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Novak MD, Holtyn AF, Toegel F, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial. AIDS Behav 2024; 28:625-635. [PMID: 38117449 DOI: 10.1007/s10461-023-04249-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 12/21/2023]
Abstract
Achieving viral suppression in people living with HIV improves their quality of life and can help end the HIV/AIDS epidemic. However, few interventions have successfully promoted HIV viral suppression. The purpose of this study was to evaluate the long-term effectiveness of financial incentives for viral suppression in people living with HIV. People living with a detectable HIV viral load (≥ 200 copies/mL) were randomly assigned to Usual Care (n = 50) or Incentive (n = 52) groups. Incentive participants earned up to $10 per day for providing blood samples with an undetectable or reduced viral load. During the 2-year intervention period, the percentage of blood samples with a suppressed viral load was significantly higher among Incentive participants (70%) than Usual Care participants (43%) (OR = 7.1, 95% CI 2.7 to 18.8, p < .001). This effect did not maintain after incentives were discontinued. These findings suggest that frequent delivery of large-magnitude financial incentives for viral suppression can produce large and long-lasting improvements in viral load in people living with HIV. ClinicalTrials.gov Identifier: NCT02363387.
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Affiliation(s)
- Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
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2
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Novak MD, Toegel F, Holtyn AF, Rodewald AM, Arellano M, Baranski M, Barnett NP, Leoutsakos JM, Fingerhood M, Silverman K. Abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder: A randomized clinical trial. Prev Med 2023; 176:107655. [PMID: 37541600 PMCID: PMC10837308 DOI: 10.1016/j.ypmed.2023.107655] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023]
Abstract
This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting alcohol abstinence and employment in adults experiencing homelessness and alcohol use disorder. A randomized clinical trial was conducted from 2019 to 2022. After a 1-month Induction period, 119 participants were randomly assigned to a Usual Care Control group (n = 57) or an Abstinence-Contingent Wage Supplement group (n = 62). Usual Care participants were offered counseling and referrals to employment and treatment programs. Abstinence-Contingent Wage Supplement participants could earn stipends for working with an employment specialist and wage supplements for working in a community job but had to maintain abstinence from alcohol as determined by transdermal alcohol concentration monitoring devices to maximize pay. Abstinence-Contingent Wage Supplement participants reported significantly higher rates of alcohol abstinence than Usual Care participants during the 6-month intervention (82.8% vs. 60.2% of months, OR = 3.4, 95% CI 1.8 to 6.3, p < .001). Abstinence-Contingent Wage Supplement participants were also significantly more likely to obtain employment (51.3% vs. 31.6% of months, OR = 2.6, 95% CI 1.5 to 4.4, p < .001) and live out of poverty (38.2% vs. 16.7% of months, OR = 3.7, 95% CI 2.0 to 7.1, p < .001) than Usual Care participants. These findings suggest that Abstinence-Contingent Wage Supplements can promote alcohol abstinence and employment in adults experiencing homelessness and alcohol use disorder. ClinicalTrials.gov Identifier: NCT03519009.
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Affiliation(s)
- Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Psychological Science, Northern Michigan University, Marquette, MI, United States
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meghan Arellano
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mackenzie Baranski
- Department of Psychological Science, Northern Michigan University, Marquette, MI, United States
| | - Nancy P Barnett
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Manolopoulos A, Delgado-Peraza F, Mustapic M, Pucha KA, Nogueras-Ortiz C, Daskalopoulos A, Knight DD, Leoutsakos JM, Oh ES, Lyketsos CG, Kapogiannis D. Comparative assessment of Alzheimer's disease-related biomarkers in plasma and neuron-derived extracellular vesicles: a nested case-control study. Front Mol Biosci 2023; 10:1254834. [PMID: 37828917 PMCID: PMC10565036 DOI: 10.3389/fmolb.2023.1254834] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction: Alzheimer's disease (AD) is currently defined according to biomarkers reflecting the core underlying neuropathological processes: Aβ deposition, Tau, and neurodegeneration (ATN). The soluble phase of plasma and plasma neuron-derived extracellular vesicles (NDEVs) are increasingly being investigated as sources of biomarkers. The aim of this study was to examine the comparative biomarker potential of these two biofluids, as well as the association between respective biomarkers. Methods: We retrospectively identified three distinct diagnostic groups of 44 individuals who provided samples at baseline and at a mean of 3.1 years later; 14 were cognitively unimpaired at baseline and remained so (NRM-NRM), 13 had amnestic MCI that progressed to AD dementia (MCI-DEM) and 17 had AD dementia at both timepoints (DEM-DEM). Plasma NDEVs were isolated by immunoaffinity capture targeting the neuronal markers L1CAM, GAP43, and NLGN3. In both plasma and NDEVs, we assessed ATN biomarkers (Aβ42, Aβ40, total Tau, P181-Tau) alongside several other exploratory markers. Results: The Aβ42/Aβ40 ratio in plasma and NDEVs was lower in MCI-DEM than NRM-NRM at baseline and its levels in NDEVs decreased over time in all three groups. Similarly, plasma and NDEV-associated Aβ42 was lower in MCI-DEM compared to NRM-NRM at baseline and its levels in plasma decreased over time in DEM-DEM. For NDEV-associated proBDNF, compared to NRM-NRM, its levels were lower in MCI-DEM and DEM-DEM at baseline, and they decreased over time in the latter group. No group differences were found for other exploratory markers. NDEV-associated Aβ42/Aβ40 ratio and proBDNF achieved the highest areas under the curve (AUCs) for discriminating between diagnostic groups, while proBDNF was positively associated with Mini-Mental State Examination (MMSE) score. No associations were found between the two biofluids for any assessed marker. Discussion: The soluble phase of plasma and plasma NDEVs demonstrate distinct biomarker profiles both at a single time point and longitudinally. The lack of association between plasma and NDEV measures indicates that the two types of biofluids demonstrate distinct biomarker signatures that may be attributable to being derived through different biological processes. NDEV-associated proBDNF may be a useful biomarker for AD diagnosis and monitoring.
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Affiliation(s)
- Apostolos Manolopoulos
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Francheska Delgado-Peraza
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Maja Mustapic
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Krishna Ananthu Pucha
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Carlos Nogueras-Ortiz
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Alexander Daskalopoulos
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - De’Larrian DeAnté Knight
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Esther S. Oh
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dimitrios Kapogiannis
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD, United States
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Antonsdottir IM, Leoutsakos JM, Sloan D, Spliedt M, Johnston D, Reuland M, Lyketsos C, Amjad H, Samus QM. The associations between unmet needs with protective factors, risk factors and outcomes among care partners of community-dwelling persons living with dementia. Aging Ment Health 2023; 27:334-342. [PMID: 35321599 PMCID: PMC9508284 DOI: 10.1080/13607863.2022.2046698] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/18/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Describe the prevalence and types of unmet needs among community-dwelling dementia care partners (CPs) and determine associations between unmet needs with protective factors, risk factors and outcomes. METHOD A cross-sectional analysis of 638 racially and cognitively diverse community-dwelling persons living with dementia (PLWD) and their CPs participating in a comprehensive in-home assessment of dementia-related needs. Unmet CP needs (19 items, 6 domains) were rated by a clinician using the Johns Hopkins Dementia Care Needs Assessment (JHDCNA). Multivariate linear regression models were used to examine associations between total percent unmet CP needs with demographic, protective and risk factors. RESULTS Nearly all CPs had at least one unmet need (99.53%), with a mean of 5.7 (±2.6). The most common domains with ≥1 unmet need were memory disorder education, care skills and knowledge of resources (98%), legal issues/concerns (73.8%), CP mental health (44.6%) and access to informal support (42.7%). Adjusted multivariate models suggest the strongest consistent predictive factors relate to informal emotional support, CP physical health, use or difficulty getting formal services/supports (both for CPs and PLWD), and CP time spent with PLWD. Greater levels of unmet needs were associated with worse PLWD outcomes and CP outcomes, after adjusting for demographics. CONCLUSIONS CPs have high rates of diverse, but modifiable unmet needs. Data suggest optimal approaches to dementia care should take a family-centered home-based approach that includes routine CP needs assessment, offer targeted interventions that include both traditional medical supports as well as strategies to increase and leverage informal social networks, and ones that can bridge and coordinate medical with non-medical supports. These findings can be used to inform new approaches to support CPs, improve PLWD and CP outcomes, and target groups most at risk for inequities.
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Affiliation(s)
- Inga Margret Antonsdottir
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Danetta Sloan
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland, USA
| | - Morgan Spliedt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Melissa Reuland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Halima Amjad
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore Maryland, USA
| | - Quincy M. Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Nieman C, Morales EG, Leoutsakos JM, Lyketsos C, Oh E. HEARING LOSS, HEARING AID USE, AND NEUROPSYCHIATRIC SYMPTOMS IN DEMENTIA: FINDINGS FROM NACC. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Hearing loss is highly prevalent among persons living with dementia (PWD) and associated with an increased risk of neuropsychiatric symptoms (NPS), while hearing aid use may be protective. We analyzed data from the National Alzheimer’s Coordinating Center’s (NACC) uniform data set. We estimated the association between hearing loss and number or severity of NPS in a negative binomial regression adjusting for demographic and clinical characteristics. In the subsample with hearing loss, we estimated the association between hearing aid use and number or severity of NPS.10,054 participants were included with a mean age of 75 years. 2,416 (24%) self-reported hearing loss with 71% reporting 2+ NPS. In PWD and hearing loss, 1,325 (54.8%) reported hearing aid use. After a well-balanced matching, in adjusted models, hearing aid use was associated with fewer (IRR=0.82; 95%CI=0.77,0.87) and less severe NPS (IRR=0.74; 95%CI=0.69,0.80). Hearing aid use may represent an underutilized, non-pharmacological intervention to address NPS.
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Affiliation(s)
- Carrie Nieman
- Johns Hopkins University School of Medicine , Baltimore, Maryland , United States
| | | | | | | | - Esther Oh
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland , United States
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Pontone GM, Perepezko KM, Hinkle JT, Gallo JJ, Grill S, Leoutsakos JM, Mills KA, Weiss HD, Mari Z. 'Anxious fluctuators' a subgroup of Parkinson's disease with high anxiety and problematic on-off fluctuations. Parkinsonism Relat Disord 2022; 105:62-68. [PMID: 36371868 PMCID: PMC9722648 DOI: 10.1016/j.parkreldis.2022.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 09/14/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Anxiety that occurs in association with on-off dopamine medication fluctuations is a major cause of distress, dysfunction, and lower quality of life in people with Parkinson's disease (PD). However, the association between anxiety and on-off fluctuations is poorly understood and it is difficult to predict which patients will suffer from this atypical form of anxiety. To understand whether fluctuating anxiety in PD exists as part of an endophenotype that is associated with other signs or symptoms, we prospectively assessed the change in anxiety and a battery of clinical variables when transitioning from the off-dopamine medication state to the on state in 200 people with PD. We performed latent profile analysis with observed variables as latent profile indicators measuring the on-off-state difference in anxiety, depression, motor function, daily functioning, and the wearing off questionnaire 19 item scale (WOQ-19) in order to model unobserved (i.e., latent) profiles. A two-class model produced the best fit. The majority of participants, 69%, were categorized as having a 'typical on-off response' compared to a second profile constituting 31% of the sample who experienced a worsening in anxiety in the off state that was three times that of other participants. This profile referred to as "anxious fluctuators" had a Hamilton Anxiety Rating Scale change between the off and on medication state of 10.22(32.85) compared to 3.27 (7.62), higher depression scores, greater disability and was less likely to improve on select WOQ-19 items when in the on-state. Anxious fluctuators were more likely to be male and have a family history of anxiety disorder. Given the adverse impact of this profile we believe it may be important to distinguish patients with a typical on-off response from those with this more problematic course of fluctuations.
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Affiliation(s)
- Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Kate M Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jared T Hinkle
- Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph J Gallo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen Grill
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Parkinson's and Movement Disorder Center of Maryland, Baltimore, MD, USA
| | | | - Kelly A Mills
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Howard D Weiss
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic Nevada, Las Vegas, NV, USA
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Roy D, Ghosh A, Yan H, Leoutsakos JM, Rao V, Peters ME, Van Meter TE, Sair H, Falk H, Korley FK, Bechtold KT. Prevalence and Correlates of Depressive Symptoms Within 6 Months After First-Time Mild Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2022; 34:367-377. [PMID: 35306831 DOI: 10.1176/appi.neuropsych.21080207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depressive symptoms are among the most common neuropsychiatric sequelae of mild traumatic brain injury (mTBI). Very few studies have compared correlates of depressive symptoms within the first 6 months of injury in cohorts experiencing their first TBI. The authors investigated whether the correlates of depressive symptoms (being female, older, lower education, having brain lesions, experiencing worse postconcussive symptoms, and incomplete functional recovery) that have been established in populations with moderate to severe TBI were the same for individuals with first-time mTBI within the first 6 months of recovery. METHODS Two hundred seventeen individuals with first-time mTBI were divided into subgroups-new-onset depressive symptoms, recurrent depressive symptoms, prior depression history only, and never depressed-and compared on clinical and demographic variables and the presence of postconcussive symptoms and functional recovery at 3 and 6 months. RESULTS New-onset depressive symptoms developed in 12% of the cohort, whereas 11% of the cohort had recurrent depressive symptoms. Both depressive symptoms groups were more likely to comprise women and persons of color and were at higher risk for clinically significant postconcussive symptoms and incomplete functional recovery for the first 6 months postinjury. CONCLUSIONS Presence of depressive symptoms after first-time mTBI was associated with persistent postconcussive symptoms and incomplete functional recovery in the first 6 months. Adding to the existing literature, these findings identified correlates of depressive symptom development and poor outcomes after mTBI, thus providing further evidence that mTBI may produce persistent symptoms and functional limitations that warrant clinical attention.
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Affiliation(s)
- Durga Roy
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Anjik Ghosh
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Haijuan Yan
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Jeannie-Marie Leoutsakos
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Vani Rao
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Matthew E Peters
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Timothy E Van Meter
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Haris Sair
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Hayley Falk
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Frederick K Korley
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
| | - Kathleen T Bechtold
- Departments of Psychiatry and Behavioral Sciences (Roy, Yan, Leoutsakos, Rao, Peters) and Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University, Baltimore; Department of Pharmacology and Physiology, Georgetown University, Washington, DC (Ghosh); ImmunArray, Inc., Richmond, Virginia (Van Meter); University of Michigan Medical School, Ann Arbor (Falk, Korley)
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Pavlovic N, Abshire Saylor M, Ndumele CE, Dennison Himmelfarb CR, Lee CS, Szanton S, Leoutsakos JM. Abstract 80: Subtypes Of Fatigue In Heart Failure In The Atherosclerosis Risk In Communities Study. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Heart failure (HF) affects ~6 million people in the US and is associated with marked morbidity and adverse clinical outcomes. Among HF patients, fatigue is common and distressing symptoms that significantly impacts patient quality of life and function. Current literature primarily examines fatigue as a single and generalized symptom. Fatigue is hypothesized, however, to manifest as multiple types, with both general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve patient-reported and clinical outcomes.
Objective:
To identify unique fatigue subtypes in persons with prevalent HF in the Atherosclerosis Risk in Communities (ARIC) study.
Methods:
We performed a cross-sectional analysis of 1,114 participants at Visit 5 (2011-13) of the ARIC study with prevalent HF. We used the Modified Medical Research Council Breathlessness scale obtained at Visit 5 to assess exertional fatigue, and the PROMIS fatigue scale obtained at the 1
st
semi-annual follow up after Visit 5 (2012-2014) to assess general fatigue. We used latent class analysis to identify unique subtypes of fatigue based on patterns of responses to each of the scales.
Results:
Participants were 54% female and 38% Black with a mean age of 77 ± 5.5. We identified four latent classes of fatigue symptoms: 1) low/no fatigue, 2) high exertional & moderate general fatigue, 3) high general & low exertional fatigue, and 4) high general & exertional fatigue. The low/no fatigue class was the largest with an estimated 35.2% of the sample. The high exertional & moderate general class and the high general & low exertional class had similar estimated prevalences (23.5% and 23.8%, respectively). The high general & high exertional class was the smallest with an estimated 17.4% prevalence.
Conclusions:
We identified unique subtypes of fatigue in HF patients that have not been previously described in the literature. Future studies should examine the relationship between these latent classes of fatigue type and important patient-reported and clinical HF outcomes. Understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication in patients with HF.
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Eren E, Leoutsakos JM, Troncoso J, Lyketsos CG, Oh ES, Kapogiannis D. Neuronal-Derived EV Biomarkers Track Cognitive Decline in Alzheimer’s Disease. Cells 2022; 11:cells11030436. [PMID: 35159246 PMCID: PMC8834433 DOI: 10.3390/cells11030436] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022] Open
Abstract
The hallmarks of Alzheimer’s disease (AD) pathology are senile plaques containing amyloid-beta (Aβ) and neurofibrillary tangles containing hyperphosphorylated tau. Additional pathologies often co-exist, whereas multiple pathogenic mechanisms are involved in AD, especially synaptic degeneration, which necessitate the need for synaptic integrity-related biomarkers alongside Aβ- and tau-related biomarkers. Plasma neuron-derived Extracellular Vesicles EVs (NDEVs) provide biomarkers related to Aβ and tau and synaptic degeneration. Here, to further establish the latter as a “liquid biopsy” for AD, we examined their relationship with ante-mortem cognition in pathologically-confirmed AD cases. We immunoprecipitated NDEVs by targeting neuronal marker L1CAM from ante-mortem plasma samples from 61 autopsy-confirmed cases of pure AD or AD with additional pathologies and measured Aβ42, p181-Tau, total Tau, synaptophysin, synaptopodin and three canonical EV markers, CD63, CD81 and CD9. Higher NDEV Aβ42 levels were consistently associated with better cognitive status, memory, fluency, working memory and executive function. Higher levels of NDEV synaptic integrity-related biomarkers were associated with better performance on executive function tasks. Our findings motivate the hypothesis that releasing Aβ42-laden NDEVs may be an adaptive mechanism in AD.
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Affiliation(s)
- Erden Eren
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD 21224, USA;
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (J.-M.L.); (C.G.L.)
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Juan Troncoso
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (J.-M.L.); (C.G.L.)
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Esther S. Oh
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Correspondence: (E.S.O.); (D.K.)
| | - Dimitrios Kapogiannis
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD 21224, USA;
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA;
- Correspondence: (E.S.O.); (D.K.)
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10
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Avramopoulos D, Kapogiannis D, Leoutsakos JM, Lyketsos CG, Mahairaki V, Nowrangi M, Oishi K, Oh ES, Rosenberg PB, Samus Q, Smith GS, Witwer K, Yasar S, Zandi PP. Developing Treatments for Alzheimer's and Related Disorders with Precision Medicine: A Vision. Adv Exp Med Biol 2022; 1339:395-402. [PMID: 35023131 DOI: 10.1007/978-3-030-78787-5_49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Precision medicine, also known as personalized medicine, is concerned with finding the right treatment for the right patient at the right time. It is a way of thinking focused on parsing heterogeneity ultimately down to the level of the individual. Its main mission is to identify characteristics of heterogeneous clinical conditions so as to target tailored therapies to individuals. Precision Medicine however is not an agnostic collection of all manner of clinical, genetic and other biologic data in select cohorts. This is an important point. Simply collecting as much information as possible on individuals without applying this way of thinking should not be considered Precision Medicine.
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Affiliation(s)
- Dimitrios Avramopoulos
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dimitrios Kapogiannis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Intramural Research Program, National Institute on Aging (NIA/NIH), Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Vasiliki Mahairaki
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Milap Nowrangi
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kenichi Oishi
- Departments of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Esther S Oh
- Departments of Medicine (Geriatric Medicine and Gerontology), School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul B Rosenberg
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Quincy Samus
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gwenn S Smith
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth Witwer
- Departments of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sevil Yasar
- Departments of Medicine (Geriatric Medicine and Gerontology), School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Peter P Zandi
- Departments of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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11
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Stuart EA, Schmid I, Nguyen T, Sarker E, Pittman A, Benke K, Rudolph K, Badillo-Goicoechea E, Leoutsakos JM. Assumptions Not Often Assessed or Satisfied in Published Mediation Analyses in Psychology and Psychiatry. Epidemiol Rev 2022; 43:48-52. [PMID: 34550343 PMCID: PMC8900288 DOI: 10.1093/epirev/mxab007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/09/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Mediation analysis aims to investigate the mechanisms of action behind the effects of interventions or treatments. Given the history and common use of mediation in mental health research, we conducted this review to understand how mediation analysis is implemented in psychology and psychiatry and whether analyses adhere to, address, or justify the key underlying assumptions of their approaches. All articles (n = 206) were from top academic psychiatry or psychology journals in the PsycInfo database and were published in English from 2013 to 2018. Information extracted from each article related to study design, covariates adjusted for in the analysis, temporal ordering of variables, and the specific method used to perform the mediation analysis. In most studies, underlying assumptions were not adhered to. Only approximately 20% of articles had full temporal ordering of exposure, mediator, and outcome. Confounding of the exposure-mediator and/or mediator-outcome relationships was controlled for in fewer than half of the studies. In almost none of the articles were the underlying assumptions of their approaches discussed or causal mediation methods used. These results provide insights to how methodologists should aim to communicate methods, and motivation for more outreach to the research community on best practices for mediation analysis.
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Affiliation(s)
- Elizabeth A Stuart
- Correspondence to Dr. Elizabeth A. Stuart, Johns Hopkins Bloomberg School of Public Health, Hampton House Room 839, 624 N. Broadway, Baltimore, MD, 21205 (e-mail: )
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12
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Cohen LM, Ash E, Outen JD, Vandrey R, Amjad H, Agronin M, Burhanullah MH, Walsh P, Wilkins JM, Leoutsakos JM, Nowrangi MA, Harper D, Rosenberg PB, Forester BP. Study rationale and baseline data for pilot trial of dronabinol adjunctive treatment of agitation in Alzheimer's dementia (THC-AD). Int Psychogeriatr 2021:1-6. [PMID: 34629131 DOI: 10.1017/s1041610221001150] [Citation(s) in RCA: 3] [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] [Indexed: 11/07/2022]
Abstract
Agitation is a common complication of Alzheimer's dementia (Agit-AD) associated with substantial morbidity, high healthcare service utilization, and adverse emotional and physical impact on care partners. There are currently no FDA-approved pharmacological treatments for Agit-AD. We present the study design and baseline data for an ongoing multisite, three-week, double-blind, placebo-controlled, randomized clinical trial of dronabinol (synthetic tetrahydrocannabinol [THC]), titrated to a dose of 10 mg daily, in 80 participants to examine the safety and efficacy of dronabinol as an adjunctive treatment for Agit-AD. Preliminary findings for 44 participants enrolled thus far show a predominately female, white sample with advanced cognitive impairment (Mini Mental Status Examination mean 7.8) and agitation (Neuropsychiatric Inventory-Clinician Agitation subscale mean 14.1). Adjustments to study design in light of the COVID-19 pandemic are described. Findings from this study will provide guidance for the clinical utility of dronabinol for Agit-AD. ClinicalTrials.gov Identifier: NCT02792257.
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Affiliation(s)
- Leah M Cohen
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Eleanor Ash
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John D Outen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Halima Amjad
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marc Agronin
- Department of Mental Health and Clinical Research, Miami Jewish Health, Miami, FL, USA
| | - M Haroon Burhanullah
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patricia Walsh
- Department of Psychiatry, North Shore Medical Center, Salem, MA, USA
| | - James M Wilkins
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Milap A Nowrangi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Harper
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
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13
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Holtyn AF, Toegel F, Novak MD, Leoutsakos JM, Fingerhood M, Silverman K. Remotely delivered incentives to promote buprenorphine treatment engagement in out-of-treatment adults with opioid use disorder. Drug Alcohol Depend 2021; 225:108786. [PMID: 34087746 PMCID: PMC8282759 DOI: 10.1016/j.drugalcdep.2021.108786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/04/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Opioid overdose remains a leading cause of death. Office-based buprenorphine could expand access to treatment to the many opioid users who are not in treatment and who are at risk for opioid overdose. However, many people in need of buprenorphine treatment do not enroll in treatment. This randomized pilot trial evaluated efficacy of a remotely delivered incentive intervention in promoting engagement in buprenorphine treatment in out-of-treatment adults with opioid use disorder. METHODS Participants (N = 41) were offered referrals to buprenorphine treatment and randomly assigned to Control or Incentive groups for 6 months. Incentive participants were offered incentives for enrolling in buprenorphine treatment, verified by providing documentation showing that they received a buprenorphine prescription, and providing videos taking daily buprenorphine doses. Participants used a smartphone application to record and submit a video of their buprenorphine prescription and daily buprenorphine administration. Incentive earnings were added remotely to reloadable credit cards. RESULTS Incentive participants were significantly more likely to enroll in treatment compared to control participants (71.4 % versus 30.0 % of participants; OR [95 % CI]: 6.24 [1.46-26.72], p = .014). Few participants in either group adhered to buprenorphine treatment, and the two groups continued to use opioids, including fentanyl at high and comparable rates. The two groups did not differ in the percentage of urine samples that were positive for buprenorphine, opiates, fentanyl, or methadone at monthly assessments conducted during the 6-month intervention. CONCLUSIONS Remotely delivered incentives can connect out-of-treatment adults with opioid use disorder to treatment, but additional supports are needed to promote buprenorphine adherence.
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Affiliation(s)
- August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew D Novak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Toegel F, Novak MD, Rodewald AM, Leoutsakos JM, Silverman K, Holtyn AF. Technology-assisted opioid education for out-of-treatment adults with opioid use disorder. Psychol Addict Behav 2021; 36:555-564. [PMID: 34323526 PMCID: PMC8799781 DOI: 10.1037/adb0000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the feasibility and potential efficacy of a technology-assisted education program in teaching adults at a high risk of opioid overdose about opioids; opioid overdose; and opioid use disorder medications. METHOD A within-subject, repeated-measures design was used to evaluate effects of the novel technology-assisted education program. Participants (N = 40) were out-of-treatment adults with opioid use disorder, recruited in Baltimore, Maryland from May 2019 to January 2020. The education program was self-paced and contained three courses. Each course presented information and required answers to multiple-choice questions. The education program was evaluated using a 50-item test, delivered before and after participants completed each course. Tests were divided into three subtests that contained questions from each course. We measured accuracy on each subtest before and after completion of each course and used a mixed-effects model to analyze changes in accuracy across tests. RESULTS The technology-assisted education program required a median time of 91 min of activity to complete. Most participants completed the program in a single day. Accuracy on each subtest increased only after completion of the course that corresponded to that subtest, and learning comparisons were significant at the p < .001 level for all subtests. Accuracy on each subtest was unchanged before completion of the relevant course, and increases in accuracy were retained across subsequent tests. Learning occurred similarly independent of participant education, employment, and poverty. CONCLUSIONS Technology-assisted education programs can provide at-risk adults with access to effective education on opioids, opioid overdose, and opioid use disorder medications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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15
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Tremblay-Mercier J, Madjar C, Das S, Pichet Binette A, Dyke SOM, Étienne P, Lafaille-Magnan ME, Remz J, Bellec P, Louis Collins D, Natasha Rajah M, Bohbot V, Leoutsakos JM, Iturria-Medina Y, Kat J, Hoge RD, Gauthier S, Tardif CL, Mallar Chakravarty M, Poline JB, Rosa-Neto P, Evans AC, Villeneuve S, Poirier J, Breitner JCS. Open science datasets from PREVENT-AD, a longitudinal cohort of pre-symptomatic Alzheimer's disease. Neuroimage Clin 2021; 31:102733. [PMID: 34192666 PMCID: PMC8254111 DOI: 10.1016/j.nicl.2021.102733] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
To move Alzheimer Disease (AD) research forward it is essential to collect data from large cohorts, but also make such data available to the global research community. We describe the creation of an open science dataset from the PREVENT-AD (PResymptomatic EValuation of Experimental or Novel Treatments for AD) cohort, composed of cognitively unimpaired older individuals with a parental or multiple-sibling history of AD. From 2011 to 2017, 386 participants were enrolled (mean age 63 years old ± 5) for sustained investigation among whom 349 have retrospectively agreed to share their data openly. Repositories are findable through the unified interface of the Canadian Open Neuroscience Platform and contain up to five years of longitudinal imaging data, cerebral fluid biochemistry, neurosensory capacities, cognitive, genetic, and medical information. Imaging data can be accessed openly at https://openpreventad.loris.ca while most of the other information, sensitive by nature, is accessible by qualified researchers at https://registeredpreventad.loris.ca. In addition to being a living resource for continued data acquisition, PREVENT-AD offers opportunities to facilitate understanding of AD pathogenesis.
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Affiliation(s)
| | - Cécile Madjar
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Samir Das
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Alexa Pichet Binette
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
| | - Stephanie O M Dyke
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Pierre Étienne
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
| | - Marie-Elyse Lafaille-Magnan
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; Centre for Child Development and Mental Health, Jewish General Hospital. Montréal, QC, Canada.
| | - Jordana Remz
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada.
| | - Pierre Bellec
- CRIUGM - Université de Montréal, Montréal, QC, Canada; Université de Montréal, Montréal, QC, Canada.
| | - D Louis Collins
- McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - M Natasha Rajah
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
| | - Veronique Bohbot
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
| | | | - Yasser Iturria-Medina
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Justin Kat
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Richard D Hoge
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; Université de Montréal, Montréal, QC, Canada.
| | - Serge Gauthier
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McGill University Research Centre for Studies in Aging, McGill University, Montréal, QC, Canada.
| | - Christine L Tardif
- McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - M Mallar Chakravarty
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
| | - Jean-Baptiste Poline
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Pedro Rosa-Neto
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University Research Centre for Studies in Aging, McGill University, Montréal, QC, Canada.
| | - Alan C Evans
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Sylvia Villeneuve
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montréal, QC, Canada; McGill University, Montréal, QC, Canada; McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montréal, QC, Canada.
| | - Judes Poirier
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
| | - John C S Breitner
- StoP-AD Centre, Douglas Mental Health Institute Research Centre, Montréal, QC, Canada; McGill University, Montréal, QC, Canada.
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Oh ES, Leoutsakos JM, Neufeld KJ. Response to Comment: "Assessing Preventative Effect of Ramelteon on Postoperative Delirium in Older Patients: Methodology is Important". Am J Geriatr Psychiatry 2021; 29:413. [PMID: 32933820 DOI: 10.1016/j.jagp.2020.09.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Esther S Oh
- Department of Medicine (ESO), Johns Hopkins University School of Medicine, Baltimore, MD; Psychiatry and Behavioral Sciences (ESO, JML, KJN), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Jeannie-Marie Leoutsakos
- Psychiatry and Behavioral Sciences (JML, KJN), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karin J Neufeld
- Psychiatry and Behavioral Sciences (JML, KJN), Johns Hopkins University School of Medicine, Baltimore, MD
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Glandon D, Leoutsakos JM, Gupta S, Marsteller J, Paina L, Bennett S. Development and psychometric testing of the FLW-MSC scale for measuring frontline worker multisectoral collaboration in rural India. BMJ Open 2021; 11:e037800. [PMID: 33664062 PMCID: PMC7934724 DOI: 10.1136/bmjopen-2020-037800] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Multisectoral collaboration (MSC) is widely recognised as a critical aspect of policies, programmes and interventions addressing complex public health issues, yet it is undertheorised and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This paper, which reports the quantitative strand of a broader mixed-methods study, takes a step toward filling in this 'missing middle' of MSC evaluation by developing and testing the FLW-MSC scale, an instrument to assess collaboration among the frontline workers of one of India's largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme. DESIGN This study involved development, field-testing and psychometric testing of an 18-item, Likert-type frontline worker collaboration scale, including internal consistency, construct validity and criterion validity. SETTING Village-level primary healthcare in rural Uttar Pradesh, India. PARTICIPANTS 281 anganwadi workers, 266 accredited social health activists and 124 auxiliary nurse midwives selected based on random sampling of anganwadi catchment areas from 346 gram panchayats (GPs), including 173 intervention GPs and 173 pair-matched control GPs from a parent evaluation study. RESULTS Results support the scale's internal consistency (ordinal α=0.92-0.95), construct validity (reasonable exploratory factor analysis model fit for five of the six dyadic relationships Tucker-Lewis Index=0.84-0.88; Root Mean Squared Error of Approximation=0.09-0.11), and criterion validity (regression of collaboration score on an information-sharing indicator β=3.528; p=0.006). CONCLUSIONS The scale may be useful for ICDS managers to detect and address poor collaboration as the Indian government redoubles its efforts to strengthen and monitor MSC, or 'convergence', with important implications for the critical priority of child development. Further, the FLW-MSC scale may be adapted for measuring frontline worker collaboration across sectors in many other scenarios and low/middle-income country contexts.
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Affiliation(s)
- Douglas Glandon
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shivam Gupta
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ligia Paina
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara Bennett
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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18
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Kidorf M, Salazzo S, Brooner RK, Peirce J, Gandotra J, Leoutsakos JM. Impact of Personality Disorder on the Treatment of Psychiatric Disorders in People Receiving Methadone-Assisted Treatment. J Pers Disord 2021; 35:114-126. [PMID: 30920940 DOI: 10.1521/pedi_2019_33_429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study evaluates personality disorder as a moderator of psychiatric treatment response in people receiving methadone-assisted treatment. Participants (N = 125) were enrolled in a 12-week parent study that evaluated the impact of incentives on attendance to psychiatric care. All participants had a current DSM IV-R Axis I disorder and were classified based on presence of an Axis II disorder: Axis I-only (n = 46) versus Axis I + II (n = 79). All participants received an identical protocol of psychiatric and substance use disorder care. Although Axis I + II participants endorsed more psychiatric distress (on the Hopkins Symptom Checklist-Revised) throughout treatment, they reported significant reductions in distress that paralleled reductions reported by Axis I-only participants. Rates of substance use were low and similar across groups. Results support the benefits of integrated psychiatric and substance use care for people with opioid use disorder, with or without a co-occurring personality disorder.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Robert K Brooner
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica Peirce
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jim Gandotra
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Oh ES, Leoutsakos JM, Rosenberg PB, Pletnikova AM, Khanuja HS, Sterling RS, Oni JK, Sieber FE, Fedarko NS, Akhlaghi N, Neufeld KJ. Effects of Ramelteon on the Prevention of Postoperative Delirium in Older Patients Undergoing Orthopedic Surgery: The RECOVER Randomized Controlled Trial. Am J Geriatr Psychiatry 2021; 29:90-100. [PMID: 32532654 PMCID: PMC8809889 DOI: 10.1016/j.jagp.2020.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 04/03/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Postoperative delirium, associated with negative consequences including longer hospital stays and worse cognitive and physical outcomes, is frequently accompanied by sleep-wake disturbance. Our objective was to evaluate the efficacy and short-term safety of ramelteon, a melatonin receptor agonist, for the prevention of postoperative delirium in older patients undergoing orthopedic surgery. DESIGN A quadruple-masked randomized placebo-controlled trial (Clinical Trials.gov NCT02324153) conducted from March 2017 to June 2019. SETTING Tertiary academic medical center. PARTICIPANTS Patients aged 65 years or older, undergoing elective primary or revision hip or knee replacement. INTERVENTION Ramelteon (8 mg) or placebo MEASUREMENTS: Eighty participants were randomized to an oral gel cap of ramelteon or placebo for 3 consecutive nights starting the night before surgery. Trained research staff conducted delirium assessments for 3 consecutive days starting on postoperative day (POD) 0, after recovery from anesthesia, and on to POD2. A delirium diagnosis was based upon DSM-5 criteria determined by expert panel consensus. RESULTS Of 80 participants, five withdrew consent (one placebo, four ramelteon) and four were excluded (four ramelteon) after randomization. Delirium incidence during the 2 days following surgery was 7% (5 of 71) with no difference between the ramelteon versus placebo: 9% (3 of 33) and 5% (2 of 38), respectively. The adjusted odds ratio for postoperative delirium as a function of assignment to the ramelteon treatment arm was 1.28 (95% confidence interval: 0.21-7.93; z-value 0.27; p-value = 0.79). Adverse events were similar between the two groups. CONCLUSION In older patients undergoing elective primary or revision hip or knee replacement, ramelteon was not efficacious in preventing postoperative delirium.
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Affiliation(s)
- Esther S Oh
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD; Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology (ESO), Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing (ESO, KJN), Baltimore, MD.
| | - Jeannie-Marie Leoutsakos
- Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul B Rosenberg
- Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra M Pletnikova
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harpal S Khanuja
- Departments of Orthopedic Surgery (HSK, RSS, JKO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert S Sterling
- Departments of Orthopedic Surgery (HSK, RSS, JKO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julius K Oni
- Departments of Orthopedic Surgery (HSK, RSS, JKO), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Frederick E Sieber
- Departments of Anesthesiology and Critical Care Medicine (FES), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Neal S Fedarko
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Narjes Akhlaghi
- Departments of Medicine (ESO, AP, NSF, NA), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karin J Neufeld
- Departments of Psychiatry and Behavioral Sciences (ESO, JML, PBR, KJN), Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University School of Nursing (ESO, KJN), Baltimore, MD
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20
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Abstract
Referral of syringe exchange registrants with opioid use disorder to agonist treatment provides a pathway to further reduce drug use risk behaviors. Objective: This study evaluates the drug use risk reduction benefits of enrolling syringe exchange registrants in methadone maintenance, and the impact of continued illicit drug use on risk reduction. Method: Baltimore Needle Exchange Program (BNEP) registrants (n = 210) participated in a parent study evaluating treatment initiation strategies for methadone maintenance and were followed for six months. The Risk Assessment Battery (RAB; Metzger, 1993) was administered monthly to evaluate drug use risks; urinalysis testing was conducted weekly. Results: Treatment enrollment reduced drug use risk behaviors, and longer treatment episodes resulted in additional, though modest, risk reduction. Use of opioids or cocaine in treatment diminished risk-reduction benefits, though drug use risks declined over time and remained well below baseline levels. Conclusions: These findings demonstrate that methadone maintenance enhances the well-known risk-reduction benefits of syringe exchange participation. Improving coordination between syringe exchanges and treatment facilities may enhance the public health.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert K Brooner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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Pollock S, Toegel F, Holtyn AF, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Effects of incentives on viral suppression in people living with HIV who use cocaine or opiates. Drug Alcohol Depend 2020; 212:108000. [PMID: 32362436 PMCID: PMC7293918 DOI: 10.1016/j.drugalcdep.2020.108000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/07/2020] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) adherence is essential to maintenance of undetectable viral loads among people living with HIV, which improves health and reduces HIV transmission. Despite these benefits, some people living with HIV do not maintain the level of adherence required to sustain an undetectable viral load. This problem is particularly common among people who use drugs. OBJECTIVE To determine effects of incentivizing viral suppression in people living with HIV who used cocaine or opiates. METHODS In this secondary analysis of data collected during a randomized controlled trial, participants (N=102) with detectable HIV viral loads (>200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with reduced or undetectable (<200 copies/mL) viral loads. All participants completed assessments every three months. Results collected during the first year were compared based on group assignment and drug use. RESULTS Among participants who used cocaine or opiates, Incentive participants (n = 27) provided more (OR:4.0, CI:1.6-10.3, p = .004) blood samples with an undetectable viral load (69 %) than Usual Care participants (n = 25; 41 %). Among participants who did not use cocaine or opiates, Incentive participants (n = 25) provided more (OR:4.1, CI:1.5-10.7, p = .005) blood samples with an undetectable viral load (78 %) than Usual Care participants (n = 25; 36 %). Effects of incentives did not differ by drug use (OR:1.0, CI:0.3-4.0, p = .992). CONCLUSIONS Incentivizing viral suppression can promote undetectable viral loads in people living with HIV who use cocaine or opiates.
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Affiliation(s)
- Sarah Pollock
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - August F. Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, USA 21224
| | - Andrew M. Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, USA 21224
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
| | - Michael Fingerhood
- Department of Medicine, Comprehensive Care Practice, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave # W2, Baltimore, MD 21224, USA.
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
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22
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Holtyn AF, Toegel F, Subramaniam S, Arellano M, Leoutsakos JM, Fingerhood M, Silverman K. Financial incentives promote engagement in employment services for unemployed adults in treatment for opioid use disorder. Drug Alcohol Depend 2020; 212:107982. [PMID: 32370931 PMCID: PMC7293927 DOI: 10.1016/j.drugalcdep.2020.107982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Promoting employment among unemployed adults with substance use disorder is a difficult challenge for which existing interventions have had limited effects. This study examined whether financial incentives could increase engagement in employment services for unemployed adults in treatment for opioid use disorder. METHODS The study was conducted from 2014 to 2019 in Baltimore, MD. After a 3-month abstinence initiation and training period, participants (N = 91) were randomly assigned to a Control group or an Incentive group and were invited to work with an employment specialist to seek employment in a community job for 12 months. Participants assigned to the Control group (n = 47) did not receive incentives for working with the employment specialist. Participants assigned to the Incentive group (n = 44) could earn financial incentives for working with the employment specialist, but had to provide opiate- and cocaine-negative urine samples to maximize pay. RESULTS Incentive participants attended the employment services and worked with the employment specialist on significantly more days than Control participants (41.8 % versus 1.1 % of days; OR = 40.42, 95 % CI = 32.46-48.38, p < .001), and for significantly more hours than Control participants (3.58 versus 1.25 h, on average; OR=2.34, 95 % CI=1.83-2.85, p < .001). Incentive participants were more likely to be retained than Control participants when analyses were based solely on attendance (HR=0.12, 95 % CI=0.06-0.25, p < .001) and attendance and employment combined (HR=0.15, 95 % CI=0.07-0.31, p < .001). CONCLUSIONS Financial incentives were effective in promoting engagement in employment services for individuals who often do not utilize employment services.
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Greene MC, Heise L, Musci RJ, Wirtz AL, Johnson R, Leoutsakos JM, Wainberg ML, Tol WA. Improving estimation of the association between alcohol use and intimate partner violence in low-income and middle-income countries. Inj Prev 2020; 27:injuryprev-2019-043433. [PMID: 32371469 PMCID: PMC9121334 DOI: 10.1136/injuryprev-2019-043433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Alcohol use is a consistent correlate of intimate partner violence (IPV) in low-income and middle-income countries (LMICs). However, the magnitude of this association differs across studies, which may be due to contextual and methodological factors. This study aims to estimate and explore sources of heterogeneity in the association between alcohol use and IPV in 28 LMICs (n=109 700 couples). METHODS In nationally representative surveys, partnered women reported on IPV victimisation and male partner's alcohol use. We estimated the relationship between alcohol use and IPV using logistic regression and full propensity score matching to account for confounding. Country-specific ORs were combined using a random-effects model. Country-level indicators of health and development were regressed on ORs to examine sources of variability in these estimates. RESULTS Partner alcohol use was associated with a 2.55-fold increase in the odds of past-year IPV victimisation (95% CI 2.27 to 2.86) with substantial variability between regions (I2=70.0%). Countries with a low (<50%) prevalence of past-year alcohol use among men displayed larger associations between alcohol use and IPV. Exploratory analyses revealed that colonisation history, religion, female literacy levels and substance use treatment availability may explain some of the remaining heterogeneity observed in the strength of the association between alcohol use and IPV across countries. CONCLUSION Partner alcohol use is associated with increased odds of IPV victimisation in LMICs, but to varying degrees across countries. Prevalences of male alcohol use and cultural factors were related to heterogeneity in these estimates between countries.
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Affiliation(s)
- M Claire Greene
- Psychiatry, Columbia University, New York, New York, USA
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rashelle J Musci
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Renee Johnson
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | | | - Wietse A Tol
- Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, New York, USA
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24
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Toegel F, Holtyn AF, Pollock S, Rodewald AM, Leoutsakos JM, Fingerhood M, Silverman K. Effects of incentivizing viral suppression in previously incarcerated adults living with HIV. HIV Res Clin Pract 2020; 21:1-10. [PMID: 32133931 DOI: 10.1080/25787489.2020.1735816] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The amount of HIV in a person's blood can be suppressed to an undetectable level through antiretroviral therapy medications (ART). Adhering to an ART regimen can improve a person's health and reduce HIV transmission. Despite these benefits, many people with HIV do not maintain the level of adherence required to achieve an undetectable viral load. This problem is particularly common among people who have been incarcerated.Objective: To determine effects of incentivizing viral suppression in previously incarcerated adults with HIV.Methods: Adults with HIV (N = 102) and detectable viral load (>200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with a reduced or undetectable (<200 copies/mL) viral load. Assessments were conducted every 3 months. Results collected during the first year were aggregated and compared based on group assignment and incarceration history.Results: Previously incarcerated participants in the Incentive group provided more (OR: 2.9; CI: 1.3-6.8; p <.05) blood samples with an undetectable viral load (69%) than those in the Usual Care group (41%). Never-incarcerated participants in the Incentive group provided more (OR: 6.8; CI: 2.2-21.0; p <.01) blood samples with an undetectable viral load (78%) than those in the Usual Care group (36%). Effects of incentives did not differ by incarceration history.Conclusions: Incentivizing viral suppression can increase viral suppression (undetectable viral load) in people who have been incarcerated.
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Affiliation(s)
- Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Pollock
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Holtyn AF, Toegel F, Subramaniam S, Jarvis BP, Leoutsakos JM, Fingerhood M, Silverman K. Abstinence-contingent wage supplements to promote drug abstinence and employment: a randomised controlled trial. J Epidemiol Community Health 2020; 74:445-452. [PMID: 32086373 DOI: 10.1136/jech-2020-213761] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Poverty, unemployment and substance abuse are inter-related problems. This study evaluated the effectiveness of abstinence-contingent wage supplements in promoting drug abstinence and employment in unemployed adults in outpatient treatment for opioid use disorder. METHODS A randomised controlled trial was conducted in Baltimore, MD, from 2014 to 2019. After a 3-month abstinence initiation and training period, participants (n=91) were randomly assigned to a usual care control group that received employment services or to an abstinence-contingent wage supplement group that received employment services plus abstinence-contingent wage supplements. All participants were invited to work with an employment specialist to seek employment in a community job for 12 months. Abstinence-contingent wage supplement participants could earn training stipends for working with the employment specialist and wage supplements for working in a community job, but had to provide opiate and cocaine-negative urine samples to maximise pay. RESULTS Abstinence-contingent wage supplement participants provided significantly more opiate and cocaine-negative urine samples than usual care control participants (65% vs 45%; OR=2.29, 95% CI 1.22 to 4.30, p=0.01) during the 12-month intervention. Abstinence-contingent wage supplement participants were significantly more likely to have obtained employment (59% vs 28%; OR=3.88, 95% CI 1.60 to 9.41, p=0.004) and lived out of poverty (61% vs 30%; OR=3.77, 95% CI 1.57 to 9.04, p=0.004) by the end of the 12-month intervention than usual care control participants. CONCLUSION Abstinence-contingent wage supplements can promote drug abstinence and employment. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02487745.
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Affiliation(s)
- August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA .,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Forrest Toegel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shrinidhi Subramaniam
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brantley P Jarvis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Richey LN, Rao V, Roy D, Narapareddy BR, Wigh S, Bechtold KT, Sair HI, Van Meter TE, Falk H, Leoutsakos JM, Yan H, Lyketsos CG, Korley FK, Peters ME. Age differences in outcome after mild traumatic brain injury: results from the HeadSMART study. Int Rev Psychiatry 2020; 32:22-30. [PMID: 31549522 DOI: 10.1080/09540261.2019.1657076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study longitudinally examined age differences across multiple outcome domains in individuals diagnosed with acute mild traumatic brain injury (mTBI). A sample of 447 adults meeting VA/DoD criteria for mTBI was dichotomized by age into older (≥65 years; n = 88) and younger (<65 years; n = 359) sub-groups. All participants presented to the emergency department within 24 hours of sustaining a head injury, and outcomes were assessed at 1-, 3-, and 6-month intervals. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), post-concussive symptoms (PCS) were ascertained with the Rivermead Post-Concussion Questionnaire (RPQ), and functional recovery from the Extended Glasgow Outcome Scale (GOSE). Mixed effects logistic regression models showed that the rate of change over time in odds of functional improvement and symptom alleviation did not significantly differ between age groups (p = 0.200-0.088). Contrary to expectation, older adults showed equivalent outcome trajectories to younger persons across time. This is a compelling finding when viewed in light of the majority opinion that older adults are at risk for significantly worse outcomes. Future work is needed to identify the protective factors inherent to sub-groups of older individuals such as this.
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Affiliation(s)
- Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shreya Wigh
- University of New Mexico, Albuquerque, NM, USA
| | - Kathleen T Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris I Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hayley Falk
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Burhanullah MH, Tschanz JT, Peters ME, Leoutsakos JM, Matyi J, Lyketsos CG, Nowrangi MA, Rosenberg PB. Neuropsychiatric Symptoms as Risk Factors for Cognitive Decline in Clinically Normal Older Adults: The Cache County Study. Am J Geriatr Psychiatry 2020; 28:64-71. [PMID: 31186157 PMCID: PMC6874723 DOI: 10.1016/j.jagp.2019.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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: 06/19/2018] [Revised: 02/17/2019] [Accepted: 03/18/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION There has been considerable progress in identifying early cognitive and biomarker predictors of Alzheimer's disease (AD). Neuropsychiatric symptoms (NPS) are common in AD and appear to predict progression after the onset of mild cognitive impairment or dementia. OBJECTIVES The objective of the study is to examine the relationship between NPS in clinically normal older adults and subsequent cognitive decline in a population-based sample. METHODS The Cache County Study on Memory in Aging consists of a population-based sample of 5,092 older adults. We identified 470 clinically normal adults who were followed for an average period of 5.73 years. NPS were evaluated at the baseline clinical assessment using the Neuropsychiatric Inventory (NPI). NPI domain scores were quantified as the product of frequency X severity in individual NPI domains, and then summed for the NPI-Total. Neuropsychological measures were collected at baseline and at each subsequent follow-up wave. Linear mixed-effects models assessed the association of NPI-Total, NPI-Depression, and NPI-Anxiety scores (obtained at baseline) on longitudinal change in neuropsychological performance, controlling for age, sex, and education. RESULTS Baseline NPI-Total score was associated with a more rapid rate of decline in word list memory, praxis recall, and animal fluency. Baseline NPI-Depression was not associated with later decline on any of the cognitive tests, while baseline NPI-Anxiety was associated with decline in Symbol Digit Modality. CONCLUSION In conclusion, among clinically normal older adults derived from this population-based study, total burden of NPS was associated with longitudinal cognitive decline. These results add to the evidence that NPS are risk factors for or clinical indicators of preclinical dementia syndrome. Our study was an exploratory study and we did not control for multiple comparisons.
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Hasan MZ, Leoutsakos JM, Story WT, Dean LT, Rao KD, Gupta S. Exploration of Factor Structure and Measurement Invariance by Gender for a Modified Shortened Adapted Social Capital Assessment Tool in India. Front Psychol 2019; 10:2641. [PMID: 31920771 PMCID: PMC6918543 DOI: 10.3389/fpsyg.2019.02641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
Social capital is defined as the nature of the social relationship between individuals or groups and the embedded resources available through their social network. It is considered as a critical determinant of health and well-being. Thus, it is essential to assess the performance of any tool when meaningfully comparing social capital between specific groups. Using measurement invariance (MI) analysis, this paper explored the factor structure of the social capital of men and women measured by a modified Shortened Adapted Social Capital Assessment Tool (SASCAT-I) in rural Uttar Pradesh (UP), India. The study sample comprised 5,287 men (18-101 years) and 7,186 women (15-45 years) from 6,218 randomly selected households who responded to SASCAT-I during a community-level cross-sectional survey. Social capital factor structure was examined by both exploratory and confirmatory factor analysis (CFA), and MI across genders was investigated using multigroup CFA. While disregarding gender, four unique factors (Organizational Participation, Social Support, Trust, and Social Cohesion) represented the structure of social capital. The MI analysis presented a partial metric-invariance indicating factor loadings for Organizational Participation and Social Support were the same across genders. The gender-stratified analysis demonstrated that a four-factor solution was best fitted for both men and women. Men and women of rural UP interpreted social capital differently as the perception of Trust and Social Cohesion varied across genders. For any future applications of SASCAT-I, we recommend gender-stratified factor analysis to quantify social capital's measure, acknowledging its multidimensionality.
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - William T. Story
- Department of Community and Behavioral Health, The University of Iowa, Iowa City, IA, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Wise EA, Rosenberg PB, Lyketsos CG, Leoutsakos JM. Time course of neuropsychiatric symptoms and cognitive diagnosis in National Alzheimer's Coordinating Centers volunteers. Alzheimers Dement (Amst) 2019; 11:333-339. [PMID: 31024987 PMCID: PMC6476801 DOI: 10.1016/j.dadm.2019.02.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPSs) are nearly universal in cognitive disorders. The mild behavioral impairment construct postulates that NPS may be the first symptom of impending dementia. METHODS Participants were cognitively normal volunteers followed up approximately annually at Alzheimer's Disease Centers, who were assessed on the Neuropsychiatric Inventory and had at least one follow-up visit during which they were diagnosed with mild cognitive impairment (MCI) or dementia. Descriptive statistics were used to determine sequencing of NPS presence with cognitive diagnoses. RESULTS Data were available for 1998 participants who progressed to MCI or dementia. Over 59% developed NPS before the diagnosis of any cognitive disorder. Depression and irritability were the most common NPSs to precede cognitive diagnoses (24 and 21%, respectively). DISCUSSION NPSs precede a cognitive diagnosis in most people who develop cognitive decline, both MCI and dementia. These individuals are an important group to focus clinical and research efforts.
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Affiliation(s)
| | | | | | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, Md
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Samus QM, Sloan D, Leoutsakos JM, Black B, Johnston D. COMMON UNMET NEEDS OF DEMENTIA CAREGIVERS AND HOW THESE DIFFER BY DISEASE STAGE AND RACE. Innov Aging 2019. [PMCID: PMC6841550 DOI: 10.1093/geroni/igz038.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This presentation (co-presentation Samus and Sloan) will use combined cross-sectional, baseline data from two intervention studies (n=-642) conducted in Maryland evaluating the impact of dementia care coordination model (MIND at home) to provide a detailed description of common modifiable unmet care needs of family caregivers of community-living persons with dementia (PWD), explore how care needs may differ by the disease stage of the PWD, and presence of racial disparities in care needs. Unmet caregiver needs were identified based on comprehensive in-home assessments using a standardized tool (JHDCNA 2.0) with 6 care domains and 18 items covering caregiver needs. Family caregivers were 77% women; 63 years old (mean); 60% White; and 52% adult children. The most prevalent needs were for education/resources (98%), legal (74%), mental health (44%), and informal support (43%). Needs varied based on dementia severity. African American caregivers (vs. white) had significantly more unmet caregiver needs at baseline (p<.001).
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Affiliation(s)
- Quincy M Samus
- The Johns Hopkins University, Baltimore, Maryland, United States
| | - Danetta Sloan
- The Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Betty Black
- The Johns Hopkins University, Baltimore, Maryland, United States
| | - Deirdre Johnston
- The Johns Hopkins University, Baltimore, Maryland, United States
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Samus QM, Gitlin LN, Carlson M, Rebok G, Johnston D, Leoutsakos JM, Black B. MAKING ENGAGEMENT MEANINGFUL THROUGH ORGANIZED ROUTINE INTERACTION (MEMORI) CORPS TRIAL: AN INTRODUCTION. Innov Aging 2019. [PMCID: PMC6846593 DOI: 10.1093/geroni/igz038.2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This presentation will review the design, methods, and early lessons learned from the Making Engagement Meaningful through Organized Routine Interaction (MEMORI) Corps trial recently funded by NIA. This trial is evaluating the feasibility and efficacy of the MEMORI Corps program, a novel 12-week activity-based companion care model designed to mobilize and equip senior volunteers to deliver individualized, evidence-based activity programming to persons with dementia PWD living at home and offer family CGs needed respite. The intervention synthesizes and adapts prior evidence-based work from the Tailored Activities Program® (an activity-based intervention persons with dementia), Experience Corps® (an intergenerational civic engagement program that engages senior volunteers to work in elementary schools), and MIND at Home® (a home-based dementia care coordination program) to simultaneously address unmet respite care needs of family CGs, provide PWD structured meaningful activities and social engagement, and provide meaningful engagement and peer support opportunities for senior volunteers.
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Affiliation(s)
- Quincy M Samus
- The Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura N Gitlin
- Drexel University, Philadelphia, Pennsylvania, United States
| | - Michelle Carlson
- The Johns Hopkins University, Baltimore, Maryland, United States
| | - George Rebok
- The Johns Hopkins University, Baltimore, Maryland, United States
| | - Deirdre Johnston
- The Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Betty Black
- The Johns Hopkins University, Baltimore, Maryland, United States
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Silverman K, Holtyn AF, Rodewald AM, Siliciano RF, Jarvis BP, Subramaniam S, Leoutsakos JM, Getty CA, Ruhs S, Marzinke MA, Fingerhood M. Incentives for Viral Suppression in People Living with HIV: A Randomized Clinical Trial. AIDS Behav 2019; 23:2337-2346. [PMID: 31297681 DOI: 10.1007/s10461-019-02592-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The HIV/AIDS epidemic can be eliminated if 73% of people living with HIV take antiretroviral medications and achieve undetectable viral loads. This study assessed the effects of financial incentives in suppressing viral load. People living with HIV with detectable viral loads (N = 102) were randomly assigned to Usual Care or Incentive groups. Incentive participants earned up to $10 per day for 2 years for providing blood samples that showed either reduced or undetectable viral loads. This report presents data on the 1st year after random assignment. Incentive participants provided more (adjusted OR = 15.6, CI 4.2-58.8, p < 0.001) blood samples at 3-month assessments with undetectable viral load (72.1%) than usual care control participants (39.0%). We collected most blood samples. The study showed that incentives can substantially increase undetectable viral loads in people living with HIV. Financial incentives for suppressed viral loads could contribute to the eradication of the HIV/AIDS epidemic.
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Affiliation(s)
- Kenneth Silverman
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
| | - August F Holtyn
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Andrew M Rodewald
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Robert F Siliciano
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brantley P Jarvis
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- Knowesis, LLC, Fairfax, VA, USA
| | - Shrinidhi Subramaniam
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- Department of Psychology and Child Development, California State University Stanislaus, Turlock, CA, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
| | - Carol-Ann Getty
- Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA
- Addictions Department, Kings College, London, England, UK
| | | | - Mark A Marzinke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Roy D, Peters ME, Everett A, Leoutsakos JM, Yan H, Rao V, Bechtold K, Sair H, Van Meter TE, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos CG, Korley F. Loss of consciousness and altered mental state predicting depressive and post-concussive symptoms after mild traumatic brain injury. Brain Inj 2019; 33:1064-1069. [DOI: 10.1080/02699052.2019.1606447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen Bechtold
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris Sair
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hayley Falk
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Anna Hall
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uju Ofoche
- Department of Forensic Science, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Freshta Akbari
- Department of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fredrick Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Mills KA, Donohue K, Swaminathan A, Leoutsakos JM, Smith G, Brandt J. Neuropsychological predictors of patient-reported cognitive decline after deep brain stimulation in Parkinson's disease. J Clin Exp Neuropsychol 2019; 41:219-228. [PMID: 30296894 PMCID: PMC6380950 DOI: 10.1080/13803395.2018.1526889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is effective for treatment of motor complications of dopaminergic therapy in Parkinson's disease (PD) but occasionally has been associated with multidomain cognitive decline. Patient- and caregiver-reported cognitive decline are clinically meaningful and increasingly recognized as important to consider when evaluating therapeutic interventions for PD. OBJECTIVE The objective was to assess presurgical neuropsychological and clinical factors associated with PD patient- and caregiver-reported cognitive decline in two or more domains after DBS. METHOD A single telephone survey was used to assess patient- and caregiver-reported cognitive decline in five domains at both one and four months after DBS surgery. Decline in two or more domains was considered multidomain cognitive decline (MDCD). Baseline demographic, clinical, and neuropsychological factors were compared in those with or without MDCD. Preoperative neuropsychological measures were evaluated as risk factors and regressed on the presence of MDCD, with demographic covariates, using multiple logistic regression. RESULTS Preoperative performance in verbal recognition memory, language knowledge, and verbal processing decline were associated with postoperative, patient-reported MDCD in the first four weeks. MDCD at four months after DBS was associated with worse preoperative verbal reasoning, verbal recall, and semantic verbal fluency. Caregiver-reported MDCD one month after DBS was associated with poorer baseline verbal memory recognition accuracy/discriminability, visuospatial problem solving, and constructional praxis. CONCLUSION Poor presurgical performance in verbal memory recognition, language processing, and visuospatial performance is associated with patient- or caregiver-reported decline following DBS surgery. Posterior cortical dysfunction seems to portend significant self-reported cognitive decline following deep brain stimulation.
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Affiliation(s)
- Kelly A Mills
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Kristyn Donohue
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Aathman Swaminathan
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jeannie-Marie Leoutsakos
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Gwenn Smith
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jason Brandt
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Forrester SN, Leoutsakos JM, Gallo JJ, Thorpe RJ, Seeman TE. Association between allostatic load and health behaviours: a latent class approach. J Epidemiol Community Health 2019; 73:340-345. [DOI: 10.1136/jech-2018-211289] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/30/2018] [Accepted: 01/11/2019] [Indexed: 12/26/2022]
Abstract
BackgroundAllostatic load (AL) has been characterised in many ways throughout the literature; however, its relationship to health behaviours has only been studied in limited populations. We aimed to uncover qualitative patterns of biological indicators in AL and determine if those patterns were associated with certain health behaviours.MethodsWe conducted latent class analysis using biological indicators from a multiethnic population. We fit latent class regression of class on health behaviours (smoking, poor diet, physical activity and alcohol use) to measure the association between each latent class of AL and each health behaviour.ResultsFour classes, ‘Metabolic+Cholesterol, ‘Blood Pressure’, ‘Metabolic+Blood Pressure’ and ‘Low’, were found in the sample. Latent class regression showed that physical activity and alcohol use were significantly associated with the ‘Metabolic+Blood Pressure’ class.ConclusionLess physical activity was required to improve AL than was previously found. Low to moderate alcohol use was beneficial for lower AL. Implications of the amount of physical activity necessary to lower AL is discussed.
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Kidorf M, Brooner RK, Peirce J, Gandotra J, Leoutsakos JM. Mobilizing community support in people receiving opioid-agonist treatment: A group approach. J Subst Abuse Treat 2018; 93:1-6. [PMID: 30126535 DOI: 10.1016/j.jsat.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022]
Abstract
This descriptive study evaluates a novel group intervention designed to help opioid-dependent patients in medication-assisted treatment identify and recruit drug-free individuals to support recovery efforts. The Social Network Activation Group works with patients who are actively using drugs and resistant to including drug-free family or friends in treatment. The group encourages patients to attend structured recovery, religious, or recreational activities in the community to find recovery support. For those with underutilized support, motivational interviewing and skills training are used to help patients resolve ambivalence and include family or friends in the treatment plan. Patients earn up to one methadone take-home each week that they attend the group and verify activity participation. They complete the group after introducing a drug-free family member or friend to their counselor. This study reports on a sample of 66 patients referred to this group as part of intensive outpatient treatment. Patients attended 71% of scheduled sessions and participated in a M = 4.3 activities. Mutual-help support groups (64%) and church (28%) were the activities most often attended. Thirty-six percent brought in a drug-free family or friend to meet their counselor. Family members were the most common choice (67%). The results demonstrate preliminary feasibility and mixed efficacy of the Social Network Activation Group for this highly select sample of patients, and provide additional evidence that many patients possess drug-free family or friends who are willing to support recovery efforts.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, United States of America.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, United States of America
| | - Jessica Peirce
- Johns Hopkins University School of Medicine, United States of America
| | - Jim Gandotra
- Johns Hopkins University School of Medicine, United States of America
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Kidorf M, Brooner RK, Leoutsakos JM, Peirce J. Treatment initiation strategies for syringe exchange referrals to methadone maintenance: A randomized clinical trial. Drug Alcohol Depend 2018; 187:343-350. [PMID: 29709732 DOI: 10.1016/j.drugalcdep.2018.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/13/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Abstract
This randomized clinical trial evaluated the efficacy of three treatment initiation strategies for improving retention to methadone maintenance for opioid-dependent individuals referred from a syringe exchange program (SEP). New admissions (n = 212) were randomly assigned to one of three 3-month initiation strategies: 1) Low Threshold (LTI), 2) Voucher Reinforcement (VRI), or 3) Standard Care (SCI). LTI was modeled on interim methadone maintenance to transition SEP admissions to the structure of medication-assisted treatment while maximizing exposure to methadone pharmacotherapy. VRI used monetary incentives to reinforce adherence to pharmacotherapy and adaptive counseling. SCI participants received standard methadone dosing and adaptive counseling. All participants were stabilized on methadone pharmacotherapy with a target dose of 80 mg. Following the initiation phase, participants in each condition received standard adaptive counseling from months 4-6. Results showed that most participants failed to achieve the target methadone dose. While no condition differences were observed in retention rates over the 3-month and 6-month observation periods, participants across conditions exhibited reductions in objective and self-report measures of drug use. Results support the benefits of referring syringe exchangers to methadone maintenance, and demonstrate the challenge of retaining these individuals in treatment.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States
| | - Jeannie-Marie Leoutsakos
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States
| | - Jessica Peirce
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, United States
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Patchen L, Leoutsakos JM, Astone NM. Early Parturition: Is Young Maternal Age at First Birth Associated with Obesity? J Pediatr Adolesc Gynecol 2017; 30:553-559. [PMID: 28011235 DOI: 10.1016/j.jpag.2016.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/01/2016] [Accepted: 12/10/2016] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE Examine the association of age at first birth with body mass index (BMI), and explore the role of young maternal age and subsequent obesity. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS This study analyzed data from the Panel Study of Income Dynamics, a nationally representative longitudinal study of US families. Analyses were conducted using a mixed effects longitudinal linear regression with a random intercept to examine the effect of aging, age at first birth, and minority status using nested data. Study criteria yielded a final sample of 146 women with 707 observations. MAIN OUTCOME MEASURES BMI. RESULTS Age at first birth exhibited a significant association with BMI. The association of age at first birth with BMI was greatest for women age 21 and younger. Overall, women who experienced their first birth at age 21 or younger had a BMI 5 units greater than women who delayed childbearing until at least age 30 (point estimate, 5.02; P = .02; 95% confidence interval, 0.65-9.40). CONCLUSION Young maternal age at first birth might be associated with increased BMI. Minority women also experience their first birth at younger ages compared with white women, suggesting possible linkages between the timing of reproductive events and obesity disparities.
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Affiliation(s)
- Loral Patchen
- Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.
| | | | - Nan M Astone
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Nevin RL, Leoutsakos JM. Identification of a Syndrome Class of Neuropsychiatric Adverse Reactions to Mefloquine from Latent Class Modeling of FDA Adverse Event Reporting System Data. Drugs R D 2017; 17:199-210. [PMID: 28063022 PMCID: PMC5318335 DOI: 10.1007/s40268-016-0167-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Although mefloquine use is known to be associated with a risk of severe neuropsychiatric adverse reactions that are often preceded by prodromal symptoms, specific combinations of neurologic or psychiatric reactions associated with mefloquine use are not well described in the literature. This study sought to identify a distinct neuropsychiatric syndrome class associated with mefloquine use in reports of adverse events. Methods Latent class modeling of US Food and Drug Administration Adverse Event Reporting System (FAERS) data was performed using indicators defined by the Medical Dictionary for Regulatory Activities neurologic and psychiatric high-level group terms, in a study dataset of FAERS reports (n = 5332) of reactions to common antimalarial drugs. Results A distinct neuropsychiatric syndrome class was identified that was strongly and significantly associated with reports of mefloquine use (odds ratio = 3.92, 95% confidence interval 2.91–5.28), defined by a very high probability of symptoms of deliria (82.7%) including confusion and disorientation, and a moderate probability of other severe psychiatric and neurologic symptoms including dementia and amnesia (18.6%) and seizures (18.1%). The syndrome class was also associated with symptoms that are considered prodromal including anxiety, depression, sleep disturbance, and abnormal dreams, and neurological symptoms such as dizziness, vertigo, and paresthesias. Conclusions This study confirms in FAERS reports the existence of a severe mefloquine neuropsychiatric syndrome class associated with common symptoms that may be considered prodromal. Clinical identification of the characteristic symptoms of this syndrome class may aid in improving case finding in pharmacovigilance studies of more serious adverse reactions to the drug.
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Affiliation(s)
- Remington L Nevin
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Peters ME, Rao V, Bechtold KT, Roy D, Sair HI, Leoutsakos JM, Diaz-Arrastia R, Stevens RD, Batty DS, Falk H, Fernandez C, Ofoche U, Vassila A, Hall AJ, Anderson B, Bessman E, Lyketsos CG, Everett AD, Van Eyk J, Korley FK. Head injury serum markers for assessing response to trauma: Design of the HeadSMART study. Brain Inj 2017; 31:370-378. [PMID: 28140672 PMCID: PMC6438171 DOI: 10.1080/02699052.2016.1231344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/29/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Accurate diagnosis and risk stratification of traumatic brain injury (TBI) at time of presentation remains a clinical challenge. The Head Injury Serum Markers for Assessing Response to Trauma study (HeadSMART) aims to examine blood-based biomarkers for diagnosing and determining prognosis in TBI. METHODS HeadSMART is a 6-month prospective cohort study comparing emergency department patients evaluated for TBI (exposure group) to (1) emergency department patients evaluated for traumatic injury without head trauma and (2) healthy persons. Study methods and characteristics of the first 300 exposure participants are discussed. RESULTS Of the first 300 participants in the exposure arm, 70% met the American Congress of Rehabilitation Medicine criteria for TBI, with the majority (80.1%) classified as mild TBI. The majority of subjects in the exposure arm had Glasgow Coma Scale scores of 13-15 (98.0%), normal head computed tomography (81.3%) and no prior history of concussion (71.7%). CONCLUSION With systematic phenotyping, HeadSMART will facilitate diagnosis and risk-stratification of the heterogeneous group of individuals currently diagnosed with TBI.
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Affiliation(s)
| | - Vani Rao
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Durga Roy
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris I. Sair
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Hayley Falk
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Uju Ofoche
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Anna J. Hall
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Braden Anderson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward Bessman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Jennifer Van Eyk
- The Heart Institute, Department of Medicine, Cedars-Sinai, Los Angeles, CA, USA
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41
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Hochstetler H, Trzepacz PT, Wang S, Yu P, Case M, Henley DB, Degenhardt E, Leoutsakos JM, Lyketsos CG. Empirically Defining Trajectories of Late-Life Cognitive and Functional Decline. J Alzheimers Dis 2016; 50:271-82. [PMID: 26639960 PMCID: PMC4927844 DOI: 10.3233/jad-150563] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is associated with variable cognitive and functional decline, and it is difficult to predict who will develop the disease and how they will progress. OBJECTIVE This exploratory study aimed to define latent classes from participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) database who had similar growth patterns of both cognitive and functional change using Growth Mixture Modeling (GMM), identify characteristics associated with those trajectories, and develop a decision tree using clinical predictors to determine which trajectory, as determined by GMM, individuals will most likely follow. METHODS We used ADNI early mild cognitive impairment (EMCI), late MCI (LMCI), AD dementia, and healthy control (HC) participants with known amyloid-β status and follow-up assessments on the Alzheimer's Disease Assessment Scale - Cognitive Subscale or the Functional Activities Questionnaire (FAQ) up to 24 months postbaseline. GMM defined trajectories. Classification and Regression Tree (CART) used certain baseline variables to predict likely trajectory path. RESULTS GMM identified three trajectory classes (C): C1 (n = 162, 13.6%) highest baseline impairment and steepest pattern of cognitive/functional decline; C3 (n = 819, 68.7%) lowest baseline impairment and minimal change on both; C2 (n = 211, 17.7%) intermediate pattern, worsening on both, but less steep than C1. C3 had fewer amyloid- or apolipoprotein-E ɛ4 (APOE4) positive and more healthy controls (HC) or EMCI cases. CART analysis identified two decision nodes using the FAQ to predict likely class with 82.3% estimated accuracy. CONCLUSIONS Cognitive/functional change followed three trajectories with greater baseline impairment and amyloid and APOE4 positivity associated with greater progression. FAQ may predict trajectory class.
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Affiliation(s)
- Helen Hochstetler
- Eli Lilly and Company or a Wholly Owned subsidiary, Indianapolis, IN, USA
| | | | - Shufang Wang
- Eli Lilly and Company or a Wholly Owned subsidiary, Indianapolis, IN, USA
| | - Peng Yu
- Eli Lilly and Company or a Wholly Owned subsidiary, Indianapolis, IN, USA
| | - Michael Case
- Eli Lilly and Company or a Wholly Owned subsidiary, Indianapolis, IN, USA
| | - David B Henley
- Eli Lilly and Company or a Wholly Owned subsidiary, Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Physician Group, Indiana University Health, Indianapolis, IN, USA
| | - Elisabeth Degenhardt
- Indiana University Physician Group, Indiana University Health, Indianapolis, IN, USA
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42
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Lozano AM, Fosdick L, Chakravarty MM, Leoutsakos JM, Munro C, Oh E, Drake KE, Lyman CH, Rosenberg PB, Anderson WS, Tang-Wai DF, Pendergrass JC, Salloway S, Asaad WF, Ponce FA, Burke A, Sabbagh M, Wolk DA, Baltuch G, Okun MS, Foote KD, McAndrews MP, Giacobbe P, Targum SD, Lyketsos CG, Smith GS. A Phase II Study of Fornix Deep Brain Stimulation in Mild Alzheimer's Disease. J Alzheimers Dis 2016; 54:777-87. [PMID: 27567810 PMCID: PMC5026133 DOI: 10.3233/jad-160017] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is used to modulate the activity of dysfunctional brain circuits. The safety and efficacy of DBS in dementia is unknown. OBJECTIVE To assess DBS of memory circuits as a treatment for patients with mild Alzheimer's disease (AD). METHODS We evaluated active "on" versus sham "off" bilateral DBS directed at the fornix-a major fiber bundle in the brain's memory circuit-in a randomized, double-blind trial (ClinicalTrials.gov NCT01608061) in 42 patients with mild AD. We measured cognitive function and cerebral glucose metabolism up to 12 months post-implantation. RESULTS Surgery and electrical stimulation were safe and well tolerated. There were no significant differences in the primary cognitive outcomes (ADAS-Cog 13, CDR-SB) in the "on" versus "off" stimulation group at 12 months for the whole cohort. Patients receiving stimulation showed increased metabolism at 6 months but this was not significant at 12 months. On post-hoc analysis, there was a significant interaction between age and treatment outcome: in contrast to patients <65 years old (n = 12) whose results trended toward being worse with DBS ON versus OFF, in patients≥65 (n = 30) DBS-f ON treatment was associated with a trend toward both benefit on clinical outcomes and a greater increase in cerebral glucose metabolism. CONCLUSION DBS for AD was safe and associated with increased cerebral glucose metabolism. There were no differences in cognitive outcomes for participants as a whole, but participants aged≥65 years may have derived benefit while there was possible worsening in patients below age 65 years with stimulation.
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Affiliation(s)
- Andres M. Lozano
- Departments of Medicine (Neurology), Surgery (Neurosurgery) Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lisa Fosdick
- Functional Neuromodulation Ltd, Minneapolis, MN, USA
| | - M. Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, QC, Canada; Departments of Psychiatry and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Jeannie-Marie Leoutsakos
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cynthia Munro
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Oh
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christopher H. Lyman
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul B. Rosenberg
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David F. Tang-Wai
- Departments of Medicine (Neurology), Surgery (Neurosurgery) Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
- University Health Network Memory Clinic, University of Toronto, Division of Neurology, Toronto, ON, Canada
| | | | - Stephen Salloway
- Department of Neurology, Butler Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Wael F. Asaad
- Department of Neurosurgery, Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Francisco A. Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna Burke
- Banner Alzheimer’s Institute, Phoenix, AZ, USA
| | - Marwan Sabbagh
- Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - David A. Wolk
- Penn Memory Center, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Gordon Baltuch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael S. Okun
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Kelly D. Foote
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Mary Pat McAndrews
- Departments of Medicine (Neurology), Surgery (Neurosurgery) Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Departments of Medicine (Neurology), Surgery (Neurosurgery) Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Constantine G. Lyketsos
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gwenn S. Smith
- Memory and Alzheimer’s Treatment Center & Alzheimer’s Disease Research Center, Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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43
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Dunn KE, Harrison JA, Leoutsakos JM, Han D, Strain EC. Continuous Abstinence During Early Alcohol Treatment is Significantly Associated with Positive Treatment Outcomes, Independent of Duration of Abstinence. Alcohol Alcohol 2016; 52:72-79. [PMID: 27567268 DOI: 10.1093/alcalc/agw059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/13/2016] [Accepted: 08/01/2016] [Indexed: 01/30/2023] Open
Abstract
AIMS Neither the predictive value of early continuous abstinence in alcohol use disorder (AUD) or the point at which this effect may emerge has been evaluated. This analysis of the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) clinical trial evaluated whether abstinence early in treatment was a predictor of longer term abstinence. METHODS Participants who stated a goal of total abstinence (N = 954) were dichotomized into Early Abstainer vs. Nonabstainers and were compared on a variety of drinking outcome measures that are frequently used in clinical trial evaluations of alcohol treatment strategies, as a function of duration of early continuous abstinence. RESULTS Significant differences existed for every outcome. Early Abstinence was significantly associated with fewer drinks per drinking day, number of drinking and number of heavy drinking days, and longer time to first drinking and first heavy drinking day. Effects were evident within the first week. The magnitude of all effects increased as the duration of early abstinence (1-4 weeks) increased, though the size of increase varied across the outcomes. CONCLUSIONS These data provide evidence that drinking at the beginning of alcohol treatment is significantly and robustly associated with drinking throughout and at the end of a clinical trial treatment for AUD. Early drinking may be a useful early index to identify whether patients are responding positively to a treatment strategy, and provides a useful method for tailoring treatment to patients that is consistent with a personalized medicine approach.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Joseph A Harrison
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Dingfen Han
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
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44
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Oh ES, Sieber FE, Leoutsakos JM, Inouye SK, Lee HB. Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes. J Am Geriatr Soc 2016; 64:1616-21. [PMID: 27384742 DOI: 10.1111/jgs.14243] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To describe the differences observed in risk factors for delirium and outcomes between men and women undergoing hip fracture repair surgery. DESIGN Prospective cohort study. SETTING Academic medical center. PARTICIPANTS Individuals with acute hip fracture admitted to an academic medical center (N = 431). MEASUREMENTS Information on preoperative demographic characteristics, medical history, laboratory results, and postoperative outcomes was obtained according to history and chart review. Delirium was assessed using the Confusion Assessment Method. RESULTS The overall incidence of postoperative delirium was 34%, with men more likely to experience postoperative delirium (44.8%) than women (30.2%) (P = .004). Male sex was associated with postoperative delirium in individuals with hip fracture, even after adjusting for other preoperative risk factors. Other significant preoperative risk factors included age, dementia, Parkinson's disease, and American Society of Anesthesiologists classification. Men were also more likely to experience other postoperative complications and have longer hospital length of stay. CONCLUSION Men are at higher risk of postoperative delirium after hip fracture repair than women and have more postoperative surgical complications. Their higher risk of postoperative delirium may be due to their underlying preoperative disease severity.
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Affiliation(s)
- Esther S Oh
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.,Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Frederick E Sieber
- Department of Anesthesiology and Critical Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Sharon K Inouye
- Aging Brain Center, Institute of Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hochang B Lee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
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45
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Oh ES, Marano CM, Leoutsakos JM, Lee RW, Rissman RA, Smith GS, Craft S, Lyketsos CG. Oral glucose tolerance testing to modulate plasma amyloid levels: A novel biomarker. Alzheimers Dement (Amst) 2015; 1:311-315. [PMID: 26413562 PMCID: PMC4578701 DOI: 10.1016/j.dadm.2015.06.002] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Plasma levels of amyloid-beta (Aβ) do not correlate well with different stages of Alzheimer's disease (AD) in cross-sectional studies. Measuring the changes in Aβ plasma levels with an acute intervention may be more sensitive to distinguishing individuals in earlier stages of AD (mild cognitive impairment; MCI) from normal controls. METHODS 57 participants (18 with AD/MCI and 39 cognitively normal controls) underwent oral glucose tolerance testing (OGTT). Blood samples were obtained over a 2 hour time period. Changes in plasma Aβ40 and42 levels were measured from either baseline or 5 minutes to the 10 minute time point. RESULTS Compared to normal controls, subjects with AD/MCI had significantly less change (Δ) in plasma levels for both Aβ40(-3.13(40.93)pg/ml vs. 41.34(57.16)pg/ml;p=0.002) and Aβ42(-0.15(3.77)pg/ml vs. 5.64(10.65)pg/ml; p=0.004). DISCUSSION OGTT combined with measures of plasma Aβ40 and 42 is potentially useful in distinguishing aging individuals who are in different stages of AD.
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Affiliation(s)
- Esther S. Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M. Marano
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rebecca W. Lee
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert A. Rissman
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, University of California San Diego, School of Medicine, San Diego, CA, USA
| | - Gwenn S. Smith
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suzanne Craft
- Division of Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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46
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Lyketsos C, Holroyd K, Fosdick L, Smith G, Leoutsakos JM, Munro C, Oh E, Drake K, Rosenberg P, Anderson W, Salloway S, Pendergrass C, Burke A, Wolk D, Tang-Wai D, Asaad W, Sabbagh M, Okun M, Baltuch G, Foote K, Targum S, Lozano A, Ponce F. Deep brain stimulation targeting the fornix for mild Alzheimer dementia: design of the ADvance randomized controlled trial. OAJCT 2015. [DOI: 10.2147/oajct.s81542] [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: 11/23/2022] Open
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47
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Tanner JA, Black BS, Johnston D, Hess E, Leoutsakos JM, Gitlin LN, Rabins PV, Lyketsos C, Samus QM. A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcomes. Am J Geriatr Psychiatry 2015; 23:391-402. [PMID: 25260557 PMCID: PMC4355038 DOI: 10.1016/j.jagp.2014.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/23/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess whether MIND at Home, a community-based, multicomponent, care coordination intervention, reduces unmet caregiving needs and burden in informal caregivers of persons with memory disorders. METHODS An 18-month randomized controlled trial of 289 community-living care recipient (CR)-caregiver (informal caregivers, i.e., unpaid individuals who regularly assisted the CR) dyads from 28 postal code areas of Baltimore, Maryland was conducted. All dyads and the CR's primary care physician received the written needs assessment results and intervention recommendations. Intervention dyads then received an 18-month care coordination intervention delivered by nonclinical community workers to address unmet care needs through individualized care planning, referral and linkage to dementia services, provision of caregiver dementia education and skill-building strategies, and care progress monitoring by an interdisciplinary team. Primary outcome was total percent of unmet caregiver needs at 18 months. Secondary outcomes included objective and subjective caregiver burden measures, quality of life (QOL), and depression. RESULTS Total percent of unmet caregiver needs declined in both groups from baseline to 18 months, with no statistically significant between-group difference. No significant group differences occurred in most caregiver burden measures, depression, or QOL. There was a potentially clinically relevant reduction in self-reported number of hours caregivers spent with the CR for MIND participants compared with control subjects. CONCLUSION No statistically significant impacts on caregiver outcomes were found after multiple comparison adjustments. However, MIND at Home appeared to have had a modest and clinically meaningful impact on informal caregiver time spent with CRs.
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Affiliation(s)
| | - Betty S Black
- Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Edward Hess
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Laura N Gitlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD, Department of Community Public Health Nursing, School of Nursing, The Johns Hopkins University, Baltimore, MD
| | - Peter V Rabins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, The Johns Hopkins University, Baltimore, MD.
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48
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Rass O, Kleykamp BA, Vandrey RG, Bigelow GE, Leoutsakos JM, Stitzer ML, Strain E, Copersino ML, Mintzer MZ. Cognitive performance in methadone maintenance patients: effects of time relative to dosing and maintenance dose level. Exp Clin Psychopharmacol 2014; 22:248-256. [PMID: 24548244 PMCID: PMC4041803 DOI: 10.1037/a0035712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the long-term nature of methadone maintenance treatment, it is important to assess the extent of cognitive side effects. This study investigated cognitive and psychomotor performance in 51 methadone maintenance patients (MMP) as a function of time since last methadone dose and maintenance dose level. MMP maintained on doses ranging from 40 to 200 mg (mean = 97 mg) completed a battery of psychomotor and cognitive measures across 2 sessions, during peak and trough states, in a double-blind crossover design. Peak sessions were associated with worse performance on measures of sensory processing, psychomotor speed, divided attention, and working memory, compared with trough sessions. The effects of maintenance dose were mixed, with higher dose resulting in worse performance on aspects of attention and working memory, improved performance on executive function, and no effects on several measures. Longer treatment duration was associated with better performance on some measures, but was also associated with increased sensitivity to time since last dose (i.e., worse performance at peak vs. trough) on some measures. The results suggest that cognitive functioning can fluctuate as a function of time since last dose even in MMP who have been maintained on stable doses for an extended time (mean duration in treatment = 4 years), but worsened performance at peak is limited to a subset of functions and may not be clinically significant at these modest levels of behavioral effect. For patients on stable methadone maintenance doses, maintenance at higher doses may not significantly increase the risk of performance impairment.
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Affiliation(s)
- Olga Rass
- Address correspondence to: Olga Rass, Department
of Psychiatry and Behavioral Sciences, Behavioral Biology Research Center, Johns
Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD
21224.
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49
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Dutcher SK, Rattinger GB, Langenberg P, Chhabra PT, Liu X, Rosenberg PB, Leoutsakos JM, Simoni-Wastila L, Walker LD, Franey CS, Zuckerman IH. Effect of medications on physical function and cognition in nursing home residents with dementia. J Am Geriatr Soc 2014; 62:1046-55. [PMID: 24823451 DOI: 10.1111/jgs.12838] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the effectiveness of medications used in the management of Alzheimer's disease and related dementias (ADRD) on cognition and activity of daily living (ADL) trajectories and to determine whether sex modifies these effects. DESIGN Two-year (2007-2008) longitudinal study. SETTING Medicare enrollment and claims data linked to the Minimum Dataset 2.0. PARTICIPANTS Older nursing home (NH) residents with newly diagnosed ADRD (n = 18,950). MEASUREMENTS Exposures included four medication classes: antidementia medications (ADMs), antipsychotics, antidepressants, and mood stabilizers. Outcomes included ADLs and cognition (Cognitive Performance Scale (CPS)). Marginal structural models were employed to account for time-dependent confounding. RESULTS The mean age was 83.6, and 76% of the sample was female. Baseline use of ADMs was 15%, antidepressants was 40%, antipsychotics was 13%, and mood stabilizers was 3%. Mean baseline ADL and CPS scores were 16.6 and 2.1, respectively. ADM use was not associated with change in ADLs over time but was associated with a slower CPS decline (slope difference: -0.09 points/year, 99% confidence interval (CI) = -0.14 to -0.03). Antidepressant use was associated with slower declines in ADL (slope difference: -0.36 points/year, 99% CI = -0.58 to -0.14) and CPS (slope difference: -0.12 points/year, 99% CI = -0.17 to -0.08). Sex modified the effect of both antipsychotic and mood stabilizer use on ADLs; female users declined most quickly. Antipsychotic use was associated with slower CPS decline (slope difference: -0.11 points/year, 99% CI = -0.17 to -0.06), whereas mood stabilizer use had no effect. CONCLUSION Despite the observed statistically significantly slower declines in cognition with ADMs, antidepressants, and antipsychotics and the slower ADL decline found with antidepressants, it is unlikely that these benefits are of clinical significance.
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Affiliation(s)
- Sarah K Dutcher
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland
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50
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Fu C, Leoutsakos JM, Underwood C. An examination of resilience cross-culturally in child and adolescent survivors of the 2008 China earthquake using the Connor-Davidson Resilience Scale (CD-RISC). J Affect Disord 2014; 155:149-53. [PMID: 24215898 DOI: 10.1016/j.jad.2013.10.041] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 09/15/2013] [Revised: 09/27/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The 2008 Sichuan earthquake in China destroyed towns and village, displaced over a million people and caused thousands of deaths. There is a need to understand how children and adolescents are able to bounce back after this distressing event. This study conducts a psychometric assessment of the Connor-Davidson Resilience Scale (CD-RISC) and the measure's validity among children and adolescent survivors in order to identify the factors associated with resilience in this socio-cultural setting. METHODS Translated and culturally verified versions of the CD-RISC, UCLA-PTSD Index and Birleson Self-rating Depression Scale were used to collect data from 2132 children and adolescents located in post-disaster areas 1 year after the event. RESULTS Through exploratory factor analysis, a 2-factor model was found and defined by Chinese scholars as Rational Thinking and Self-Awareness. Internal consistency of total CD-RISC was 0.86, 0.91 for Rational Thinking and 0.74 for Self-Awareness. Convergent validity between items ranged from 0.17-0.69 and 0.12-0.20 to the total score. Items related to post-traumatic stress disorder loaded separately than CD-RISC items, demonstrating discriminant validity. CONCLUSIONS Our findings demonstrate that resilience may be understood and manifested dissimilarly in different socio-cultural settings. This study confirms the applicability of the CD-RISC scale to Chinese children and adolescent earthquake survivors, and adds to the richness of resilience research cross-culturally.
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Affiliation(s)
- Christine Fu
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205.
| | - Jeannie-Marie Leoutsakos
- Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Science, Johns Hopkins School of Medicine
| | - Carol Underwood
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205
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