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Browne J, Wu WC, Jiang L, Singh M, Bozzay ML, Kunicki ZJ, Bayer TA, De Vito AN, Primack JM, McGeary JE, Kelso CM, Rudolph JL. Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data. J Psychiatr Res 2024; 173:58-63. [PMID: 38489871 DOI: 10.1016/j.jpsychires.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Jennifer M Primack
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
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Browne J, Rudolph JL, Jiang L, Bayer TA, Kunicki ZJ, De Vito AN, Bozzay ML, McGeary JE, Kelso CM, Wu WC. Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure. J Psychosom Res 2024; 178:111604. [PMID: 38309130 DOI: 10.1016/j.jpsychores.2024.111604] [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: 08/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure. METHODS This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics. RESULTS The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07). CONCLUSIONS Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
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Grau PP, Browne J, Nelson SM, Austin K, Keith JA, Claes NJ, Kawentel LM, Bowersox NW. Engagement in posttraumatic stress disorder treatment for veterans who experienced military sexual trauma and are diagnosed with serious mental illness. Psychol Serv 2024:2024-53069-001. [PMID: 38358699 DOI: 10.1037/ser0000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
It is important to ensure that veterans who have experienced military sexual trauma (MST) and have posttraumatic stress disorder (PTSD) have access to trauma-focused treatment. For veterans with serious mental illness (SMI), prior work documents decreased likelihood to receive trauma-focused care. This study focused on evaluating the engagement of Veterans Health Administration (VHA) patients diagnosed with PTSD and who have experienced MST in PTSD specialty care, as well as how this differs for veterans with SMI. Using VHA administrative data, all VHA patients who screened positive for MST prior to fiscal year 2019 (FY2019) were identified (N = 84,503). Based on information from FY2019, measures of psychiatric diagnosis status and VHA treatment participation were generated for all cohort members. Logistic regressions assessed whether there were differences in the likelihood to initiate PTSD care (1+ VHA PTSD specialty clinic encounter) or receive guideline-concordant levels of PTSD specialty care (8+ VHA PTSD specialty clinic encounter) during FY2019. Several other patient characteristics associated with decreased likelihood to receive VHA PTSD specialty servies were identified, including White race and older age. Patient SMI status was not significantly associated with likelihood to initiate or receive guideline-concordant levels of PTSD specialty care. Overall, PTSD treatment initiation was low (11% of veterans with SMI initiated PTSD specialty treatment, as opposed to 10% of veterans without SMI). Additional work is merited to identify ways that VHA is able to overcome barriers to trauma care participation experienced by persons who have experienced MST and been diagnosed with PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Peter P Grau
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
| | - Julia Browne
- Durham VA Health Care System Geriatric Research Education and Clinical Center
| | - Sharon M Nelson
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
| | - Karen Austin
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
| | - Jessica A Keith
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention
| | - Nathan J Claes
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention
| | - Linda M Kawentel
- Quality Enhancement Research Initiative Center for Evaluation and Implementation Resources
| | - Nicholas W Bowersox
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
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Bowersox NW, Smith CM, Austin K, Bradford DW, Browne J, Nelson SM, Szymanski BR, Glynn SM. Mortality and suicidality in veterans health administration patients with newly-identified early episode psychosis. Schizophr Res 2024; 264:362-369. [PMID: 38219412 DOI: 10.1016/j.schres.2024.01.007] [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: 07/19/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
Within the Veterans Affairs (VA), management of self-harm is a major clinical priority. However, there is limited information on risks for self-harm among VA patients with emerging psychotic disorders relative to VA patients with other emerging mental health conditions. Using information from fiscal years 2010 through 2018, a national cohort of VA patients 30 or younger was classified based on mental health diagnoses into three groups: 1) early episode psychosis (EEP), 2) non-early episode psychosis mental health (non-EEP MH), or 3) no mental health (no MH). Analyses focused on cohort members' risk for all-cause mortality, suicide mortality, and non-fatal suicide attempts (NFSA) during the year following initial diagnosis of mental health conditions (or first year of VA care, for the no MH group). In unadjusted analyses, the EEP group had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the non-EEP MH and no MH groups and the non-EEP MH had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the no MH group. After adjusting for demographics and care receipt, EEP status was unrelated to all-cause mortality but associated with increased suicide mortality risk and NFSA. Non-EEP MH status was associated with reduced risk of all-cause mortality but increased risk for NFSA. In the year following first diagnosis, VA patients with EEP are at increased risk for suicide mortality and self-harm even after accounting for other risk factors. Clinical services targeting this crucial time can help promote safety for this vulnerable group.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Colin M Smith
- Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA
| | - Karen Austin
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Daniel W Bradford
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Duke University Medical Center, Durham, NC, USA
| | - Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sharon M Nelson
- Center for Evaluation and Implementation Resources, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Psychology Department, Pennsylvania State University, University Park, PA, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System at West Los Angeles, Los Angeles, CA, USA; Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
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Onyango E, Browne J, Fulchand S, Kilgour J. Evaluating the publication practices of medical students: A mixed-methods study. Med Teach 2024; 46:252-257. [PMID: 37776891 DOI: 10.1080/0142159x.2023.2244661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
PURPOSE Engagement in research and publication helps medical students develop the skills to improve healthcare through evidence-based medicine. The qualitative evidence-base for the medical student experience of publishing is limited. This study aims to explore medical students' publication practices and understand their experiences of research and publication. METHODS The study is based on a mixed-methods convergent design. A survey questionnaire was distributed to medical students in UK medical schools by social media and email communication. We recruited volunteer participants through the survey and interviewed a sample whilst the survey was open. We purposively selected the sample to ensure representation from research-intensive and other universities. RESULTS Survey results indicated that 21.3% (27/127) of respondents had a publication. The most common publication type was a conference abstract. The main motivation to publish was career progression and the main barriers were lack of opportunity or support to submit an article. There was no significant association between attending a research-intensive university and submitting an article. The interviews revealed that contributing to academic advancement was also a motivation to publish. Participants expressed receiving differing levels of support from supervisors and their institutions. CONCLUSIONS Data from the interviews suggested that the most commonly perceived barriers identified in the survey (lack of opportunity and support to conduct and publish research) may vary in prevalence between different medical schools. Further research is required to explore how different types of support offered by medical schools affect student engagement in publishing research.
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Affiliation(s)
- E Onyango
- School of Medicine, Cardiff University, Cardiff, UK
| | - J Browne
- School of Medicine, Cardiff University, Cardiff, UK
| | - S Fulchand
- School of Medicine, Cardiff University, Cardiff, UK
- Department of Dermatology, Stanford University, Stanford, California, USA
| | - J Kilgour
- School of Medicine, Cardiff University, Cardiff, UK
- Department of Dermatology, Stanford University, Stanford, California, USA
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Browne J, Naslund JA, Salwen-Deremer JK, Sarcione C, Cabassa LJ, Aschbrenner KA. Factors influencing engagement in in-person and remotely delivered lifestyle interventions for young adults with serious mental illness: A qualitative study. Early Interv Psychiatry 2024; 18:42-48. [PMID: 37220910 PMCID: PMC10665543 DOI: 10.1111/eip.13432] [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: 10/04/2022] [Revised: 01/20/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
AIM Young adults (ages 18-35) are underrepresented in lifestyle interventions for people with serious mental illness (SMI), such as schizophrenia, bipolar disorder, and severe depression, and little is known about factors influencing their engagement in these programmes. This qualitative study examined factors affecting engagement amongst young adults with SMI who were enrolled in a lifestyle intervention trial at community mental health centres. METHODS Seventeen young adults with SMI participated in this qualitative study. Participants were drawn from a 12-month randomized controlled trial (n = 150) comparing an in-person group lifestyle intervention augmented with mobile health technology (PeerFIT) to one-on-one personalized remote health coaching (BEAT) using purposive sampling. The 17 participants completed semi-structured qualitative interviews at post-intervention to explore their perceived benefits of the intervention and factors impacting engagement. We used a team-based descriptive qualitative approach to code transcripts and identify themes in the data. RESULTS Participants across both interventions reported experiencing improved ability to engage in health behaviour change. Participants described managing psychosocial stressors and family and other responsibilities that limited their ability to attend in-person PeerFIT sessions. The remote and flexible BEAT remote health coaching intervention appeared to facilitate engagement even in the context of challenging life circumstances. CONCLUSIONS Remotely delivered lifestyle interventions can facilitate engagement amongst young adults with SMI navigating social stressors.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Research Service, VA Providence Health Care System, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Carrie Sarcione
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Abrantes AM, Browne J, Uebelacker LA, Anderson BJ, Barter S, Shah Z, Kunicki ZJ, Caviness C, Price LH, Desaulniers J, Brown RA. Randomized Controlled Trial of Aerobic Exercise for Smoking Cessation among Individuals with Elevated Depressive Symptoms. Nicotine Tob Res 2023:ntad201. [PMID: 37819741 DOI: 10.1093/ntr/ntad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Adults with depression have higher rates of cigarette smoking and are more likely to relapse than those without depression. Pharmacological, psychological, and combined interventions have largely yielded small improvements in smoking outcomes for adults with depression. Aerobic exercise (AE) may facilitate smoking cessation in this subpopulation. METHODS This study was a 12-week two-arm randomized controlled trial that evaluated the effect of a moderate-intensity AE program compared to a health education contact (HEC) control on smoking cessation in adults with elevated depressive symptoms (mild to severe). Participants (n=231) were randomized to AE or HEC and received smoking cessation treatment (telephone counseling and nicotine replacement therapy). Primary (biologically confirmed 7-day point prevalence abstinence) and secondary (depressive symptoms, objective and self-reported physical activity, and cardiorespiratory fitness) outcomes were assessed at baseline, 3-, 6-, and 12-months. Data were analyzed with mixed-effects generalized linear models controlling for age, gender, nicotine dependence, history of major depression disorder, and month of follow-up assessment. RESULTS There were no significant differences in primary or secondary outcomes between the AE and HEC groups. CONCLUSIONS The AE program was not superior to HEC in facilitating smoking cessation, increases in physical activity, or improved depressive symptoms. Given evidence for the positive acute effects of exercise on mood and smoking urges, future research should consider testing alternative exercise approaches for aiding smoking cessation beyond structured, aerobic exercise programs. IMPLICATIONS This study found that an adjunctive aerobic exercise (AE) program was not superior to a health education contact control for adults with elevated depressive symptoms, all of whom also received standard smoking cessation treatment. This finding adds to the growing body of literature that structured aerobic exercise programs for smoking cessation may have limited efficacy for cessation outcomes. Future research is needed to test alternative methods of integrating AE into smoking cessation treatment, such as strategically using exercise to manage cravings and low mood in the moment.
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Affiliation(s)
- Ana M Abrantes
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | - Julia Browne
- Alpert Medical School of Brown University, Providence, RI
- Research Service, VA Providence Healthcare System, Providence, RI
| | - Lisa A Uebelacker
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
| | | | | | | | | | | | - Lawrence H Price
- Butler Hospital, Providence, RI
- Alpert Medical School of Brown University, Providence, RI
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Browne J, Elbogen EB, Mueser KT, Rudolph JL, Wu WC, Philip NS, Mills WL, Sloane R, Hall KS. Physical Function Assessment of Older Veterans With Serious Mental Illness. Am J Geriatr Psychiatry 2023; 31:657-666. [PMID: 36941144 PMCID: PMC10474249 DOI: 10.1016/j.jagp.2023.02.048] [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: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To characterize the physical function of older veterans with serious mental illness (SMI) across endurance, strength, and mobility domains. DESIGN Retrospective analysis of clinical performance data. SETTING Gerofit program, a national outpatient supervised exercise program for older veterans, delivered in Veterans Health Administration sites. PARTICIPANTS Older veterans aged 60 and older (n = 166 with SMI, n = 1,441 without SMI) enrolled across eight national Gerofit sites between 2010 and 2019. MEASUREMENTS Performance measures of physical function covering endurance (6-minute walk test), strength (chair stands, arm curls), and mobility (10-m walk, 8-foot-up-and-go), were administered at Gerofit enrollment. Baseline data from these measures were analyzed to characterize the functional profiles of older veterans with SMI. One sample t tests were examined to compare functional performance of older veterans with SMI to age- and sex-based reference scores. Propensity score matching (1:3) and linear mixed effects models were used to evaluate differences in function between veterans with and without SMI. RESULTS Older veterans with SMI performed worse on all measures of function (chair stands, arm curls, 10-m walk, 6-minute walk test, 8-foot-up-and-go) compared to age- and sex-based reference scores with statistically significant differences present in the male sample. Functional performance of those with SMI was also worse compared to propensity-score matched older veterans without SMI with statistically significant differences on chair stands, 6-minute walk test, and 10-m walk. CONCLUSION Older veterans with SMI have compromised strength, mobility, and endurance. Physical function should be a core component of screening and treatment for this population.
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Affiliation(s)
- Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC.
| | - Eric B Elbogen
- Durham VA Health Care System, Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston, MA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI
| | - Whitney L Mills
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI; Department of Health Services, Policy & Practice, Brown University, Providence, RI
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
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Bowersox NW, Browne J, Grau PP, Merrill SL, Haderlein TP, Llorente MD, Washington DL. COVID-19 mortality among veterans with serious mental illness in the veterans health administration. J Psychiatr Res 2023; 163:222-229. [PMID: 37230006 PMCID: PMC10171776 DOI: 10.1016/j.jpsychires.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Persons with serious mental illness (SMI: schizophrenia-spectrum disorders, bipolar disorder) experience increased risk of mortality after contracting COVID-19 based on the results of several international evaluations. However, information about COVID-19 mortality risk among patients with SMI in the Veterans Health Administration (VHA) has been limited, precluding identification of protective factors. The current evaluation was conducted to assess COVID-19 mortality risk among VHA patients with SMI and to evaluate potential protective factors in mitigating mortality risk following a positive COVID-19 diagnosis. METHODS National VHA administrative data was used to identify all patients (N = 52,916) who received a positive COVID-19 test result between March 1, 2020, and September 30, 2020. Mortality risk was assessed by SMI status via bivariate comparisons and multivariate regression analyses. RESULTS In unadjusted analyses, VHA patients with SMI overall and patients with bipolar disorder in particular did not experience increased mortality risk in the 30 days following a positive COVID test, although patients with schizophrenia had increased risk. Within adjusted analyses, patients with schizophrenia remained at increased mortality risk (OR = 1.38), but at reduced levels relative to previous evaluations in other healthcare settings. CONCLUSIONS Within VHA, patients with schizophrenia, but not those with bipolar disorder, experience increased mortality risk in the 30 days following a positive COVID-19 test. Large integrated healthcare settings such as VHA may offer services which may protect against COVID-19 mortality for vulnerable groups such as persons with SMI. Additional work is needed to identify practices which may reduce the risk of COVID-19 mortality among persons with SMI.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter P Grau
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie L Merrill
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA
| | - Taona P Haderlein
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Maria D Llorente
- Patient Care Services, Department of Veterans Affairs, Washington DC, USA; Department of Psychiatry, Georgetown University School of Medicine, Washington DC, USA
| | - Donna L Washington
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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Browne J, Elbogen EB, Mueser KT, Rudolph JL, Wu WC, Philip NS, Mills WL, Young AS, Sloane R, Hall KS. Retention of older veterans with serious mental illness in a clinical exercise program. Front Psychiatry 2023; 14:1221030. [PMID: 37426110 PMCID: PMC10323680 DOI: 10.3389/fpsyt.2023.1221030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
Older adults with serious mental illness (SMI) have compromised physical function that could be improved with exercise; however, retention in exercise programs is a challenge. This study was a retrospective analysis of retention for the 150 older veterans with SMI that enrolled in Gerofit, a clinical exercise program offered in the Veterans Health Administration. Chi-square and t-tests were conducted to evaluate baseline differences between those that were and were not retained at six and 12 months. Retention was 33% and better health-related quality of life and endurance were related to retention. Future work is needed to improve exercise program retention in this population.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, United States
| | - Eric B. Elbogen
- Durham VA Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston, MA, United States
| | - James L. Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, United States
- Department of Health Services, Policy & Practice, Brown University, Providence, RI, United States
| | - Wen Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, United States
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United States
| | - Whitney L. Mills
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, United States
- Department of Health Services, Policy & Practice, Brown University, Providence, RI, United States
| | - Alexander S. Young
- Mental Illness Research, Education and Clinical Center, VA Greater Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, United States
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
| | - Katherine S. Hall
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, United States
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, United States
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11
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Browne J, Chipps KA, Schmidt K, Schatz H, Ahn S, Pain SD, Montes F, Ong WJ, Greife U, Allen J, Bardayan DW, Blackmon JC, Blankstein D, Cha S, Chae KY, Febbraro M, Hall MR, Jones KL, Kontos A, Meisel Z, O'Malley PD, Schmitt KT, Smith K, Smith MS, Thompson P, Toomey R, Vostinar M, Walter D. First Direct Measurement Constraining the ^{34}Ar(α,p)^{37}K Reaction Cross Section for Mixed Hydrogen and Helium Burning in Accreting Neutron Stars. Phys Rev Lett 2023; 130:212701. [PMID: 37295108 DOI: 10.1103/physrevlett.130.212701] [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] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/19/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
The rate of the final step in the astrophysical αp process, the ^{34}Ar(α,p)^{37}K reaction, suffers from large uncertainties due to a lack of experimental data, despite having a considerable impact on the observable light curves of x-ray bursts and the composition of the ashes of hydrogen and helium burning on accreting neutron stars. We present the first direct measurement constraining the ^{34}Ar(α,p)^{37}K reaction cross section, using the Jet Experiments in Nuclear Structure and Astrophysics gas jet target. The combined cross section for the ^{34}Ar,Cl(α,p)^{37}K,Ar reaction is found to agree well with Hauser-Feshbach predictions. The ^{34}Ar(α,2p)^{36}Ar cross section, which can be exclusively attributed to the ^{34}Ar beam component, also agrees to within the typical uncertainties quoted for statistical models. This indicates the applicability of the statistical model for predicting astrophysical (α,p) reaction rates in this part of the αp process, in contrast to earlier findings from indirect reaction studies indicating orders-of-magnitude discrepancies. This removes a significant uncertainty in models of hydrogen and helium burning on accreting neutron stars.
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Affiliation(s)
- J Browne
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - K A Chipps
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - Konrad Schmidt
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
- Institute of Radiation Physics, Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - H Schatz
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - S Ahn
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - S D Pain
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - F Montes
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - W J Ong
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - U Greife
- Physics Department, Colorado School of Mines, Golden, Colorado 80401
| | - J Allen
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - D W Bardayan
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - J C Blackmon
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803
| | - D Blankstein
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - S Cha
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K Y Chae
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Febbraro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - M R Hall
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - K L Jones
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - A Kontos
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - Z Meisel
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824
- Joint Institute for Nuclear Astrophysics (JINA-CEE), Michigan State University, East Lansing, Michigan 48824
| | - P D O'Malley
- Department of Physics and Astronomy, University of Notre Dame, Notre Dame, Indiana 46556
| | - K T Schmitt
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - K Smith
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - M S Smith
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - P Thompson
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996
| | - R Toomey
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
| | - M Vostinar
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
| | - D Walter
- Department of Physics and Astronomy, Rutgers University, Piscataway, New Jersey 08854
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12
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Johnson L, White P, Jeevan R, Browne J, Gulliver-Clarke C, O’Donoghue J, Mohiuddin S, Hollingworth W, Fairbrother P, MacKenzie M, Holcombe C, Potter S. P185 Long-term impact of radiotherapy on the clinical and patient-reported outcomes of immediate breast reconstruction in a UK population-based cohort study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00303-x] [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: 03/15/2023] Open
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13
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Browne J, Mohamed S. Evaluation of disparities in impact of mental health intensive case management on 6-month symptoms, functioning, and quality of life between black and white veterans diagnosed with schizophrenia. Schizophr Res 2023; 253:68-74. [PMID: 34247886 DOI: 10.1016/j.schres.2021.07.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Substantial health disparities have been reported between Black and White Americans diagnosed with schizophrenia. The nature and extent of these disparities among individuals receiving services in an equal-access health care system remains understudied. PURPOSE AND AIMS The purpose of this study was to examine disparities in enrollment characteristics, service delivery and clinical outcomes between Black and White veterans diagnosed with schizophrenia who received care in the Veterans Health Administration (VHA), an equal-access health care system. METHODS National program evaluation data from the VHA Intensive Community Mental Health Recovery (ICMHR) program were used to evaluate disparities between 2436 Black and 3565 White veterans who enrolled between 1999 and 2013. Veterans and case managers completed measures of sociodemographic factors, clinical history, clinical characteristics, and justice system involvement at enrollment and six months. Chi square and ANOVAs were used to evaluate enrollment and service delivery differences. Six-month changes were evaluated using multiple regression controlling for potentially confounding baseline characteristics. Effect sizes were evaluated with Cohen's d. RESULTS Results indicated differences between Black and White veterans in clinical history, justice system involvement, and clinical characteristics at enrollment. Minimal differences in service delivery were noted and longitudinal analyses revealed no significant differences between Black and White veterans on the majority of outcomes. CONCLUSION Fewer racial disparities in service use and outcomes were observed in ICMHR than in standard non-VA clinic settings. This study demonstrates that disparities may emerge more strongly from systemic rather than individual-level differences.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Somaia Mohamed
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven CT, USA; Yale School of Medicine, New Haven, CT, USA.
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14
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Browne J, Battaglini C, Jarskog LF, Sheeran P, Abrantes AM, Elliott T, Gonzalez O, Penn DL. Virtual Group-based Walking Intervention for Persons with Schizophrenia: A Pilot Randomized Controlled Trial. Ment Health Phys Act 2023; 24:100515. [PMID: 37123563 PMCID: PMC10135421 DOI: 10.1016/j.mhpa.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Persons with schizophrenia have reduced cardiorespiratory fitness (CRF), a predictor of all-cause mortality. Exercise is effective for improving CRF; however, motivational challenges affecting those with schizophrenia impact exercise engagement and maintenance. Virtual Physical Activity Can Enhance Life (Virtual PACE-Life), a multicomponent walking intervention guided by self-determination theory (SDT), was developed to target CRF in this population while addressing motivational difficulties. Virtual PACE-Life includes live video-delivered group walking sessions, Fitbit activity tracking, recommendations for home-based walking sessions, goal setting, and if-then plans. The present study was a 16-week pilot randomized controlled trial that evaluated the impact of Virtual PACE-Life against Fitbit Alone in a sample of 37 participants with schizophrenia on intermediate targets (competence, autonomy, and relatedness satisfaction, autonomous motivation), proximal outcomes (Fitbit-measured steps/day and minutes spent walking), and the primary outcome (CRF using the 6-minute walk test). Blinded research staff completed assessments at baseline, midpoint, posttest, and one-month follow-up. Analysis of covariance and hierarchical linear regression analyses were used to evaluate group differences at each timepoint controlling for baseline. Attendance at Virtual PACE-Life groups was 58% and Fitbit adherence was above 70% in both conditions. Intent-to-treat results indicated greater competence and autonomy satisfaction for Virtual PACE-Life but not in relatedness satisfaction or autonomous motivation. There were no group differences in proximal or primary outcomes during the intervention period. Completer analyses showed improvements in steps/day and autonomous motivation favoring Virtual PACE-Life. Future research is needed to maximize the exercise and CRF benefits of virtual group-based exercise for persons with schizophrenia.
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Affiliation(s)
- Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Oscar Gonzalez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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15
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Buck B, Browne J, Gagen EC, Penn DL. Hostile attribution bias in schizophrenia-spectrum disorders: narrative review of the literature and persisting questions. J Ment Health 2023; 32:132-149. [PMID: 32228272 DOI: 10.1080/09638237.2020.1739240] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Social cognition is often aberrant or impaired in psychotic disorders and related to functional outcomes. In particular, one core social cognitive bias - hostile attribution bias - is proposed to be implicated in paranoia, anxiety, mood disturbances and interpersonal conflict outcomes. However, questions remain about this domain's specificity to psychosis and its relationship to general functional outcomes. AIMS The present paper offers a descriptive and critical review of the literature on hostile attribution bias in psychotic disorders, in order to examine (1) its impact on persecutory symptoms in schizophrenia-spectrum disorders, (2) impact on other related psychopathology among those experiencing psychosis and (3) relationship to functioning. METHODS Twenty-eight studies included in this review after parallel literature searches of PsycINFO and PubMed. RESULTS Evidence from these studies highlighted that hostile attribution bias is elevated in schizophrenia, and that it is related to anxiety, depression and interpersonal conflict outcomes. CONCLUSION While results suggest that hostile attributions are elevated in schizophrenia and associated with symptoms and functioning, there exist numerous persisting questions in the study of this area, including identifying which measures are most effective and determining how it presents: as a state or trait-like characteristic, via dual processes, and its situational variation.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Julia Browne
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Emily C Gagen
- Research Service, Providence VA Medical Center, Providence, RI, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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16
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Browne J, Xie H, Wolfe RS, Naslund JA, Gorin AA, Aschbrenner KA. Factors associated with weight gain prevention in young adults with serious mental illness. Early Interv Psychiatry 2023; 17:39-46. [PMID: 35347848 DOI: 10.1111/eip.13289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM The purpose of this study was to examine factors associated with weight gain prevention among young adults with serious mental illness who participated in the Fit Forward randomized controlled trial evaluating lifestyle interventions adapted for this high-risk group. The aims were to: (1) examine baseline differences between participants that gained weight and those that lost or maintained weight at six and 12 months, and (2) evaluate whether changes in weight control strategies were associated with weight gain prevention at 6 and 12 months. METHODS This study was a secondary analysis of the Fit Forward Study. Participants were young adults (age 18-35) with a serious mental illness and a body mass index in the overweight or obese range. Participants completed assessments at baseline and 6 and 12 months. t-Tests and chi-squared tests were used to examine baseline differences between those that gained weight and those that lost/maintained weight. Logistic regression was used to evaluate whether changes in weight control strategies were associated with weight gain prevention in the sample overall. RESULTS Lower baseline BMI was significantly associated with weight gain prevention at six and 12 months. Greater increases in weight control strategies total score and psychological coping subscale were significantly associated with weight gain prevention at six and 12 months. CONCLUSIONS Weight control strategies, particularly psychological coping tools that support positive thinking and reduce negative self-talk should be considered as core strategies in healthy lifestyle interventions aimed at preventing weight gain in young adults with serious mental illness.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Haiyi Xie
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Rosemarie S Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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17
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Browne J, Morey M, Elbogen E, Mueser K, Hall K. EXPLORING THE PHYSICAL FUNCTION PROFILES OF OLDER ADULTS WITH SERIOUS MENTAL HEALTH CONDITIONS. Innov Aging 2022. [PMCID: PMC9770505 DOI: 10.1093/geroni/igac059.1893] [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
Older adults with serious mental health conditions experience high rates of comorbid chronic medical diseases, which affect the physical function and long-term aging trajectory of this population. Existing physical function research in this population has focused almost exclusively on endurance with little to no attention paid to other important domains such as balance, mobility, and strength, which are critical to promoting independence and improved quality of life. The primary aim of this study was to explore the multiple dimensions of function that are important to maintaining independence and health in older adults with serious mental health conditions. This study examined publicly available data from the 2014 and 2016 waves of the Health and Retirement Study, a national longitudinal panel study of older adults. Analyses were limited to participants that self-reported lifetime diagnoses of serious mental health conditions (schizophrenia, bipolar disorder, depression, posttraumatic stress disorder). The sample comprised 428 older adults over age 50 (M=67.1, SD=10.1; 68% female) who completed standardized assessments of grip strength, single-leg standing balance, and usual walking speed. Scores on these three measures were compared to established age- and/or gender-based norms for each assessment to characterize performance. Overall, 65% of the sample demonstrated deficits in strength and 31% of the sample performed below established norms for both balance and walking speed. These findings highlight that physical function in this population is compromised across multiple domains and suggest a need for multicomponent interventions.
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Affiliation(s)
- Julia Browne
- Durham VA Health Care System, Durham, North Carolina, United States
| | - Miriam Morey
- Durham VA Health Care System, Durham, North Carolina, United States
| | - Eric Elbogen
- Durham VA Health Care System, Durham, North Carolina, United States
| | - Kim Mueser
- Boston University, Boston, Massachusetts, United States
| | - Katherine Hall
- Durham VA Health Care System, Durham, North Carolina, United States
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18
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Browne J, Mohamed S. The Impact of Mental Health Intensive Case Management on Functioning and Clinical Outcomes of Older Black and White Veterans With Serious Mental Illness. Am J Geriatr Psychiatry 2022; 30:1183-1194. [PMID: 35365385 DOI: 10.1016/j.jagp.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To examine differences in service delivery, functioning, and clinical outcomes between older Black and White veterans participating in a national Veterans Health Administration (VHA) program of intensive case management. DESIGN Secondary analysis of national program evaluation data. SETTING VHA Intensive Community Mental Health Recovery (ICMHR) program. PARTICIPANTS Black (n = 1327) and White (n = 4402) veterans age 55 and older who enrolled in ICMHR between 2000-2013. MEASUREMENTS Measures evaluated sociodemographic factors, service delivery, functioning, and clinical outcomes. ANOVA and chi-squares were used to evaluate differences in enrollment characteristics and service delivery between Black and White veterans. Regression analyses were used to examine changes in outcomes over 6 months controlling for confounding baseline differences and service delivery. Cohen's d of .20 was used as a threshold for a clinically meaningful effect. RESULTS Black veterans were more likely to be diagnosed with schizophrenia, alcohol use disorder, and drug use disorder. Although case managers spent significantly less time with Black veterans, there was no difference in the frequency of contacts. Medication management and substance use treatment were more often provided to Black veterans. Black veterans experienced substantially greater improvement in anxiety/depression than White veterans with a small effect size (Cohen's d =-0.25). Changes in all other outcome measures did not meet criteria for clinically meaningful differences. CONCLUSIONS Black veterans experienced meaningfully greater improvements than White veterans on anxiety/depression but not on other measures. Provision of high-intensity services in an equal-access setting may reduce health disparities between Black and White older adults with serious mental illness.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center (JB), Durham VA Health Care System, Durham, NC
| | - Somaia Mohamed
- VA New England Mental Illness Research, Education and Clinical Center, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT.
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19
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Dunbar P, Barry F, Browne J, O'Connor L. Determinants of regulatory compliance in health and social care services: a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.286] [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: 11/13/2022] Open
Abstract
Abstract
Background
The delivery of high quality health and social care services is a fundamental goal for health systems worldwide. Quality is variable in services and settings. One response to variation in quality is a regulatory framework that looks to set minimum standards that are enforced by an independent public authority. This systematic review seeks to identify and describe determinants of regulatory compliance in health and social care services.
Methods
Systematic searches were carried out on five electronic databases and grey literature sources. Titles and abstracts were screened by two reviewers independently. Determinants evaluated in studies were identified, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The included studies were quality appraised by two reviewers independently. The results were synthesised narratively under each CFIR domain.
Results
The search yielded 6,515 articles for screening, of which 148 were included. Most studies were quantitative designs focused on specific exposures (e.g. staffing levels, size, for-profit status). Qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. Most of the determinants identified fit within the inner and outer setting domains of the CFIR, many with mixed findings in terms of an association with compliance. There were fewer determinants identified in the intervention characteristics, characteristics of individuals, and process domains of the CFIR.
Conclusions
The literature in this field focuses on the broader concept of quality and appears to neglect the more nuanced issues surrounding the successful implementation of regulatory standards i.e. compliance. A number of gaps, particularly in terms of qualitative work focussed on the mechanism involved in implementing regulations, remain in the literature and further research in this area is needed to provide a clearer picture.
Key messages
• No clear determinants of regulatory compliance were identified, suggesting it is complex and context specific.
• There are gaps in the literature around the underlying processes which contribute to the achievement of compliance that warrant research attention.
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Affiliation(s)
- P Dunbar
- Regulation Directorate, Health Information and Quality Authority , Cork, Ireland
| | - F Barry
- School of Public Health, University College Cork , Cork, Ireland
| | - J Browne
- School of Public Health, University College Cork , Cork, Ireland
| | - L O'Connor
- Regulation Directorate, Health Information and Quality Authority , Cork, Ireland
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20
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Wright AC, Kritikos K, Bhiku K, LeFeber L, Skiest H, Whitman A, Browne J, Arntz D, Fortuna KL, Mueser KT, Cather C. The impact of the COVID-19 pandemic on peer specialists. Psychiatr Rehabil J 2022; 45:201-211. [PMID: 35511511 DOI: 10.1037/prj0000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with mental health challenges are at particularly high risk of experiencing negative outcomes (e.g., worsening of mental health, increased risk of mortality) due to the coronavirus disease (COVID-19) pandemic. Peer specialists may have the benefit of several protective factors, including higher levels of social support and better illness self-management skills that buffer against negative effects of the pandemic. In this study, we compared the differences in the impact of COVID-19 on those trained as peer specialists (e.g., certified peer specialists, recovery coaches) to those not trained in this role. METHOD Participants with self-reported mental health and/or substance use challenges completed an online survey to collect information on their experiences during COVID-19 (Epidemic-Pandemic Impacts Inventory [EPII]), loneliness (3-item Loneliness Scale), and access to and satisfaction with mental health support. Respondents self-identified as peer specialists or not. RESULTS One hundred seventy-three U.S. resident participants from 23 states were included in the final analysis: 109 were peer specialists and 64 were nonpeer specialists. Those who were trained as peer specialists reported fewer negative outcomes during the pandemic, including less disruption in employment, less loneliness, and less worsening of mental health, while reporting more positive attitudes in the face of difficulties. Peer specialists were also likely to report more access to and satisfaction with mental health services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Possibly as a function of their role, peer specialists reported better mental health outcomes during COVID-19, providing key, empirical evidence to support the benefits of helping others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Katherine Kritikos
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Kamila Bhiku
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Lisa LeFeber
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Anne Whitman
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Diana Arntz
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
| | - Karen L Fortuna
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
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21
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Wright AC, Browne J, Cather C, Meyer-Kalos P, Mueser KT. Relationship between patterns of cannabis use and functional and symptomatic trajectories in first-episode psychosis. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01441-5. [PMID: 35900474 DOI: 10.1007/s00406-022-01441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/29/2022] [Indexed: 02/04/2023]
Abstract
Cannabis use is common in first-episode psychosis (FEP) but evidence is mixed about the extent to which cannabis use predicts symptoms and functional outcomes among those who seek treatment. This study sought to characterize cannabis use patterns and examine the relationship with clinical outcomes, including interactions with early intervention services (EIS). Data were drawn from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study including FEP individuals receiving treatment at sites randomized to provide either EIS (NAVIGATE) or community care (CC). Cannabis use was assessed monthly and symptom and functioning data were collected at baseline, 6, 12, 18, and 24 months. Among the 404 participants enrolled, 334 were classified into four cannabis use groups (consistent, sporadic, stopped, and never users) based on their use during the first year. Consistent and sporadic cannabis users were younger, whereas those who had stopped using were older. Sporadic users had the highest depression and the lowest functioning at baseline and improved less during treatment in negative emotions and intrapsychic foundations (e.g., motivation and sense of purpose) than non-users. However, sporadic users who received NAVIGATE improved more in overall symptoms and functioning than those who received CC. Consistent users did not tend to differ in their trajectories from non-users. Individuals with FEP who use cannabis sporadically showed less clinical improvement than non-users. However, EIS treatment reduced the negative effects of sporadic cannabis use on clinical outcomes. Those who use cannabis sporadically may have unique needs that require attention in EIS.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Piper Meyer-Kalos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA.
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22
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Browne J, Cather C, Ponce AN. A Preliminary Study of Clinical Psychology Doctoral Students' Training in Food Insecurity Assessment and Resource Provision. J Health Care Poor Underserved 2022; 33:623-632. [DOI: 10.1353/hpu.2022.0052] [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: 11/11/2022]
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23
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Flattery A, McKiernan F, Browne J, Gray J, Zaid T, O'Connor J, Zintl A. The prevalence and distribution of Anaplasma phagocytophilum genotypes in Ixodes ricinus nymphs collected from farm- and woodland sites in Ireland. Ticks Tick Borne Dis 2022; 13:101928. [DOI: 10.1016/j.ttbdis.2022.101928] [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] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
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24
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Wright AC, Moody E, Browne J, Cather C. Self-defining memories among persons with mental health, substance use, cognitive, and physical health conditions: a systematic review. Memory 2022; 30:823-844. [DOI: 10.1080/09658211.2022.2042565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Abigail C. Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erin Moody
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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25
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Browne J, Harvey PD, Buchanan RW, Kelly DL, Strauss GP, Gold JM, Holden JL, Granholm E. A Longitudinal Examination of Real-World Sedentary Behavior in Adults with Schizophrenia-Spectrum Disorders in a Clinical Trial of Combined Oxytocin and Cognitive Behavioral Social Skills Training. Behav Sci (Basel) 2022; 12:bs12030060. [PMID: 35323379 PMCID: PMC8945120 DOI: 10.3390/bs12030060] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022] Open
Abstract
Sedentary behavior contributes to a shortened life expectancy in individuals with schizophrenia-spectrum disorders (SSDs), highlighting the need for effective interventions to improve health. This study examined whether reduced ecological momentary assessment (EMA) measures of sedentary activities were observed in individuals with SSDs who participated in a 24-week randomized trial of cognitive behavioral social skills training (CBSST) and either intranasal oxytocin or placebo (NCT01752712). Participants (n = 57) were prompted with EMA surveys seven times per day for seven days during the baseline, 12-week, and 24-week timepoints to sample sedentary behavior ratings, positive and negative affect, interpersonal interactions, and interpersonal interaction appraisals. Results revealed that sedentary behavior and social interactions did not significantly change over the 24-week clinical trial; however, positive and negative affect and defeatist interaction appraisals improved with treatment, and oxytocin produced modest additional improvements in these EMA outcomes. Greater momentary positive affect was significantly associated with greater activity and greater frequency of interactions. Overall, CBSST was effective at improving functioning, momentary affect, and defeatist interaction appraisals, although it did not reduce sedentary behavior; therefore, targeting these factors is not sufficient to reduce sedentary behavior, and adjunct interventions are needed.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC 27705, USA
- Correspondence:
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL 33125, USA
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | - Deanna L. Kelly
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | | | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA; (R.W.B.); (D.L.K.); (J.M.G.)
| | - Jason L. Holden
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (J.L.H.); (E.G.)
| | - Eric Granholm
- Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (J.L.H.); (E.G.)
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA 92093, USA
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26
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Browne J, Wolfe RS, Xie H, Bartels SJ. Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial. Psychiatr Serv 2022; 73:141-148. [PMID: 34189933 DOI: 10.1176/appi.ps.202100047] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese. METHODS Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m2, who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01). CONCLUSION The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - John A Naslund
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Amy A Gorin
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Kim T Mueser
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Julia Browne
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Rosemarie S Wolfe
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Haiyi Xie
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Stephen J Bartels
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
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27
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Halverson TF, Browne J, Thomas SM, Palenski P, Vilardaga R. An examination of neurocognition and theory of mind as predictors of engagement with a tailored digital therapeutic in persons with serious mental illness. Schizophr Res Cogn 2022; 28:100236. [PMID: 35242605 PMCID: PMC8861409 DOI: 10.1016/j.scog.2022.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/16/2022]
Abstract
There is an increasing interest in the development and implementation of digital therapeutics (apps) in individuals with serious mental illness (SMI). However, there is limited understanding of the role of neurocognition and social cognition on engagement with apps. The present study is a secondary analysis of a pilot randomized controlled trial (N = 62) comparing a tailored digital intervention to treat tobacco use disorder in individuals with SMI to a standard of care digital intervention for the general population. The purpose of this study was to examine the impact of neurocognition, social cognition, and clinical characteristics on indices of app engagement in users of the tailored app compared to users of the standard of care app. Correlational analyses demonstrated that individuals with low levels of neurocognition and social cognition engaged more often and for longer duration with the tailored app compared to the standard of care app. In a series of multilevel zero-inflated negative binomial models, assignment to the tailored app remained the most robust predictor of app interactions (Risk Ratio [RR] = 1.72; p < .01), duration of app use (RR = 6.47; p < .01), and average length of interaction (RR = 2.70; p < .01), after adjusting for key demographic and clinical characteristics, and two measures of cognition. This is one of the first studies to demonstrate that digital therapeutics can be designed to mitigate the impact of neurocognition and social cognition on device engagement in SMI populations. Recommendations are made to advance the use of new analytic models to uncover patterns of engagement with digital therapeutics.
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Affiliation(s)
- Tate F. Halverson
- Durham VA Health Care System, Durham, NC, United States of America,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, United States of America
| | - Julia Browne
- Durham VA Health Care System, Durham, NC, United States of America,Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, United States of America
| | - Samantha M. Thomas
- Duke Cancer Institute, Duke University, Durham, NC, United States of America,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States of America
| | - Paige Palenski
- Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of america,Corresponding author at: Psychiatry and Behavioral Sciences, Duke University, 2812 Erwin Road, Suite 403 Box 13, Durham, NC 27705, United States of America.
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28
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Aschbrenner KA, Naslund JA, Salwen-Deremer JK, Browne J, Bartels SJ, Wolfe RS, Xie H, Mueser KT. Sleep quality and its relationship to mental health, physical health and health behaviours among young adults with serious mental illness enrolled in a lifestyle intervention trial. Early Interv Psychiatry 2022; 16:106-110. [PMID: 33594828 PMCID: PMC10047807 DOI: 10.1111/eip.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/28/2023]
Abstract
AIM To characterize subjective sleep quality and examine its associations with mental health, physical health and health behaviours in a transdiagnostic sample of young adults with serious mental illness (SMI) enrolled in a lifestyle intervention trial. METHODS Baseline data from a lifestyle intervention trial with young adults (ages 18-35 years) with SMI included the Pittsburgh Sleep Quality Index (PSQI), mental health, physical health and health behaviour outcomes. Descriptive statistics and multiple linear regression were used in analyses. RESULTS Of 150 participants, 76% were categorized with poor sleep quality. Depressive symptoms were significantly associated with sleep quality (β = .438, p < .001); however, no association was found with physical health and health behaviours. CONCLUSIONS Young adults with SMI enrolled in lifestyle interventions may benefit from treatment that addresses sleep as part of a comprehensive approach to health promotion with attention to the role of depressive symptoms in sleep quality.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Julia Browne
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina
| | - Stephen J Bartels
- Department of Medicine, Massachusetts General Hospital, Mongan Institute, Boston, Massachusetts
| | - Rosemarie S Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Haiyi Xie
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kim T Mueser
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts.,Department of Psychological & Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
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29
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Browne J, Halverson TF, Vilardaga R. Erratum to: Engagement with a digital therapeutic for smoking cessation designed for persons with psychiatric illness fully mediates smoking outcomes in a pilot randomized controlled trial. Transl Behav Med 2021; 12:722. [PMID: 34875095 DOI: 10.1093/tbm/ibab127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.,Durham VA Health Care System, Durham, NC, USA
| | - Tate F Halverson
- Durham VA Health Care System, Durham, NC, USA.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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30
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NandyMazumdar M, Paranjapye A, Yin S, Browne J, Leir S, Harris A. 653: BACH1, the master regulator of oxidative stress, has a dual effect on CFTR expression. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Browne J, Sanders AS, Friedman-Yakoobian M, Guyer-Deason M, Keshavan M, Kim B, Kline E. Implementation case study: Multifamily group intervention in first-episode psychosis programs. Early Interv Psychiatry 2021; 15:1362-1368. [PMID: 33161640 PMCID: PMC8105421 DOI: 10.1111/eip.13066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/03/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
AIM Family interventions are a core component of first-episode psychosis (FEP) treatment; however, low implementation rates are consistently reported. As such, work is needed to understand the factors impacting real-world treatment delivery. The present paper describes the implementation of the McFarlane-model multifamily psychoeducational groups (MFG) in established FEP early intervention programs within a single state. The aims were to examine (a) training participation and implementation of MFG, (b) barriers and facilitators to implementation, and (c) modifications made to MFG. METHODS Practitioners from six established FEP early intervention programs received in-person training and ongoing consultation in MFG. Training participation data were obtained via attendance and implementation outcomes were obtained from practitioner reports. Fifteen months following the initial training, practitioners reported on clinic-specific barriers, facilitators, and modifications across four categories (context, intervention, practitioner, and recipient). RESULTS Twenty-three practitioners across six clinics received in-person training and were offered ongoing consultation to support implementation. Difficulties in starting MFG were salient as the earliest group was run 7 months after the initial training, thereby resulting in low overall frequency of groups. A number of barriers spanning context, intervention, practitioner, and recipient domains were noted, the majority of which were clinic-specific. Despite challenges, practitioners identified several facilitators and made modifications to the intervention and its delivery in service of implementation. CONCLUSIONS Results from this implementation case study highlighted the challenges of delivering MFG in real-world FEP early intervention programs. Further, this paper emphasizes the value in identifying and addressing clinic-specific factors when implementing MFG.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aliyah S. Sanders
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
| | - Michelle Friedman-Yakoobian
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
| | | | - Matcheri Keshavan
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
| | - Bo Kim
- Harvard Medical School, Boston, MA, USA
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Emily Kline
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston MA, USA
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32
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Browne J, Morey MC, Beckham JC, Bosworth HB, Porter Starr KN, Bales CW, McDermott J, Sloane R, Gregg JJ, Hall KS. Diet quality and exercise in older veterans with PTSD: a pilot study. Transl Behav Med 2021; 11:2116-2122. [PMID: 34487181 PMCID: PMC8846334 DOI: 10.1093/tbm/ibab116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/14/2022] Open
Abstract
Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
| | - Miriam C Morey
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jean C Beckham
- Mental Illness Research, Education, and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Health Services Research and Development Service, Center of Innovation to Accelerate Discovery and Practice Transformation, VA Durham Healthcare System, Durham, NC, USA
| | - Kathryn N Porter Starr
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Connie W Bales
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jessica McDermott
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jeffrey J Gregg
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Mental and Behavioral Health Service, Durham VA Health Care System, Durham, NC, USA
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA,Correspondence to: KS Hall,
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Browne J, Halverson TF, Vilardaga R. Engagement with a digital therapeutic for smoking cessation designed for persons with psychiatric illness fully mediates smoking outcomes in a pilot randomized controlled trial. Transl Behav Med 2021; 11:1717-1725. [PMID: 34347865 DOI: 10.1093/tbm/ibab100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Understanding the mechanisms of change of digital therapeutics is a critical step to improve digital health outcomes and optimize their development. Access to and engagement with digital content is arguably a core mechanism of change of these interventions. However, the mediational role of app engagement has been largely unexamined. To evaluate the mediational effect of engaging with a digital therapeutic for smoking cessation designed for adults with psychiatric disorders. Secondary analysis of a pilot clinical trial of 62 adults with serious mental illness who were randomized to receive either a tailored digital therapeutic (Learn to Quit) or a digital therapeutic for the general public (NCI QuitGuide). Engagement was captured using background analytics of app utilization, including (a) number of interactions with app content, (b) minutes/day of app use, and (c) number of days used. The main outcome was reductions in cigarettes per day from baseline to the four-month endpoint. Mediational analysis followed the Preacher and Hayes bootstrap method. Number of application interactions fully mediated reductions in cigarettes per day in the Learn to Quit application but not in QuitGuide (Average Causal Mediation Effect = .31, p = .02). Minutes/day of app use played an uncertain role, and number of days used was not a significant mediator. Results suggest that one of the mechanisms of action of the Learn to Quit device, engagement with theory-based content, functioned as intended. Future research of digital therapeutics should emphasize granular approaches to evaluating apps' mechanisms of action.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC 27705, USA.,Durham VA Health Care System, Durham, NC 27705, USA
| | - Tate F Halverson
- Durham VA Health Care System, Durham, NC 27705, USA.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27705, USA
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Browne J, Cather C, Zvonar V, Thayer K, Skiest H, Arntz D, Kritikos K, Schnitzer K, Brown H, Evins AE, Donovan A. Developing a Sound Body: Open Trial Results of a Group Healthy Lifestyle Intervention for Young Adults with Psychosis. Community Ment Health J 2021; 57:864-871. [PMID: 32524260 DOI: 10.1007/s10597-020-00655-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
The mortality disparity for persons with schizophrenia spectrum disorders (SSDs) due to cardiovascular disease is a devastating problem. Many risk factors are present in young adults with psychosis that may be ameliorated with lifestyle interventions. Sixteen participants with SSDs enrolled in an 11-week open trial of a novel lifestyle intervention comprised of group high intensity interval training exercise and health and wellness education. The aims were to evaluate (1) feasibility and (2) impact on sedentary behavior, physical activity, nutritional knowledge, physiological outcomes, and psychological well-being at end of intervention and 11-week follow-up. Attendance rates were 70% or higher for both intervention components and participants reported increased learning about healthy eating and exercise habits. Moderate to large effect sizes were observed for physical activity and sedentary behavior with sustained improvements in sedentary behavior at follow-up. Meaningful changes were not observed in other domains.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Vanya Zvonar
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Thayer
- Department of Psychiatry, Mount Auburn Hospital, Cambridge, MA, USA
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Diana Arntz
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Katherine Kritikos
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kristina Schnitzer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Hannah Brown
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - A Eden Evins
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail Donovan
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Browne J, Medenblik A, Pebole M, Gregg JJ, Hall KS. Qualitative Analysis of a Supervised Exercise Program for Older Veterans With PTSD. Am J Geriatr Psychiatry 2021; 29:565-572. [PMID: 33162307 DOI: 10.1016/j.jagp.2020.10.014] [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] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Older veterans with post-traumatic stress disorder (PTSD) experience substantial physical and mental health challenges. Given the well-known and wide-reaching benefits of exercise, exploring the impact of interventions designed specifically for this population would be valuable. As such, the present study explored perspectives from older veterans with PTSD who participated in Warrior Wellness, a 12-week supervised exercise intervention designed for older veterans with PTSD. This study was aimed at evaluating 1) facilitators of engagement, 2) perceived benefits from the intervention, and 3) recommendations about possible modifications to the intervention. DESIGN Qualitative study. SETTING Face-to-face semistructured interviews conducted after the Warrior Wellness trial was completed. PARTICIPANTS Fifteen veterans (100% male, 93% African American or Black, 100% non-Hispanic or Latinx, average age = 68.7 years) who completed the Warrior Wellness exercise program. MEASUREMENTS Semistructured interviews were conducted using an interview guide that assessed veterans' experience in Warrior Wellness and recommendations for future intervention modifications. Interviews were subsequently transcribed and analyzed by thematic analysis. RESULTS Shared experience, program features, camaraderie during workouts, and accountability emerged as facilitators of engagement. Perceived benefits spanned physical health, mental health, and behavioral domains. Finally, veterans provided several suggestions for modifying the intervention such as increasing its duration, adding a nutritional component, and including significant others in enrollment. CONCLUSIONS This study offers valuable insights into the intervention and interpersonal factors that veterans view as important for their engagement in exercise, the perceived benefits of exercise, and the ways in which interventions designed for this population can be refined.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System (JB, MP, KH), Durham, NC
| | - Alyssa Medenblik
- Department of Psychology, University of Tennessee (AM), Knoxville, TN
| | - Michelle Pebole
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System (JB, MP, KH), Durham, NC; Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign (MP), Champaign, IL
| | - Jeffrey J Gregg
- Mental and Behavioral Health Service, Durham VA Health Care System (JJG), Durham, NC; Geriatrics Division, Department of Medicine, Duke University (JJG, KH), Durham, NC
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System (JB, MP, KH), Durham, NC; Geriatrics Division, Department of Medicine, Duke University (JJG, KH), Durham, NC; Center for the Study of Aging and Human Development, Duke University (KH), Durham, NC.
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Wright AC, Browne J, Skiest H, Bhiku K, Baker JT, Cather C. The relationship between conventional clinical assessments and momentary assessments of symptoms and functioning in schizophrenia spectrum disorders: A systematic review. Schizophr Res 2021; 232:11-27. [PMID: 34004382 DOI: 10.1016/j.schres.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Symptoms and functioning are critical dimensions in those with schizophrenia and are typically measured using validated conventional clinical assessments. Researchers and clinicians have begun to use real-time digital methods, such as ecological momentary assessment (EMA), to assess symptoms and functioning in the moment and outside of traditional hospital and laboratory settings, which may yield more naturalistic data. Although digital methods have advantages, it is unclear whether these momentary assessments capture core aspects of symptoms and functioning. OBJECTIVE This systematic literature review aimed to evaluate the association between conventional clinical and momentary-based assessments of functioning and symptoms in individuals with schizophrenia. METHODS Studies were included if they met the following criteria: (1) written or translated into English; (2) peer-reviewed; (3) included primary quantitative data; (4) 60% of the clinical sample included persons with schizophrenia spectrum disorders; (5) included a clinical assessment of functioning and/or symptoms; (6) included active momentary assessment and/or passive data; and (7) assessed the relationship between the momentary and conventional clinical assessments. RESULTS A total of 49 studies (87 analyses) were included. Conventional clinical assessments of functioning and positive, negative, and depressive symptoms were related to momentary assessments of these symptom domains. Passive data was beneficial for assessing negative symptoms, but research is warranted for other domains. CONCLUSIONS The reviewed studies highlight the utility of EMA methodologies to collect detailed data on symptoms and functioning. Such data is being used to develop more sophisticated models of schizophrenia to enhance our understanding of important mechanisms and develop targeted interventions.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kamila Bhiku
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Justin T Baker
- Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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McCurley J, Browne J, Fung V, Levy D, Clark C, Thorndike AN. Abstract MP20: Implementation Of Social Determinants Of Health Screening And Referrals In A Medicaid Accountable Care Organization: A Qualitative Study. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp20] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Systematic screening for social determinants of health (SDOH), such as food and housing insecurity, is increasingly implemented in primary care, particularly in the context of Accountable Care Organizations (ACO), to improve health outcomes. The objective of this study was to explore aspects of implementation of annual SDOH screening and referrals in a Medicaid ACO, including facilitators and barriers and experiences of community resource staff.
Methods:
Qualitative interviews were conducted between January and March 2020 with fifteen staff (eight frontline resource staff and seven managers) in a large health care system in Massachusetts. Interviews focused on barriers and facilitators of screening for and addressing SDOH and the experiences of staff involved in this process. Interviews were audio recorded, transcribed, coded, and analyzed using the Framework Method of qualitative analysis.
Results:
Facilitators for addressing SDOH included close collaborations with community organizations, updated resource lists, leadership buy-in, and trusting relationships with patients. Barriers that prevented staff from addressing patients’ social needs effectively included high caseloads, time constraints, inefficiencies in workflows, lack of availability of resources, and patient characteristics (e.g., immigration status, mental health challenges). Resource staff described rewarding and stressful aspects of their jobs, including distress when unable to address challenging social needs such as housing. The Table provides examples of quotes from staff related to the themes identified in this study.
Conclusions:
Facilitators and barriers for successful SDOH screening and referrals occur at the health system, community, and individual levels and must be considered for developing effective screening and referral processes. The psychological burden on resource staff is an important and underrecognized factor that could impact patient care and contribute to staff burnout.
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Browne J, Wright AC, Berry K, Mueser KT, Cather C, Penn DL, Kurtz MM. The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis: A meta-analysis. Schizophr Res 2021; 231:154-163. [PMID: 33866260 DOI: 10.1016/j.schres.2021.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/04/2023]
Abstract
The therapeutic alliance, or client-provider relationship, has been associated with better treatment engagement and outcomes for persons with schizophrenia-spectrum disorders (SSDs) and early psychosis in some studies, but not others. We conducted a meta-analysis of the research on alliance in SSDs and early psychosis across a range of interventions and outcomes. Parallel literature searches were conducted in PubMed and PsycINFO databases for articles between inception and 6/11/2020. English-language studies were included if they evaluated the relationship between alliance and a prospective outcome (treatment engagement, medication adherence, functioning, or total, positive, negative, or depressive symptoms) in an individual clinical treatment for SSDs/early psychosis and contained analyzable data. Correlations and partial correlations were meta-analyzed with random effects models to calculate mean across-study correlations and to carry out subsequent homogeneity and moderator variable analyses. Fourteen studies consisting of 2968 participants that assessed six outcomes across six psychosocial treatments were included. Results indicated that better client-rated (r = 0.20) and other-rated (i.e., provider- or observer-rated; r = 0.25) alliance were associated with better treatment engagement. Treatment type and sample race/ethnicity, but not age, gender, or timing of alliance rating moderated the association between other-rated alliance and engagement. Further, better other-rated alliance was related to improvements in positive (r = -0.14) and negative (r = -0.22) symptoms. A strong therapeutic alliance is important for both engaging clients with SSDs and early psychosis in treatment and facilitating improvements in positive and negative symptoms. Delivery and monitoring of treatments for this population should include assessment of the therapeutic alliance from multiple perspectives.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
| | - Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Katherine Berry
- School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA; Department of Occupational Therapy and Psychological, Boston University, Boston, MA, USA; Department of Brain Sciences, Boston University, Boston, MA, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Australian Catholic University, School of Behavioural and Health Sciences, VIC, Australia
| | - Matthew M Kurtz
- Department of Psychology and Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
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Browne J, Battaglini C, Jarskog LF, Sheeran P, Abrantes AM, McDermott J, Elliott T, Gonzalez O, Penn DL. Targeting Physical Health in Schizophrenia: Results from the Physical Activity Can Enhance Life (PACE-Life) 24-Week Open Trial. Ment Health Phys Act 2021; 20:100393. [PMID: 34178113 PMCID: PMC8224902 DOI: 10.1016/j.mhpa.2021.100393] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor health and low cardiorespiratory fitness (CRF) contribute substantially to the shortened lifespan of individuals with schizophrenia spectrum disorders (SSDs). Increasing physical activity has demonstrated value; however, there are limited interventions that are accessible and adequately address motivational challenges. This paper reports on an open trial of Physical Activity Can Enhance Life (PACE-Life), a motivational theory-based manualized multicomponent walking intervention. The primary aim was to examine the feasibility of implementing PACE-Life through meeting the recruitment target (n=14), attendance and adherence rates, and participant feedback. The secondary aim was to assess the impact of PACE-Life on intermediate targets (autonomous motivation and satisfaction of autonomy, relatedness, and competence needs), proximal outcomes (Fitbit steps/day and minutes spent walking), the primary outcome (CRF), and secondary outcomes (loneliness, symptoms, resting heart rate, blood pressure, weight, body mass index, and hip and waist circumference). Seventeen participants with SSDs enrolled in a 24-week open trial. Assessments occurred at baseline, midpoint, post-test, and one-month follow-up. The recruitment target was exceeded, the group attendance rate was 34%, Fitbit adherence rate was 54%, and participant feedback indicated satisfaction with the intervention as well as a positive group environment. There was a large improvement in the primary outcome of CRF with 77% of participants achieving clinically significant improvement at post-test. Small and medium effect size increases were observed in autonomous motivation and satisfaction of autonomy, relatedness, and competence needs. Fitbit data and secondary outcomes generally remained unchanged or worsened during the intervention. Results from this open trial indicate that PACE-Life leads to meaningful changes in CRF among people with SSDs.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jessica McDermott
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Oscar Gonzalez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Orleans-Pobee M, Browne J, Ludwig K, Merritt C, Battaglini CL, Jarskog LF, Sheeran P, Penn DL. Physical Activity Can Enhance Life (PACE-Life): results from a 10-week walking intervention for individuals with schizophrenia spectrum disorders. J Ment Health 2021; 31:357-365. [PMID: 33527859 DOI: 10.1080/09638237.2021.1875403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/22/2022]
Abstract
BACKGROUND Premature mortality in individuals with schizophrenia spectrum disorders (SSDs) is largely due to high rates of chronic health conditions. Although exercise has been shown to improve health in this population, scalable and accessible interventions are limited. AIM To examine the impact of Physical Activity Can Enhance Life (PACE-Life), a novel walking intervention, on physical activity, and on secondary outcomes of cardiorespiratory fitness (CRF), physical health, autonomous motivation, social support, and quality of life. METHOD Sixteen individuals with SSDs were enrolled in a 10-week open trial. The intervention included walking groups, home-based walks, Fitbit use, and goal-setting and if-then plans. Within-group effect sizes were calculated to represent changes from baseline to post-test and 1-month follow-up. RESULTS Participants increased self-reported weekly walking minutes and decreased daily hours spent sitting; however, Fitbit-recorded exercise behavior changed only minimally. There were also improvements in secondary outcomes including autonomous motivation and hip circumference. CRF improved only minimally, and findings were relatively unchanged with outliers removed from the full sample. CONCLUSIONS This open trial demonstrates modest improvements in key parameters of exercise behavior and physical health from participating in PACE-Life. Future research should assess the efficacy of this intervention in a randomized controlled trial.
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Affiliation(s)
- Maku Orleans-Pobee
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelsey Ludwig
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrington Merritt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudio L Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
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Hallam S, Lotay G, Gade A, Doherty DT, Belarge J, Bender PC, Brown BA, Browne J, Catford WN, Elman B, Estradé A, Hall MR, Longfellow B, Lunderberg E, Montes F, Moukaddam M, O'Malley P, Ong WJ, Schatz H, Seweryniak D, Schmidt K, Timofeyuk NK, Weisshaar D, Zegers RGT. Exploiting Isospin Symmetry to Study the Role of Isomers in Stellar Environments. Phys Rev Lett 2021; 126:042701. [PMID: 33576674 DOI: 10.1103/physrevlett.126.042701] [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] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
Proton capture on the excited isomeric state of ^{26}Al strongly influences the abundance of ^{26}Mg ejected in explosive astronomical events and, as such, plays a critical role in determining the initial content of radiogenic ^{26}Al in presolar grains. This reaction also affects the temperature range for thermal equilibrium between the ground and isomeric levels. We present a novel technique, which exploits the isospin symmetry of the nuclear force, to address the long-standing challenge of determining proton-capture rates on excited nuclear levels. Such a technique has in-built tests that strongly support its veracity and, for the first time, we have experimentally constrained the strengths of resonances that dominate the astrophysical ^{26m}Al(p,γ)^{27}Si reaction. These constraints demonstrate that the rate is at least a factor ∼8 lower than previously expected, indicating an increase in the stellar production of ^{26}Mg and a possible need to reinvestigate sensitivity studies involving the thermal equilibration of ^{26}Al.
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Affiliation(s)
- S Hallam
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - G Lotay
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - A Gade
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - D T Doherty
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - J Belarge
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - P C Bender
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - B A Brown
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Browne
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - W N Catford
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - B Elman
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Estradé
- Department of Physics, Central Michigan University, Mount Pleasant, Michigan 48859, USA
| | - M R Hall
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - B Longfellow
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - E Lunderberg
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - F Montes
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - M Moukaddam
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - P O'Malley
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - W-J Ong
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - H Schatz
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - D Seweryniak
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - K Schmidt
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - N K Timofeyuk
- Department of Physics, University of Surrey, Guildford GU2 7XH, United Kingdom
| | - D Weisshaar
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
| | - R G T Zegers
- National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics, Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
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McDermott A, Kerr G, Browne J. Association Between Clinical Frailty Scale Score and Length of Stay in a Complex Discharge Unit. Ir Med J 2021; 114:238. [PMID: 37555922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Browne J, Mccurley JL, Fung V, Levy DE, Clark CR, Thorndike AN. Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study. J Prim Care Community Health 2021; 12:2150132721993651. [PMID: 33576286 PMCID: PMC7883146 DOI: 10.1177/2150132721993651] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Received: 12/12/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Systematic screening for social determinants of health (SDOH), such as food and housing insecurity, is increasingly implemented in primary care, particularly in the context of Accountable Care Organizations (ACO). Despite the importance of developing effective systems for SDOH resource linkage, there is limited research examining these processes. The objective of the study was to explore facilitators and barriers to addressing SDOH identified by systematic screening in a healthcare system participating in a Medicaid ACO. METHODS This qualitative case study took place between January and March 2020. Semi-structured interviews were conducted with fifteen staff (8 community resource staff and 7 managers) from community health centers and hospitals affiliated with a large healthcare system. Interviews were transcribed, coded, and analyzed using the Framework Method. RESULTS Facilitators for addressing SDOH included maintaining updated resource lists, collaborating with community organizations, having leadership buy-in, and developing a trusting relationship with patients. Barriers to addressing SDOH included high caseloads, time constraints, inefficiencies in tracking, lack of community resources, and several specific patient characteristics. Further, resource staff expressed distress associated with having to communicate to patients that they were unable to address certain needs. CONCLUSIONS Health system, community, and individual-level facilitators and barriers should be considered when developing programs for addressing SDOH. Specifically, the psychological burden on resource staff is an important and underappreciated factor that could impact patient care and lead to staff burnout.
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Affiliation(s)
- Julia Browne
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Durham VA Health Care System, Durham, NC, USA
| | - Jessica L. Mccurley
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Vicki Fung
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Douglas E. Levy
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Cheryl R. Clark
- Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Anne N. Thorndike
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ong WJ, Brown EF, Browne J, Ahn S, Childers K, Crider BP, Dombos AC, Gupta SS, Hitt GW, Langer C, Lewis R, Liddick SN, Lyons S, Meisel Z, Möller P, Montes F, Naqvi F, Pereira J, Prokop C, Richman D, Schatz H, Schmidt K, Spyrou A. β Decay of ^{61}V and its Role in Cooling Accreted Neutron Star Crusts. Phys Rev Lett 2020; 125:262701. [PMID: 33449748 DOI: 10.1103/physrevlett.125.262701] [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] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
The interpretation of observations of cooling neutron star crusts in quasipersistent x-ray transients is affected by predictions of the strength of neutrino cooling via crust Urca processes. The strength of crust Urca neutrino cooling depends sensitively on the electron-capture and β-decay ground-state-to-ground-state transition strengths of neutron-rich rare isotopes. Nuclei with a mass number of A=61 are predicted to be among the most abundant in accreted crusts, and the last remaining experimentally undetermined ground-state-to-ground-state transition strength was the β decay of ^{61}V. This Letter reports the first experimental determination of this transition strength, a ground-state branching of 8.1_{-3.1}^{+4.0}%, corresponding to a log ft value of 5.5_{-0.2}^{+0.2}. This result was achieved through the measurement of the β-delayed γ rays using the total absorption spectrometer SuN and the measurement of the β-delayed neutron branch using the neutron long counter system NERO at the National Superconducting Cyclotron Laboratory at Michigan State University. This method helps to mitigate the impact of the pandemonium effect in extremely neutron-rich nuclei on experimental results. The result implies that A=61 nuclei do not provide the strongest cooling in accreted neutron star crusts as expected by some predictions, but that their cooling is still larger compared to most other mass numbers. Only nuclei with mass numbers 31, 33, and 55 are predicted to be cooling more strongly. However, the theoretical predictions for the transition strengths of these nuclei are not consistently accurate enough to draw conclusions on crust cooling. With the experimental approach developed in this work, all relevant transitions are within reach to be studied in the future.
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Affiliation(s)
- W-J Ong
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - E F Brown
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Computational Mathematics, Science, and Engineering, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Browne
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - S Ahn
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
- Cylotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - K Childers
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - B P Crider
- Department of Physics and Astronomy, Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - A C Dombos
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - S S Gupta
- Indian Institute of Technology Ropar, Nangal Road, Rupnagar (Ropar), Punjab 140 001, India
| | - G W Hitt
- Department of Physics and Engineering Science, Coastal Carolina University, Conway, South Carolina 29528, USA
| | - C Langer
- Institute for Applied Physics, Goethe-University Frankfurt a. M., Frankfurt am Main 60438, Germany
| | - R Lewis
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - S N Liddick
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - S Lyons
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - Z Meisel
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Ohio Univeristy, Athens, Ohio 45701, USA
| | - P Möller
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
- Theoretical Division, Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - F Montes
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - F Naqvi
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics & Astrophysics, University of Delhi, Delhi 110007, India
| | - J Pereira
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Prokop
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D Richman
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - H Schatz
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - K Schmidt
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Spyrou
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
- Joint Institute for Nuclear Astrophysics-Center for the Evolution of the Elements, Michigan State University, East Lansing, Michigan 48824, USA
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Izquierdo M, Browne J, Rodriguez I, Tresserra F, Garcia M, Ara C, Baulies S, Pascual M, Fabregas R. Visual versus automatic measurement of mammographic breast density (MBD). Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Browne J, Ponce A. Assessing Food Insecurity in Individuals with Serious Mental Illness: A Pilot Training for Community Mental Health Providers. Community Ment Health J 2020; 56:1110-1114. [PMID: 32107661 DOI: 10.1007/s10597-020-00593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 02/21/2020] [Indexed: 11/24/2022]
Abstract
Food insecurity (FI), or limited or uncertain access to food, is a significant public health issue, especially for individuals with serious mental illness. As such, mental health providers should regularly assess FI and link individuals to resources. The purpose of this project was to create and pilot test a provider training on FI assessment at a community mental health center. Fifteen providers participated in the training and completed surveys at post-training and one-month follow-up. Results suggested success in delivering an acceptable training that conveyed the importance of FI and inspired confidence in assessment. Yet, it was not sufficient to modify providers' FI assessment behavior. A brief training can effectively teach providers about FI and promote confidence in assessment; however, it is not adequate to change behavior. Future work should examine the provider training in a larger sample and wider variety of CMHC providers and explore ways to integrate FI assessment into existing practices to address implementation barriers.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, 235 E. Cameron Ave, Davie Hall, CB #3270, Chapel Hill, NC, 27599, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Allison Ponce
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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McDermott JM, Browne J, Battaglini C, Jarskog F, Abrantes A, Sheeran P, Penn DL. Adherence To A Six-Month Walking Intervention For Individuals With Schizophrenia Spectrum Disorder: Preliminary Results. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678924.12019.54] [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: 11/21/2022]
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Donovan AL, Browne J, Freudenreich O, Cather C. Suicide in Schizophrenia Spectrum Disorders. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200309-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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Hurley E, McHugh S, Browne J, Vaughan L, Normand C. A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland's hospitals. BMC Health Serv Res 2019; 19:766. [PMID: 31665004 PMCID: PMC6819558 DOI: 10.1186/s12913-019-4629-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. METHODS We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme's outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme's implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme's outcomes can be explained by the level of implementation. DISCUSSION This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.
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Affiliation(s)
- E Hurley
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
| | - S McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - J Browne
- School of Public Health, University College Cork, Cork, Ireland
| | | | - C Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
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