, while pharmacy students reported the least helpful beliefs. A greater proportion of chiropractic and physiotherapy students reported guideline-consistent recommendations compared with other disciplines. HC-PAIRS and BBQ scores were strongly associated with clinical recommendations, independent to the discipline of study and prior experience of LBP. CONCLUSIONS Aligning cross-discipline university curricula with current evidence may provide an opportunity to facilitate translation of this evidence into practice with a focus on a consistent, cross-discipline approach to LBP management.
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Affiliation(s)
- A M Briggs
- Department of Health, Government of Western Australia, Perth, Australia.
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26
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Tampin B, Briffa N, Slater H. Self-reported sensory descriptors are associated with quantitative sensory testing parameters in patients with cervical radiculopathy, but not in patients with fibromyalgia. Eur J Pain 2012; 17:621-33. [DOI: 10.1002/j.1532-2149.2012.00227.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 01/22/2023]
Affiliation(s)
| | - N.K. Briffa
- School of Physiotherapy; Curtin Health Innovation Research Institute; Curtin University; Perth; Western Australia; Australia
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27
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Haley S, Beachy J, Ivaska KK, Slater H, Smith S, Moyer-Mileur LJ. Tactile/kinesthetic stimulation (TKS) increases tibial speed of sound and urinary osteocalcin (U-MidOC and unOC) in premature infants (29-32weeks PMA). Bone 2012; 51:661-6. [PMID: 22846674 PMCID: PMC3434881 DOI: 10.1016/j.bone.2012.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 05/03/2012] [Revised: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 11/17/2022]
Abstract
Preterm delivery (<37 weeks post-menstrual age) is associated with suboptimal bone mass. We hypothesized that tactile/kinesthetic stimulation (TKS), a form of infant massage that incorporates kinesthetic movement, would increase bone strength and markers of bone accretion in preterm infants. Preterm, AGA infants (29-32 weeks) were randomly assigned to TKS (N=20) or Control (N=20). Twice daily TKS was provided 6 days per week for 2 weeks. Control infants received the same care without TKS treatment. Treatment was masked to parents, health care providers, and study personnel. Baseline and week two measures were collected for tibial speed of sound (tSOS, m/sec), a surrogate for bone strength, by quantitative ultrasound (Sunlight8000) and urine markers of bone metabolism, pyridinium crosslinks and osteocalcin (U-MidOC and unOC). Infant characteristics at birth and study entry as well as energy/nutrient intake were similar between TKS and Control. TKS intervention attenuated the decrease in tSOS observed in Control infants (p<0.05). Urinary pyridinium crosslinks decreased over time in both TKS and CTL (p<0.005). TKS infants experienced greater increases in urinary osteocalcin (U-MidOC, p<0.001 and unOC, p<0.05). We conclude that TKS improves bone strength in premature infants by attenuating the decrease that normally follows preterm birth. Further, biomarkers of bone metabolism suggest a modification in bone turnover in TKS infants in favor of bone accretion. Taken together, we speculate that TKS improves bone mineralization.
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Affiliation(s)
- S Haley
- Center for Pediatric Nutrition Research, University of Utah, 295 Chipeta Way Salt Lake City, 84108 Utah, USA.
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28
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Abstract
The authors asserted the need for increased postvention efforts for suicide survivors, individuals left behind to grieve the loss of a loved one by suicide, because they have an increased risk for suicide. Indeed, Shneidman (1972) asserted that suicide postvention efforts serve the dual purpose of assisting survivors through the grief process and preventing suicide for future generations. First, the authors briefly discussed the increased risk for suicide among survivors. Second, the authors overviewed the potential benefits of postvention programs and current strategies for suicide postvention in the United States. Finally, they recommended plans for suicide postvention program development such as states should include efforts to create or expand traditional postvention services as well as active survivor outreach to link survivors to these services.
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Affiliation(s)
- Regina T P Aguirre
- School of Social Work, The University of Texas at Arlington, Arlington, Texas 76019, USA.
| | - Holli Slater
- School of Social Work, The University of Texas at Arlington, Arlington, Texas 76019, USA
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Tampin B, Briffa K, Slater H. 127 DETECTION OF ALTERED SENSATION IN FIBROMYALGIA PATIENTS — DO RESPONSES TO THE PAINDETECT QUESTIONNAIRE MATCH WITH QUANTITATIVE SENSORY TESTING? Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- B. Tampin
- School of Physiotherapy, Curtin University of Technology, Perth, Australia
| | - K. Briffa
- School of Physiotherapy, Curtin University of Technology, Perth, Australia
| | - H. Slater
- School of Physiotherapy, Curtin University of Technology, Perth, Australia
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Aballay AM, Recio P, Slater H, Goldfarb IW, Tolchin E, Papasavas P, Caushaj PF. The use of esmarch exsanguination for the treatment of extremity wound burns. Ann Burns Fire Disasters 2007; 20:22-24. [PMID: 21991062 PMCID: PMC3188049] [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] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Indexed: 05/31/2023]
Abstract
Tourniquets are routinely used during the excising and grafting of burn wounds located on the limbs in order to decrease blood loss. It has been postulated that the exsanguination of extremities by using Esmarch bandages might further reduce blood loss. However, there are concerns about a decrease in graft quality when Esmarch bandages are applied. The purpose of this prospective, double-blinded randomized study was to compare Esmarch application in addition to tourniquet (exsanguinated extremities) with the application of tourniquet alone. Thirty-eight excisions of bilateral extremity wounds were performed. Both limbs were tangentially excised after tourniquet application with one limb randomly chosen for prior Esmarch exsanguination. Blood loss was estimated during this procedure. Graft take was assessed twice: on post-operative days 3 and 7. The burn surface area and total area grafted were equivalent in the extremities with Esmarch bandages when compared to the extremities without them. Total blood loss was less in the extremities where Esmarch was applied. Graft take was similar in the two groups. Statistical analysis was performed with a two-tailed paired T-test. It is concluded that the use of Esmarch exsanguination in addition to tourniquet further reduces blood loss without affecting the quality of the engraftment.
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Affiliation(s)
- A M Aballay
- Department of Surgery, The Western Pennsylvania Hospital Burn Trauma Unit, Clinical Campus, Temple University School of Medicine, Pittsburgh, Pennsylvania, USA
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Juang D, Caushaj P, Caushaj P, Goldfarb I, Slater H, Tissue K, Aballay A. A single institution experience with fresh frozen plasma resuscitation of critically burned patients. Burns 2007. [DOI: 10.1016/j.burns.2006.10.043] [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: 11/17/2022]
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Woodward FI, Slater H. Cutting-edge international tree research in New Phytologist. New Phytol 2007; 173:661-663. [PMID: 17286813 DOI: 10.1111/j.1469-8137.2007.01993.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Juang D, Slater H, Goldfarb I, Papasavas P, Caushaj P. Functional outcome of immediate split thickness skin grafting of deep hand burns. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.395] [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: 11/26/2022]
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Huntington MA, Slater H, Wilkinson R, Hammond S, Winder S, Clarke KK, Chan GM, Moyer-Mileur LJ. 242 BONE AND BODY COMPOSITION IN INFANTS AND YOUNG CHILDREN: CROSS-VALIDATION OF NON-INVASIVE METHODS. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.241] [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: 11/18/2022]
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Huntington M, Slater H, Wilkinson R, Hammond S, Winder S, Clarke K, Chan G, Moyer-Mileur L. Bone and Body Composition in Infants and Young Children: Cross-Validation of Non-Invasive Methods. J Investig Med 2006. [DOI: 10.1177/108155890605401s125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - H. Slater
- Pediatrics, University of Utah, Salt Lake City, UT
| | - R. Wilkinson
- Pediatrics, University of Utah, Salt Lake City, UT
| | - S. Hammond
- Pediatrics, University of Utah, Salt Lake City, UT
| | - S. Winder
- Pediatrics, University of Utah, Salt Lake City, UT
| | - K.K. Clarke
- Pediatrics, University of Utah, Salt Lake City, UT
| | - G.M. Chan
- Pediatrics, University of Utah, Salt Lake City, UT
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Piazza-Waggoner C, Dotson C, Adams CD, Joseph K, Goldfarb IW, Slater H. Preinjury Behavioral and Emotional Problems Among Pediatric Burn Patients. ACTA ACUST UNITED AC 2005; 26:371-8; discussion 369-70. [PMID: 16006849 DOI: 10.1097/01.bcr.0000169890.84175.dd] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Standardized behavior rating scales have been used in the routine care of children during medical visits because they provide an objective, norm-based index for the child's behavioral functioning. The purpose of this study was to examine behavior problems among children (aged 2.5-18 years) with burn injuries using the Behavioral Assessment System for Children, a multi-informant system of standardized rating scales that assesses clinical and adaptive behavior areas. Parents and youth (ages 8-18) completed the Behavioral Assessment System for Children with reference to the pediatric patient's behavioral functioning before hospital admission for a burn injury. In total, data were collected on 94 children. Results suggested that a substantial portion of the sample endorsed significantly elevated levels of behavioral difficulties across a broad range of problem behaviors. On the basis of parent report, preschoolers exhibited concerns related to hyperactivity, anxiety, aggression, and attention problems, whereas school-aged children were reported to have these same concerns as well as depression and conduct problems. Twenty percent of our adolescent sample (ages 12-18 years) were described to be experiencing even more internalizing and externalizing behavior problems relative to the two groups of their younger counterparts. Boys were found to contribute to the cause of their burn injury significantly more often than girls. The strengths, limitations, and clinical implications of our findings are discussed.
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Affiliation(s)
- Carrie Piazza-Waggoner
- Cincinnati Children's Hospital Medical Center, MLC 3015, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Abstract
OBJECTIVE Deep vein thrombosis (DVT) represents a major cause of morbidity in surgical patients. Controversial reports exist on the incidence of DVT in burn patients. We report our experience over a 10-year period. METHODS Patients admitted to our Burn Unit over the period 1991-2001 and diagnosed with DVT were identified. Their records were retrospectively reviewed for demographic factors, extent and severity of burn injury and outcome. RESULTS A total of 4102 patients were admitted to the WPH Burn unit during the study period. All patients received routine subcutaneous heparin prophylaxis. Ten patients were diagnosed with DVT (0.25%). Compared to our total burn population, these patients were older (mean age 47 +/- 22.7 years versus 35 +/- 22 years P = 0.14) and had more extensive burns (mean total body surface area (TBSA) 34.7 +/- 25.3% versus 12 +/- 15.7% P = 0.02). Two patients developed non-fatal pulmonary embolism (PE). There were three deaths, none due to thromboembolic disease. There were no complications from the routine administration of subcutaneous heparin. CONCLUSION The incidence of DVT in our study is much less than the incidence reported in other critically ill patients and less than that of most reports on burn patients. In our experience, routine heparin prophylaxis is effective for the prevention of DVT in burn patients.
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Affiliation(s)
- A M Fecher
- Department of Surgery, Burn Trauma Unit, The Western Pennsylvania Hospital, Temple University School of Medicine, Clinical Campus, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
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Abstract
The purpose of this study was to assess the incidence of diagnosed sinusitis and the effect of diagnosis and treatment on the outcome in critically ill burn victims. Chart analysis of 84 consecutive burn victims requiring mechanical ventilation for greater than 7 days was performed. Sinusitis was diagnosed in 13/84 patients (15%). There was no difference in age or total body surface area burned, or the incidence of inhalation injury, ARDS, pneumonia and sepsis (P>0.05). Co-morbid disease was similar in both the groups. The number of ventilator-dependent days and hospital length of stay were higher in the sinusitis group (P<0.05). The hospital mortality in those diagnosed and treated for sinusitis was 23% (3/13) as opposed to 48% (34/71) in those not diagnosed with sinusitis (P<0.05). Increased number of ventilator-dependent days and longer hospital stay are associated with the diagnosis of sinusitis. Our findings suggest an improved survival in those diagnosed and treated for sinusitis.
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Affiliation(s)
- J T McCormick
- The Western Pennsylvania Hospital Burn Trauma Unit, Temple University School of Medicine Clinical Campus at the Western Pennsylvania Hospital, Pittsburgh, PA, USA
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Piazza-Waggoner C, Adams CD, Goldfarb IW, Slater H. An assessment of burn prevention knowledge in a high burn-risk environment: restaurants. J Burn Care Rehabil 2002; 23:342-50; discussion 341. [PMID: 12352137 DOI: 10.1097/00004630-200209000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our facility has seen an increase in the number of cases of children burned in restaurants. Fieldwork has revealed many unsafe serving practices in restaurants in our tristate area. The current research targets what appears to be an underexamined burn-risk environment, restaurants, to examine server knowledge about burn prevention and burn care with customers. Participants included 71 local restaurant servers and 53 servers from various restaurants who were recruited from undergraduate courses. All participants completed a brief demographic form as well as a Burn Knowledge Questionnaire. It was found that server knowledge was low (ie, less than 50% accuracy). Yet, most servers reported that they felt customer burn safety was important enough to change the way that they serve. Additionally, it was found that length of time employed as a server was a significant predictor of servers' burn knowledge (ie, more years serving associated with higher knowledge). Finally, individual items were examined to identify potential targets for developing prevention programs.
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Affiliation(s)
- Carrie Piazza-Waggoner
- Department of Psychology, PO Box 6040, West Virginia University, Morgantown, WV 26505, USA
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Adams CD, Girolami PA, Joseph KE, Sauvageot SA, Slater H. Use of a token reinforcement system to promote appropriate behavior at a pediatric burn summer camp. J Burn Care Rehabil 2002; 23:297-305; discussion 294-6. [PMID: 12142587 DOI: 10.1097/00004630-200207000-00015] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Child behavior management can be an important concern in conducting summer camps for pediatric burn patients, because many of these patients have a history of significant behavioral difficulties. To be efficient, a flexible camp-wide behavior management system, such as a token economy, would be ideal. In this article we discuss the concept and principles of a token reinforcement system and outline how this intervention was applied to our pediatric burn summer camp across 2 consecutive years. We also provide a description of modifications made for the second camp, based on counselor ratings of and our experience with the token system during the first camp. Results from counselor assessments indicated that after using the token system, counselors' perceptions of its utility (eg, effective in decreasing problem behavior in campers, useful in making behavior management easier) increased significantly across both years.
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Affiliation(s)
- C D Adams
- Morgantown, West Virginia, and Pittsburgh, Pennsylvania, USA
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Abstract
Analysis of 437 consecutive acute burn patients transported to our burn center revealed 339 transported by ground and 98 by helicopter. There were 18 air transport patients from within a 25-mile-radius, and 80 flown further than 25 miles. Mean age was the same in all groups (P>0.05). Percent total body surface area (TBSA) burned was 8.26% in ground transport patients, significantly less than the 20.35% (within 25 miles) and 21.40% (greater than 25 miles) seen in helicopter transports (P<0.0001). Three percent of ground transport patients and 28% of helicopter patients had inhalation injury (P<0.0001). There was no difference in incidence of inhalation injury among helicopter groups (28 vs. 29%, P=0.8). In patients with coexistent inhalation injury, the mean TBSA burned was significantly larger when compared with the TBSA of burns without inhalation injury (P<0.001). Air transported groups contained patients whose status was not critical based upon lack of inhalation injury and small burn size, and who could have been transported by ground. Non clinical factors such as insurance status, desire to keep ground ambulances in their community, and competing helicopter services reluctant to refuse to transport a patient appears to be factors in choosing air ambulance transportation. Regional single helicopter services and regional cooperative ground ambulance services should reduce use of helicopter transport of burn patients when it is not clinically indicated.
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Affiliation(s)
- H Slater
- The Western Pennsylvania Hospital, 4815 Liberty Avenue, Pittsburgh, PA 15224, USA.
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Daniel A, Wu Z, Bennetts B, Slater H, Osborn R, Jackson J, Pupko V, Nelson J, Watson G, Cooke-Yarborough C, Loo C. Karyotype, phenotype and parental origin in 19 cases of triploidy. Prenat Diagn 2001; 21:1034-48. [PMID: 11746161 DOI: 10.1002/pd.164] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The parental origin of triploidy in 19 cases was examined by inheritance of DNA microsatellites and by methylation patterns of SNRPN or PW71 (where parents' blood was unavailable). The fetal and placental morphology on these cases was reviewed. The phenotype of the fetuses with non-mosaic triploidy was assessed in relation to the two types described by McFadden and Kalousek. Of the diandric fetuses three of the six showed mild-to-moderate symmetrical growth retardation and the other three had growth characteristics in accordance with their gestational ages. This study would suggest the fetal triploid 'Type 1' definition be modified to 'well grown to moderate symmetrical IUGR' to allow for such variation. In the digynic fetuses (McFadden/Kalousek Type 2) there were poor growth characteristics with IUGR being more severe and asymmetrical. The diandric fetuses were as common as digynic fetuses in this series. The ratio of diandric to digynic specimens was 11:8 but if only fetal specimens (not embryos or mosaic children) were included the ratio was 6:5. Many diandric conceptions end as partial moles but later in gestation diandric fetuses may be well grown. It is proposed that there may be a survival barrier for diandric fetuses early in gestation (possibly based on the proportion of vascularised placental villi), although once this is passed the diandric fetuses are comparatively more viable and better grown than digynic fetuses. In the XXY triploid fetuses, 5/6 had hypoplastic or ambiguous external genitalia (two were recorded as of female phenotype) as has been reported previously. In these, the gonadal histology was testicular in all the diandrics but in the single digynic XXY case, sex reversal was complete with normal uterus and Fallopian tubes and the gonads were histologically ovaries. Two triploid/diploid mosaics were proven to be due to digyny. The probable cause is delayed incorporation of the second polar body into a blastomere and there was evidence of identical alleles from the same sperm being present in both diploid and triploid cells. In one of these triploid/diploid mosaics in which there was a termination of pregnancy (TOP) after prenatal karyotyping the diploid cell line had trisomy 16 which was not evident in the triploid line. This trisomy was probably of post-zygotic origin and we suggest the fetus was rescued by the prominence of the triploid line.
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Affiliation(s)
- A Daniel
- Department of Cytogenetics, The Children's Hospital at Westmead, Parramatta, NSW 2145, Australia.
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Vojnov AA, Slater H, Newman MA, Daniels MJ, Dow JM. Regulation of the synthesis of cyclic glucan in Xanthomonas campestris by a diffusible signal molecule. Arch Microbiol 2001; 176:415-20. [PMID: 11734884 DOI: 10.1007/s002030100341] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 05/21/2001] [Revised: 07/26/2001] [Accepted: 08/15/2001] [Indexed: 11/29/2022]
Abstract
The rpf gene cluster of Xanthomonas campestris pv. campestris is involved in the co-ordinate positive regulation of the production of extracellular enzymes and the extracellular polysaccharide xanthan. Several of the rpf genes are involved in a regulatory system involving the small diffusible molecule DSF (for diffusible signal factor). Synthesis of DSF requires RpfF, and a two-component sensory transduction system involving RpfC has been implicated in the perception of the signal and signal transduction. Here we show that mutations in both rpfF and rpfC lead to reductions in the levels of cyclic glucan. The levels of cyclic glucan synthetase in membrane preparations from rpfF and rpfC mutants were, however, unaltered from the wild-type. Similar alterations in the level of cyclic glucan without changes in cyclic glucan synthetase activity were seen when wild-type bacteria were exposed to osmotic stress. These results extend the range of cellular functions subject to regulation by the rpf genes and DSF system.
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Affiliation(s)
- A A Vojnov
- The Sainsbury Laboratory, John Innes Centre, Colney Lane, Norwich NR4 7UH, UK
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Abstract
It has become increasingly and widely recognised that bacteria do not exist as solitary cells, but are colonial organisms that exploit elaborate systems of intercellular communication to facilitate their adaptation to changing environmental conditions. The languages by which bacteria communicate take the form of chemical signals, excreted from the cells, which can elicit profound physiological changes. Many types of signalling molecules, which regulate diverse phenotypes across distant genera, have been described. The most common signalling molecules found in Gram-negative bacteria are N-acyl derivatives of homoserine lactone (acyl HSLs). Modulation of the physiological processes controlled by acyl HSLs (and, indeed, many of the non-acyl HSL-mediated systems) occurs in a cell density- and growth phase-dependent manner. Therefore, the term 'quorum-sensing' has been coined to describe this ability of bacteria to monitor cell density before expressing a phenotype. In this paper, we review the current state of research concerning acyl HSL-mediated quorum-sensing. We also describe two non-acyl HSL-based systems utilised by the phytopathogens Ralstonia solanacearum and Xanthomonas campestris.
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Affiliation(s)
- N A Whitehead
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Building O, Downing Site, CB2 1QW, Cambridge, UK
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Voullaire L, Saffery R, Earle E, Irvine DV, Slater H, Dale S, du Sart D, Fleming T, Choo KH. Mosaic inv dup(8p) marker chromosome with stable neocentromere suggests neocentromerization is a post-zygotic event. Am J Med Genet 2001; 102:86-94. [PMID: 11471179 DOI: 10.1002/1096-8628(20010722)102:1<86::aid-ajmg1390>3.0.co;2-t] [Citation(s) in RCA: 24] [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: 12/17/2022]
Abstract
Marker chromosomes containing active human neocentromeres have been described in individuals where the chromosomes are non-mosaic, suggesting that they are mitotically stable, but also in individuals where there is mosaicism, raising the possibility of neocentromere instability. We report two independently ascertained individuals who are mosaic for a supernumerary marker chromosome, shown by reverse chromosome painting to have an 8p origin, resulting in mosaicism for tetrasomy 8p23.1-->pter in the patient. The markers have a primary constriction but show no detectable centromeric alpha-satellite DNA. The marker in Patient 1 demonstrated no centromere protein CENP-B binding, but associated with nine different functionally critical centromere proteins. Investigation of peripheral blood lymphocytes from this patient on five separate occasions over a 13-year period showed 23-46% mosaicism for the marker chromosome with no decrease in incidence. In vitro investigation of primary and secondary sub-clones of a lymphoblast cell line derived from the patient demonstrated 100% stability of the marker chromosome indicating that neocentromere instability is unlikely to be responsible for the mosaicism in the patient. This and other available data support a general model of neocentromerization as a post-zygotic event, irrespective of whether the supernumerary chromosome fragment has arisen during meiosis or post-fertilization at mitosis.
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Affiliation(s)
- L Voullaire
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
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46
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Vojnov AA, Slater H, Daniels MJ, Dow JM. Expression of the gum operon directing xanthan biosynthesis in Xanthomonas campestris and its regulation in planta. Mol Plant Microbe Interact 2001; 14:768-74. [PMID: 11386372 DOI: 10.1094/mpmi.2001.14.6.768] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The gum gene cluster of Xanthomonas campestris pv. campestris comprises 12 genes whose products are involved in the biosynthesis of the extracellular polysaccharide xanthan. These genes are expressed primarily as an operon from a promoter upstream of the first gene, gumB. Although the regulation of xanthan synthesis in vitro has been well studied, nothing is known of its regulation in planta. A reporter plasmid was constructed in which the promoter region of the gum operon was fused to gusA. In liquid cultures, the expression of the gumgusA reporter was correlated closely with the production of xanthan, although a low basal level of beta-glucuronidase activity was seen in the absence of added carbon sources when xanthan production was very low. The expression of the gumgusA fusion also was subject to positive regulation by rpfF, which is responsible for the synthesis of the diffusible signal factor (DSF). The expression of the gumgusA fusion in bacteria recovered from inoculated turnip leaves was maximal at the later phases of growth and was subject to regulation by rpfF. These results provide indirect support for the operation of the DSF regulatory system in bacteria in planta.
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Affiliation(s)
- A A Vojnov
- The Sainsbury Laboratory, John Innes Centre, Norwich, UK
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Ilutovich S, Parafioriti E, Tórtora A, Slater H. Atherosclerosis: primary prevention. goal reaching. ATHEROSCLEROSIS SUPP 2001. [DOI: 10.1016/s1567-5688(01)80068-4] [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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Slater H, Alvarez-Morales A, Barber CE, Daniels MJ, Dow JM. A two-component system involving an HD-GYP domain protein links cell-cell signalling to pathogenicity gene expression in Xanthomonas campestris. Mol Microbiol 2000; 38:986-1003. [PMID: 11123673 DOI: 10.1046/j.1365-2958.2000.02196.x] [Citation(s) in RCA: 250] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The synthesis of extracellular enzymes and extracellular polysaccharide (EPS) in Xanthomonas campestris pv. campestris (Xcc) is regulated by a cluster of genes called rpf (for regulation of pathogenicity factors). Two of the genes, rpfF and rpfB, have previously been implicated in the synthesis of a diffusible regulatory molecule, DSF. Here, we describe a screen of transposon insertion mutants of Xcc that identified two DSF-overproducing strains. In each mutant, the gene disrupted is rpfC, which encodes a hybrid two-component regulatory protein in which the sensor and regulator domains are fused and which contains an additional C-terminal phosphorelay (HPt) domain. We show that rpfC is in an operon with rpfH and rpfG. The predicted protein RpfG has a regulatory input domain attached to a specialized version of an HD domain, previously suggested to function in signal transduction. The predicted protein RpfH is structurally related to the sensory input domain of RpfC. We show that RpfC and RpfG act positively to regulate the synthesis of extracellular enzymes and EPS, but that RpfC acts negatively to regulate the synthesis of DSF. We propose that RpfGHC is a signal transduction system that couples the synthesis of pathogenicity factors to sensing of environmental signals that may include DSF itself.
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Affiliation(s)
- H Slater
- The Sainsbury Laboratory, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
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Abstract
BACKGROUND Diagnosis of fragile X syndrome in mentally retarded individuals is satisfactorily achieved using a Southern blot test that detects the typical triplet repeat expansion (>200 repeats) within the FMR1 gene. All such individuals inherit the mutation from a carrier, who usually shows a lower triplet repeat number and may be asymptomatic. Having identified a fragile X proband, it is necessary to identify related carriers of this familial X-linked dominant mutation to provide family counseling and testing. METHODS AND RESULTS For one family in which a fragile XA repeat expansion occurs, Southern blot hybridization did not give accurate sizing data because of the very small premutation associated with the unstable allele. PCR sizing methods and linkage analysis were adapted to identify family members with the premutation. CONCLUSION Although most carriers can be detected using Southern blot and/or direct PCR sizing tests, very small expansions (55-70 repeats) are difficult to distinguish from larger, normal alleles. We have used linkage analysis in combination with direct allele analysis to identify carriers of very small expansions of a fragile X chromosome in a four-generation family.
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Affiliation(s)
- D Francis
- Cytogenetics Laboratory, Victorian Clinical Genetics Services, Royal Children's Hospital, Parkville, Victoria, Australia.
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Tortora A, Parafioriti E, Ilutovich S, Slater H. Plasma fibrinogen behavior during treatment of hypercholesterolemia with simvastatin. Atherosclerosis 2000. [DOI: 10.1016/s0021-9150(00)80167-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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