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Leyde S, Price CJ, Colgan DD, Pike KC, Tsui JI, Merrill JO. Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone. Subst Use Addctn J 2024:29767342241227402. [PMID: 38327009 DOI: 10.1177/29767342241227402] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND The relationships between opioid use disorder (OUD), chronic pain, and mental health distress are complex and multidirectional. The objective of this exploratory study was to examine the relationship between mental health conditions and Chronic pain severity and interference among patients stabilized on either buprenorphine or methadone. METHODS We report baseline data from a randomized trial of a mind-body intervention conducted at 5 outpatient clinics that provided either buprenorphine or methadone treatment. Validated scales were used to measure substance use, mental health distress, and pain severity and interference. Statistical analyses examined the relationship between mental health conditions and pain severity and interference. RESULTS Of 303 participants, 57% (n = 172) reported Chronic pain. A total of 88% (n = 268) were prescribed buprenorphine. Mental health conditions were common, with one-quarter of the sample screening positive for all 3 mental health conditions (anxiety, depression, and posttraumatic stress disorder [PTSD]). Compared to participants without Chronic pain, participants with Chronic pain were more likely to screen positive for moderate-severe anxiety (47% vs 31%); moderate-severe depression (54% vs 41%); and the combination of anxiety, depression, and PTSD (31% vs 18%). Among participants with Chronic pain, mental health conditions were associated with higher pain interference. Pain severity was higher among participants with mental health conditions, but only reached statistical significance for depression. Pain interference scores increased with a higher number of co-occurring mental health conditions. CONCLUSIONS Among individuals stabilized on either buprenorphine or methadone, highly symptomatic and comorbid mental health distress is common and is associated with increased pain interference. Adequate screening for, and treatment of, mental health conditions in patients with OUD and Chronic pain is needed.
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Affiliation(s)
- Sarah Leyde
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Cynthia J Price
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Dana D Colgan
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Kenneth C Pike
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joseph O Merrill
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Thomas AJ, Mitchell ES, Pike KC, Woods NF. Stressful life events during the perimenopause: longitudinal observations from the seattle midlife women's health study. Womens Midlife Health 2023; 9:6. [PMID: 37667359 PMCID: PMC10478480 DOI: 10.1186/s40695-023-00089-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Midlife is a time of increased responsibilities for women who have multiple roles including taking care of children, caring for elderly parents, managing households, and working outside the home. With little time for themselves, women additionally experience stressful life events (SLEs). The purpose of this study was to describe the longitudinal patterns of SLEs of women during midlife and to identify predictors of the SLE longitudinal patterns using baseline data of socio-economic factors and demographic characteristics. METHODS Women who were part of the Seattle Midlife Women's Health Study (SMWHS), a longitudinal study spanning more than 23 years, who had SLEs measured at baseline and at years 2, 7, and 10 were included in these analyses (N = 380 women at baseline). The Life Event Scale (LES), a 70-item scale based on a yes/no response and a Likert-based scoring system with 0 (no effect) to 4 (large effect), was used to determine the total and impact scores of midlife women. The LES was adapted to midlife women from the Norbeck Scale for younger, pregnant women. Analytic strategies consisted of a group-based trajectory model (GBTM) to examine subgroups of women with similar exposure to SLEs using socio-economic factors (gross family income, education, race/ethnicity, employment), demographic variables (age, marital status, being a parent), and menopausal transition stage to differentiate trajectories over time. RESULTS Approximately 86% of women had medium high exposure to undesirable SLEs with a slight decrease (65.5%), or a sharp decrease (20.1%), over 10 years. The majority (approximately 64%) had moderate, sustained impact ratings, while approximately 35% had impact ratings that decreased over time. Most women (approximately 88%) reported desirable life events, which were sustained over the ten years, and which may help to balance or offset the high ratings of undesirable stressful life events. The rated impact of these desirable events decreased slightly over time for 65% of the sample. Socio-economic factors, demographic variables, and menopausal transition stages were not significant predictors of any of the four GBTMs. CONCLUSION Midlife women experience SLEs throughout the menopausal transition. Most of these midlife women had had a large amount of sustained stress over 10 years although all trajectories decreased to some extent over time. Since the menopausal transition stages were not significant predictors of the ratings of SLEs, a more complex set of factors, including social as well as biological, may explain the ratings of the women over the course of this ten-year observational study.
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Affiliation(s)
| | | | - Kenneth C Pike
- Office of Nursing Research, University of Washington, Seattle, WA, USA
| | - Nancy Fugate Woods
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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3
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Sonney JT, Thompson HJ, Landis CA, Pike KC, Chen ML, Garrison MM, Ward TM. Sleep intervention for children with asthma and their parents (SKIP Study): a novel web-based shared management pilot study. J Clin Sleep Med 2021; 16:925-936. [PMID: 32056537 DOI: 10.5664/jcsm.8374] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVES The objective of this study was to describe the feasibility, acceptability, and preliminary efficacy of a novel Sleep Intervention for Kids and Parents (SKIP). Parent and child primary sleep outcomes were total sleep time, wake after sleep onset (WASO), sleep efficiency (SE), and bedtime range. METHODS Children 6-11 years of age with asthma and 1 parent, both with behavioral sleep disturbance, enrolled in this single-group pilot. The 8-week shared management intervention included weekly online educational modules, goal setting, and progress reporting. Feasibility was measured by the number of dyads who were eligible, enrolled, and retained. Acceptability was measured by survey and semistructured interview. Total sleep time, WASO, SE, and bedtime range were measured by actigraphy at baseline, after the intervention, and 12-week follow-up. Mixed-effects regression models were used to determine change in sleep outcomes from baseline. RESULTS Thirty-three of 39 eligible dyads enrolled; of 29 dyads that started the intervention, 25 (86%) completed all study visits. SKIP was acceptable for 61% of children and 92% of parents. Compared with baseline, at follow-up, children had significantly improved WASO (-37 minutes; 95% confidence interval [CI], -44.5 to -29.7; P < .001), SE (5.4%; 95% CI, 4.2-6.5; P < .001), and bedtime range (-35.2 minutes; 95% CI, -42.9 to -27.5; P < .001). Parents also had significantly improved WASO (-13.9 minutes; 95% CI, -19.5 to -8.2; P < .001), SE (2.7%; 95% CI, 1.7-.7; P < .001), and bedtime range (-35.3 minutes; 95% CI, -51.0 to -19.7; P < .001). CONCLUSIONS SKIP was feasible, acceptable, and we observed improved child and parent sleep outcomes except total sleep time. Following refinements, further testing of SKIP in a controlled clinical trial is warranted. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Sleep Intervention for Kids and Parents: A Self-Management Pilot Study; URL: https://www.clinicaltrials.gov/ct2/show/study/NCT03144531; Identifier: NCT03144531.
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Affiliation(s)
- Jennifer T Sonney
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
| | - Hilaire J Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington
| | - Carol A Landis
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington
| | - Kenneth C Pike
- Office of Nursing Research, University of Washington School of Nursing, Seattle, Washington
| | - Maida L Chen
- Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Michelle M Garrison
- Department of Health Services, University of Washington School of Public Health, Division of Child and Adolescent Psychiatry, University of Washington School of Medicine, Seattle, Washington.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Teresa M Ward
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington
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4
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Yang PL, Burr RL, Buchanan DT, Pike KC, Kamp KJ, Heitkemper MM. Indirect effect of sleep on abdominal pain through daytime dysfunction in adults with irritable bowel syndrome. J Clin Sleep Med 2021; 16:1701-1710. [PMID: 32620184 DOI: 10.5664/jcsm.8658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Sleep deficiency, psychological distress, daytime dysfunction, and abdominal pain are common in adults with irritable bowel syndrome. Prior research on individuals with chronic pain has identified the indirect effect of sleep on pain through psychological distress or daytime dysfunction; however, this effect is less clear in irritable bowel syndrome. The purpose of this study was to examine potential indirect effects of sleep on abdominal pain symptoms simultaneously through psychological distress and daytime dysfunction in adults with irritable bowel syndrome. METHODS Daily symptoms of nighttime sleep complaints (sleep quality and refreshment), psychological distress, daytime dysfunction (fatigue, sleepiness, and difficulty concentrating), and abdominal pain were collected in baseline assessments from 2 randomized controlled trials of 332 adults (mean age 42 years and 85% female) with irritable bowel syndrome. Structural equation modeling was used to examine the global relationships among nighttime sleep complaints, psychological distress, daytime dysfunction, and abdominal pain. RESULTS The structural equation modeling analyses found a strong indirect effect of poor sleep on abdominal pain via daytime dysfunction but not psychological distress. More than 95% of the total effect of nighttime sleep complaints on abdominal pain was indirect. CONCLUSIONS These findings suggest that the primary impact of nighttime sleep complaints on abdominal pain is indirect. The indirect effect appears primarily through daytime dysfunction. Such understanding provides a potential avenue to optimize personalized and hybrid behavioral interventions for adults with irritable bowel syndrome through addressing daytime dysfunction and sleep behaviors. Additional study integrating symptoms with biological markers is warranted to explore the underlying mechanisms accounting for these symptoms. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov. Name: Nursing Management of Irritable Bowel Syndrome: Improving Outcomes, Nursing Management of IBS: Improving Outcomes. URLs: https://clinicaltrials.gov/ct2/show/NCT00167635, https://clinicaltrials.gov/ct2/show/NCT00907790. Identifiers: NCT00167635, NCT00907790.
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Affiliation(s)
- Pei-Lin Yang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington.,Office of Nursing Research, School of Nursing, University of Washington, Seattle, Washington
| | - Diana T Buchanan
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
| | - Kenneth C Pike
- Office of Nursing Research, School of Nursing, University of Washington, Seattle, Washington
| | - Kendra J Kamp
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, Washington
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
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5
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Tang HYJ, McCurry SM, Pike KC, Riegel B, Vitiello MV. Open-loop Audio-Visual Stimulation for sleep promotion in older adults with comorbid insomnia and osteoarthritis pain: results of a pilot randomized controlled trial. Sleep Med 2021; 82:37-42. [PMID: 33878522 DOI: 10.1016/j.sleep.2021.03.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Osteoarthritis is commonly comorbid with insomnia in older adults. While cognitivebehavioral therapy for insomnia is the recommended first-line treatment for insomnia, alternative efficacious non-pharmacological options are needed. This study examined sleep and pain in 30 community-dwelling older adults with comorbid insomnia and osteoarthritis pain randomized to two weeks of 30 min of bedtime active (n = 15, mean age 66.7 ± 5.2) or placebo control (n = 15, mean age 68.9 ± 5.0) Audiovisual Stimulation (AVS). After AVS use, improvements in sleep, pain, and depression were reported for both groups but between-group comparisons were non-significant. A posthoc analysis examined the effects of AVS in the 11 subjects who reported sleep latency complaints (≥30 min). No significant group differences were found for this small sleep latency subsample; however, the pre-post effect sizes (ES) of active AVS versus placebo were greatly increased for the subsample relative to the total sample for sleep (ES = 0.41 versus 0.18 for the Insomnia Severity Index, and 0.60 versus 0.03 for the Pittsburgh Sleep Quality Index, respectively). A similar enhanced effect pattern was found for pain (ES = 0.41 versus 0.15 for the Brief Pain Inventory). Study findings suggest that the 30-min AVS program may have potential to improve sleep in older adults with sleep onset but not sleep maintenance difficulty. Despite study limitations of a small sample size and lack of follow-up, results offer valuable insights into the functionality of AVS treatment. Future research should focus on subjects with sleep onset complaints, who are most likely to receive benefit from this treatment modality.
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Affiliation(s)
- Hsin-Yi Jean Tang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States.
| | - Susan M McCurry
- Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Kenneth C Pike
- Department of Child, Family and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Barbara Riegel
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States
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6
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Yohannes AM, Kohen R, Nguyen HQ, Pike KC, Borson S, Fan VS. Serotonin transporter gene polymorphisms and depressive symptoms in patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 15:681-687. [PMID: 33325315 DOI: 10.1080/17476348.2021.1865159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: We examined the relationship between polymorphisms in the promoter region of the serotonin transport (SERT) gene (5-HTTLPR, short 'S' and long 'L' alleles) and in intron 2 variable number tandem repeat (STin2VNTR, 9, 10, or 12-repeat alleles) with depression or anxiety in patients with COPD.Methods: 302 patients with moderate to severe COPD participated in SERT study. History and number of prior depressive episodes were measured using the Structured Clinical Interview for Depression; Hospital Anxiety Depression Scale (HAD) depression ≥8 or a Patient Health Questionnaire-9 (PHQ-9) >,10.Results: 240 (80%) male sample had a mean age of 68.0 years. Current depression was 22% (HAD) or 21% (PHQ-9), anxiety was 25% (HAD), and suicidal ideation (6%). 5-HTTLPR or STin2 VNTR genotypes were not associated with current depressive or anxiety symptoms. The mean number of prior depressive episodes was higher for patients with the 5-HTTLPR genotype S/S or S/L compared with L/L (4.4 ± 6.1; 5.3 ± 6.8; 4.0 ± 6.1, p < 0.001) and with STin2VNTR high-risk genotype (9/12 or 12/12), medium risk (9/10 or 10/12) compared to low risk (10/10) genotypes (5.1 ± 6.8; 4.9 ± 6.7; 2.7 ± 4.5, p < 0.001).Conclusions: SERT 5-HTTLPR and STin2-VNTR polymorphisms were not associated with current depressive and anxiety symptoms, but the high-risk STin2-VNTR genotypes and S/L were associated with the number of prior depressive episodes.
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Affiliation(s)
| | - Ruth Kohen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Huong Q Nguyen
- Department of research and evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kenneth C Pike
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Soo Borson
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Vincent S Fan
- VA Puget Sound, University of Washington, Seattle, WA, USA
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7
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Teri L, Logsdon RG, McCurry SM, Pike KC, McGough EL. Translating an Evidence-based Multicomponent Intervention for Older Adults With Dementia and Caregivers. Gerontologist 2020; 60:548-557. [PMID: 30304477 DOI: 10.1093/geront/gny122] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Effective community-based programs to maintain health and well-being of adults with dementia are needed. This article describes the translation, implementation, and effectiveness of a multicomponent exercise plus behavioral/psychosocial intervention (Reducing Disability in Alzheimer's Disease-NorthWest [RDAD-NW]) conducted by staff in regional Area Agencies on Aging (AAAs). RESEARCH DESIGN AND METHODS Staggered multiple baseline design was used; 10 AAAs, 20 case managers, and 255 community-residing persons with dementia (PWDs), and family caregivers were enrolled. RDAD-NW was conducted in-home over 6 weeks with aerobic/endurance, strength, and balance/flexibility exercises, dementia education, training to increase pleasant events, and activator-behavior-consequence problem-solving approach. Outcomes included case manager treatment fidelity, and caregiver/PWD physical activity, restricted activity days, physical functioning, quality of life, and affect. RESULTS RDAD-NW was successfully translated and implemented by AAA agency staff through their usual service provision mechanisms. Staff responded positively and delivered the program with a high degree of fidelity. Caregiver/PWD dyads also responded favorably engaging in both exercise and behavioral/psychosocial portions of the program. A total of 207 dyads (81%) completed the intervention and 140 (55%) completed the 13-month follow-up. PWD physical activity increased significantly pre- to posttreatment (p < .001, ES = .54), and 13 months (p < .01, ES = .21). Quality of life of PWD increased significantly pre- to posttreatment (p < .001, ES = .29); caregiver depression improved pre- to posttreatment (p = .01, ES = -.18). DISCUSSION AND IMPLICATIONS RDAD-NW was successfully translated and implemented by AAA case managers and resulted in increased physical activity and improved behavioral and emotional outcomes of caregiver/PWDs. Results support continued dissemination and implementation of RDAD-NW. CLINICAL TRIALS REGISTRATION NCT01708304.
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Affiliation(s)
- Linda Teri
- Department of Psychosocial and Community Health, University of Washington, Seattle
| | - Rebecca G Logsdon
- Department of Psychosocial and Community Health, University of Washington, Seattle
| | - Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle
| | - Kenneth C Pike
- Office of Nursing Research, School of Nursing, University of Washington, Seattle
| | - Ellen L McGough
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle
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Yee N, Locke ER, Pike KC, Chen Z, Lee J, Huang JC, Nguyen HQ, Fan VS. Frailty in Chronic Obstructive Pulmonary Disease and Risk of Exacerbations and Hospitalizations. Int J Chron Obstruct Pulmon Dis 2020; 15:1967-1976. [PMID: 32848382 PMCID: PMC7429100 DOI: 10.2147/copd.s245505] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background Frailty is a complex clinical syndrome associated with vulnerability to adverse health outcomes. While frailty is thought to be common in chronic obstructive pulmonary disease (COPD), the relationship between frailty and COPD-related outcomes such as risk of acute exacerbations of COPD (AE-COPD) and hospitalizations is unclear. Purpose To examine the association between physical frailty and risk of acute exacerbations, hospitalizations, and mortality in patients with COPD. Methods A longitudinal analysis of data from a cohort of 280 participants was performed. Baseline frailty measures included exhaustion, weakness, low activity, slowness, and undernutrition. Outcome measures included AE-COPD, hospitalizations, and mortality over 2 years. Negative binomial regression and Cox proportional hazard modeling were used. Results Sixty-two percent of the study population met criteria for pre-frail and 23% were frail. In adjusted analyses, the frailty syndrome was not associated with COPD exacerbations. However, among the individual components of the frailty syndrome, weakness measured by handgrip strength was associated with increased risk of COPD exacerbations (IRR 1.46, 95% CI 1.09–1.97). The frailty phenotype was not associated with all-cause hospitalizations but was associated with increased risk of non-COPD-related hospitalizations. Conclusion This longitudinal cohort study shows that a high proportion of patients with COPD are pre-frail or frail. The frailty phenotype was associated with an increased risk of non-COPD hospitalizations but not with all-cause hospitalizations or COPD exacerbations. Among the individual frailty components, low handgrip strength was associated with increased risk of COPD exacerbations over a 2-year period. Measuring handgrip strength may identify COPD patients who could benefit from programs to reduce COPD exacerbations.
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Affiliation(s)
- Nathan Yee
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Emily R Locke
- Department of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Kenneth C Pike
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Zijing Chen
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Joe C Huang
- Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Huong Q Nguyen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Vincent S Fan
- Department of Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
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McCurry SM, Vitiello MV, Pike KC, Thakral M, Morin CM, Von Korff M. 0469 Perceptions of an Education Only Control Group in the Osteoarthritis and Therapy for Sleep (OATS) Study: An Ongoing Statewide, Telephone-Delivered CBT for Insomnia (CBT-I) Randomized Trial. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.466] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Comorbid osteoarthritis (OA) and insomnia is common in older adults. CBT-I is efficacious for improving sleep in older persons with OA but not widely accessible. We examined treatment process data from OATS, a large ongoing clinical trial of telephone-delivered CBT-I.
Methods
327 Kaiser Permanente Washington members aged 60+ with OA, Insomnia Severity Index scores of 11+, and Brief Pain Inventory scores of 9+ were randomized to individual CBT-I vs. education only control (EOC). Six telephone sessions of CBT-I or EOC were offered over eight weeks. Participants rated their perceptions of treatment (credibility, acceptability, suitability, perceived effectiveness, adherence, and therapeutic relationship) on a 7-point Likert scale after session 1 and at 2-month post-test.
Results
Participants (mean age=70.2 years, 74.6% female) were randomized to the two treatment arms (CBT-I=163, EOC=164). Participants did not differ significantly across arms by age, gender, education, or by sleep, pain, or mood (depression, fatigue) outcome measures at baseline. CBT-I had significantly (p=.03) more white participants (90% CBT-I, 78% EOC). Study retention was 82% and 88% at post-test for CBT-I versus EOC, respectively. There was no difference in number of sessions attended (median=6). CBT-I sessions were somewhat longer than EOC (24.2 vs. 22.8 minutes; p=.005). Most participants in both groups at both time points gave high rankings (5+/7 points) on all six treatment perception ratings (CBT-I range: 75.9-99.3%; EOC range: 69.0-97.9%). Average summed treatment perception ratings improved between Session 1 and post-test for both conditions (mean=5.9 and 6.1, respectively, for CBT-I; mean=5.6 and 5.8, respectively, for EOC).
Conclusion
The OATS EOC group was credible and acceptable to participants, resulting in equivalently high levels of participation and retention compared to CBT-I. Findings suggest the ongoing trial has adequately controlled for nonspecific participant treatment effects that might confound interpretation of efficacy outcomes.
Support
This work was supported by PHS grant 5R01AG053221.
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Affiliation(s)
| | | | - K C Pike
- University of Washington, Seattle, WA
| | - M Thakral
- University of Massachusetts Boston, Boston, MA
| | - C M Morin
- Université Laval, Quebec City, QC, CANADA
| | - M Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Leitao Filho FS, Mattman A, Schellenberg R, Criner GJ, Woodruff P, Lazarus SC, Albert RK, Connett J, Han MK, Gay SE, Martinez FJ, Fuhlbrigge AL, Stoller JK, MacIntyre NR, Casaburi R, Diaz P, Panos RJ, Cooper JA, Bailey WC, LaFon DC, Sciurba FC, Kanner RE, Yusen RD, Au DH, Pike KC, Fan VS, Leung JM, Man SFP, Aaron SD, Reed RM, Sin DD. Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis. Chest 2020; 158:1420-1430. [PMID: 32439504 DOI: 10.1016/j.chest.2020.04.058] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypogammaglobulinemia (serum IgG levels < 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations. RESEARCH QUESTION To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD. STUDY DESIGN AND METHODS Serum IgG levels were measured on baseline samples from four COPD cohorts (n = 2,259): Azithromycin for Prevention of AECOPD (MACRO, n = 976); Simvastatin in the Prevention of AECOPD (STATCOPE, n = 653), Long-Term Oxygen Treatment Trial (LOTT, n = 354), and COPD Activity: Serotonin Transporter, Cytokines and Depression (CASCADE, n = 276). IgG levels were determined by immunonephelometry (MACRO; STATCOPE) or mass spectrometry (LOTT; CASCADE). The effect of hypogammaglobulinemia on COPD hospitalization risk was evaluated using cumulative incidence functions for this outcome and deaths (competing risk). Fine-Gray models were performed to obtain adjusted subdistribution hazard ratios (SHR) related to IgG levels for each study and then combined using a meta-analysis. Rates of COPD hospitalizations per person-year were compared according to IgG status. RESULTS The overall frequency of hypogammaglobulinemia was 28.4%. Higher incidence estimates of COPD hospitalizations were observed among participants with low IgG levels compared with those with normal levels (Gray's test, P < .001); pooled SHR (meta-analysis) was 1.29 (95% CI, 1.06-1.56, P = .01). Among patients with prior COPD admissions (n = 757), the pooled SHR increased to 1.58 (95% CI, 1.20-2.07, P < .01). The risk of COPD admissions, however, was similar between IgG groups in patients with no prior hospitalizations: pooled SHR = 1.15 (95% CI, 0.86-1.52, P =.34). The hypogammaglobulinemia group also showed significantly higher rates of COPD hospitalizations per person-year: 0.48 ± 2.01 vs 0.29 ± 0.83, P < .001. INTERPRETATION Hypogammaglobulinemia is associated with a higher risk of COPD hospital admissions.
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Affiliation(s)
- Fernando Sergio Leitao Filho
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Schellenberg
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Prescott Woodruff
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Stephen C Lazarus
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | | | - John Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Steven E Gay
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Anne L Fuhlbrigge
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Neil R MacIntyre
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Philip Diaz
- Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Ralph J Panos
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - J Allen Cooper
- Birmingham VA Medical Center, Birmingham, AL; Department of Medicine, University of Alabama Medical School, Birmingham, AL
| | - William C Bailey
- Department of Medicine, University of Alabama Medical School, Birmingham, AL
| | - David C LaFon
- Department of Medicine, University of Alabama Medical School, Birmingham, AL
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Richard E Kanner
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Roger D Yusen
- Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine in Saint Louis, Saint Louis, MO
| | - David H Au
- Division of Pulmonary, Critical Care and Sleep Medicine and School of Nursing, University of Washington, Seattle, WA
| | - Kenneth C Pike
- Division of Pulmonary, Critical Care and Sleep Medicine and School of Nursing, University of Washington, Seattle, WA
| | - Vincent S Fan
- Division of Pulmonary, Critical Care and Sleep Medicine and School of Nursing, University of Washington, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA
| | - Janice M Leung
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shu-Fan Paul Man
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shawn D Aaron
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert M Reed
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Souza AM, Tsai JHC, Pike KC, Martin F, McCurry SM. Cognition, Health, and Social Support of Formerly Homeless Older Adults in Permanent Supportive Housing. Innov Aging 2020; 4:igz049. [PMID: 32405543 PMCID: PMC7207261 DOI: 10.1093/geroni/igz049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/12/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Formerly homeless older adults residing in Permanent Supportive Housing (PSH) represent an invisible subsector of two distinct, yet related populations: the homeless population and the elderly population. Little research is focused on the complex health concerns facing this aging population within the homelessness response system. Of particular concern is the identification and support of individuals with cognitive impairment and co-occurring chronic conditions. We collaborated with a leading housing services provider to develop a systematic screening system for case managers to capture the cognitive, physical, and psychosocial health of older adults served within homeless housing programs. RESEARCH DESIGN AND METHODS PSH residents aged ≥50 years in four sites screened as being without cognitive impairment on the Mini-Cog were enrolled. A brief demographic survey and selected PROMIS measures were used to characterize participants' demographics, cognition, global physical and mental health, physical functioning, self-efficacy for social interactions, and instrumental support. PSH case managers were trained to recruit participants and collect data. PROMIS scales were scored using the Health Measures Scoring Service. Descriptive statistics, correlations, and one sample t-tests were performed. RESULTS Fifty-three residents (mean age = 60.8 years, range 50-76 years) participated. The majority self-identified as male and were military veterans; 60% reported having a history of two or more episodes of homelessness. All PROMIS scores were significantly (p < .05) lower than reference U.S. population means, with global mental health and cognition having the lowest scores. DISCUSSION AND IMPLICATIONS Self-reported cognitive functioning and global mental health were residents' greatest concerns. Strengthening housing case manager capacity to assess residents' cognitive and health status could increase support for older adults in PSH. It is feasible to train PSH staff to conduct structured interviews to identify resident cognitive and health needs to help support this "invisible" population to successfully age in place.
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Affiliation(s)
- Anita M Souza
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle
| | - Jenny Hsin-Chin Tsai
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle
| | - Kenneth C Pike
- Office of Nursing Research, University of Washington School of Nursing, Seattle
| | | | - Susan M McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle
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McCurry SM, Von Korff M, Morin CM, Cunningham A, Pike KC, Thakral M, Wellman R, Yeung K, Zhu W, Vitiello MV. Telephone interventions for co-morbid insomnia and osteoarthritis pain: The OsteoArthritis and Therapy for Sleep (OATS) randomized trial design. Contemp Clin Trials 2019; 87:105851. [PMID: 31614214 PMCID: PMC6886712 DOI: 10.1016/j.cct.2019.105851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022]
Abstract
The OsteoArthritis and Therapy for Sleep (OATS) study is a population-based randomized controlled trial of cognitive behavioral therapy for insomnia (CBTI) with four innovative methodological aims. These are to: (1) Enroll representative participants across Washington state, including those from medically underserved communities; (2) Enroll persons with persistent insomnia and chronic osteoarthritis (OA) pain; (3) Test a scalable CBT-I intervention; and (4) Evaluate patient-reported outcomes (insomnia, pain severity, fatigue, depression) and cost-effectiveness over one year. This paper describes progress towards achieving these aims. The target population was persons age 60+ who had received OA care within the Kaiser Permanente Washington (KPW) health care system. We employed a two-phase screening via mail survey and telephone follow-up, with a 3-week interval between screens to exclude persons with spontaneous improvement in sleep or pain symptoms. Participants were randomized to a 6-session telephone-delivered CBT-I intervention or a 6-session telephone education only control condition (EOC). Blinded outcome assessments (completed online or on mailed paper forms) included primary and secondary sleep and pain outcome measures and quality of life measures. We obtained healthcare utilization from administrative claims data. Intent to treat analyses, including all participants randomized when they scheduled the first telephone session, will be conducted to compare CBT-I and EOC outcomes. The trial will be the largest experimental evaluation of telephone CBT-I to date, and the first to evaluate its cost-effectiveness. Trial registration: ClinicalTrials.gov identifier: NCT02946957.
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Affiliation(s)
- Susan M McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States of America.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Charles M Morin
- Department of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Amy Cunningham
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States of America
| | - Kenneth C Pike
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States of America
| | - Manu Thakral
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States of America
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
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13
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Price CJ, Merrill JO, McCarty RL, Pike KC, Tsui JI. A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder. J Subst Abuse Treat 2019; 108:123-128. [PMID: 31174929 DOI: 10.1016/j.jsat.2019.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/08/2019] [Accepted: 05/21/2019] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to pilot-test a mind-body intervention called Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to buprenorphine for individuals with opioid use disorder (OUD). MABT, a manualized 8 week protocol, teaches interoceptive awareness skills to promote self-care and emotion regulation. A small study was designed to assess MABT recruitment and retention feasibility, and intervention acceptability, among this population. Individuals were recruited from two office-based programs providing buprenorphine treatment within a large urban community medical center. Participants were randomized to receive either treatment as usual (TAU), or TAU plus MABT. Assessments administered at baseline and 10-week follow-up included validated self-report health questionnaires and a process measure, the Multidimensional Assessment of Interoceptive Awareness, to examine interoceptive awareness skills. An additional survey and exit interview for those in the MABT study arm were administered to assess intervention satisfaction. Results showed the ability to recruit and enroll 10 participants within two-weeks, and no loss to follow-up. The MABT study group showed an increase in interoceptive awareness skills from baseline to follow-up, whereas the control group did not. Responses to the satisfaction questionnaire and exit interview were positive, indicating skills learned, satisfaction with the interventionists, and overall perceived benefit of the intervention. In summary, study results demonstrated recruitment and retention feasibility, and high intervention acceptability. This pilot study suggests preliminary feasibility of successfully implementing a larger study of MABT as an adjunct to office-based medication treatment for opioid use disorder.
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Affiliation(s)
- Cynthia J Price
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Box 357266, Seattle, WA 98195, USA.
| | - Joseph O Merrill
- Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98195, USA
| | - Rachelle L McCarty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Box 357266, Seattle, WA 98195, USA
| | - Kenneth C Pike
- Department of Psychosocial and Community Health Nursing, University of Washington, Box 357263, Seattle, WA 98185, USA
| | - Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98195, USA
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Tang HY(J, McCurry SM, Riegel B, Pike KC, Vitiello MV. Open-Loop Audiovisual Stimulation Induces Delta EEG Activity in Older Adults With Osteoarthritis Pain and Insomnia. Biol Res Nurs 2019; 21:307-317. [PMID: 30862174 PMCID: PMC6700899 DOI: 10.1177/1099800419833781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE People with chronic insomnia tend to have cortical hyperarousal marked by excessive beta-/gamma-frequency brain activity during both wake and sleep. Currently, treatment options for managing hyperarousal are limited. Open-loop audiovisual stimulation (AVS) may be such a treatment. The purpose of this study was to provide a mechanistic foundation for future AVS research in sleep promotion by examining quantitative electroencephalogram (QEEG) responses to an AVS sleep-induction program. METHOD Sixteen older adults with both chronic insomnia and osteoarthritis pain were randomly assigned to either active- or placebo-control AVS. Electroencephalogram (EEG) was collected during baseline (5 min, eyes closed/resting) and throughout 30 min of AVS. RESULTS Findings showed significantly elevated mean baseline gamma (35-45 Hz) power in both groups compared to an age- and gender-matched, noninsomnia normative database, supporting cortical hyperarousal. After 30 min of exposure to AVS, the active group showed significantly increased delta power compared to the placebo-control group, providing the first controlled evidence that active AVS induction increases delta QEEG activity in insomnia patients and that these changes are immediate. In the active group, brain locations that showed the most delta induction (Cz, Fp, O1, and O2) were associated with the sensory-thalamic pathway, consistent with the sensory stimulation provided by the active AVS program. CONCLUSIONS Findings demonstrate that delta induction, which can promote sleep, is achievable using a 30-min open-loop AVS program. The potential for AVS treatment of insomnia in the general population remains to be demonstrated in well-designed clinical trials.
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Affiliation(s)
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth C. Pike
- School of Nursing, University of Washington, Seattle, WA, USA
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Tang J, McCurry SM, Riegel B, Pike KC, Vitiello MV. 0403 Older Adults with Sleep Onset Insomnia Are More Responsive to Open-Loop Audio-Visual Stimulation Based Delta Induction Than Are Those with Sleep Maintenance Insomnia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jean Tang
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, WA, USA
| | | | - Kenneth C Pike
- School of Nursing, University of Washington, Seattle, WA, USA
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16
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Price CJ, Crowell SE, Pike KC, Cheng SC, Puzia M, Thompson EA. Psychological and Autonomic Correlates of Emotion Dysregulation among Women in Substance Use Disorder Treatment. Subst Use Misuse 2019; 54:110-119. [PMID: 30273086 PMCID: PMC6379107 DOI: 10.1080/10826084.2018.1508297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Emotion regulation is increasingly recognized as important for the prevention and treatment of substance use disorder (SUD). However, there is an identified lack of physiological indexes of emotion dysregulation in SUD treatment studies, critically needed to better understand the link between emotion regulation capacity (measured physiologically) and self-report health outcomes among individuals in SUD treatment. OBJECTIVE To examine the association between respiratory sinus arrhythmia (RSA) and self-report health outcomes among women in SUD treatment. METHODS This is a cross-sectional study based on baseline data from 217 women enrolled in a randomized control trial to study a mind-body intervention as an adjunct to SUD treatment. All participants were enrolled in community-based outpatient treatment. Participants were administered questionnaires to examine sample characteristics, mental health symptoms, and interoceptive awareness and mindfulness skills. RSA data was gathered as an index of emotion dysregulation. Descriptive statistics, bivariate correlations, and regression were used in the analyses. RESULTS Findings highlight the extensive trauma histories, low SES, and the high symptoms of distress in this sample. RSA was only significantly correlated with interoceptive awareness after controlling for age and BMI. Measures of symptomatic distress and mindfulness were not correlated with RSA. Conclusions/Importance: Results provide the first evidence of RSA as an index of interoceptive awareness in this population. The inclusion of biomarkers such as RSA in SUD clinical studies may help identify individuals that are in need of targeted treatments that include interoceptive awareness training focused on improving emotion regulation.
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Affiliation(s)
- Cynthia J Price
- a Department of Biobehavioral Nursing and Health Informatics , University of Washington , Seattle , Washington , USA
| | - Sheila E Crowell
- b Department of Psychology , University of Utah , Salt Lake City , Utah, USA
| | - Kenneth C Pike
- c Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
| | - Sunny Chieh Cheng
- d Nursing and Healthcare Leadership , University of Washington , Tacoma , Washington, USA
| | - Megan Puzia
- b Department of Psychology , University of Utah , Salt Lake City , Utah, USA
| | - Elaine Adams Thompson
- c Department of Psychosocial and Community Health Nursing , University of Washington , Seattle , Washington , USA
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17
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Tang J, McCurry SM, Riegel B, Pike KC, Vitiello MV. 0393 Open-Loop Audio-Visual Stimulation for Insomnia in Older Adults with Osteoarthritis Pain. Sleep 2018. [DOI: 10.1093/sleep/zsy061.392] [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)
- J Tang
- School of Nursing, University of Washington, Seattle, WA
| | - S M McCurry
- School of Nursing, University of Washington, Seattle, WA
| | - B Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - K C Pike
- School of Nursing, University of Washington, Seattle, WA
| | - M V Vitiello
- School of Medicine, University of Washington, Seattle, WA
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18
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Chi NC, Demiris G, Pike KC, Washington K, Oliver DP. Exploring the Challenges that Family Caregivers Faced When Caring for Hospice Patients with Heart Failure. J Soc Work End Life Palliat Care 2018; 14:162-176. [PMID: 29856280 PMCID: PMC6274608 DOI: 10.1080/15524256.2018.1461168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
Although patients with heart disease comprise the second largest diagnostic group in hospice care, the challenges faced by family caregivers of hospice patients with heart failure are poorly understood and often go unaddressed. This study explored the challenges and needs of family caregivers of adults with advanced heart failure receiving hospice care in the home. The baseline quantitative and qualitative data from 28 family caregivers' participation in a large-scale hospice clinical trial of a problem-solving therapy intervention were analyzed. The quantitative data showed that family caregivers were mildly anxious and had worse financial and physical quality of life than their social and emotional quality of life. The qualitative data showed that caregiver challenges were related to patient care and symptom management, inadequate social support, communication issues, and financial concerns. The results provide insight to hospice social workers and researchers to develop practical tools that can be used in routine care to evaluate family caregivers' needs comprehensively.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kenneth C. Pike
- Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Karla Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Debra Parker Oliver
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
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19
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Lee J, Nguyen HQ, Jarrett ME, Mitchell PH, Pike KC, Fan VS. Effect of symptoms on physical performance in COPD. Heart Lung 2018; 47:149-156. [PMID: 29395264 DOI: 10.1016/j.hrtlng.2017.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/26/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance. OBJECTIVES The purpose of this study was to examine interrelationships among dyspnea, anxiety, depressive symptoms, and fatigue as contributing factors to physical performance in COPD. METHODS This study used baseline data of 282 COPD patients from a longitudinal observational study to explore the relationship between depression, inflammation, and functional status. Data analyses included confirmatory factor analyses and structural equation modeling. RESULTS Dyspnea, anxiety and depression had direct effects on fatigue, and both dyspnea and anxiety had direct effects on physical performance. Higher levels of dyspnea were significantly associated with impaired physical performance whereas higher levels of anxiety were significantly associated with enhanced physical performance. CONCLUSION Dyspnea was the strongest predictor of impaired physical performance in patients with COPD.
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Affiliation(s)
- Jungeun Lee
- School of Nursing, University of Washington, Seattle, WA, USA.
| | - Huong Q Nguyen
- Reseach & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - Kenneth C Pike
- School of Nursing, University of Washington, Seattle, WA, USA
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20
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McCurry SM, Logsdon RG, Pike KC, LaFazia DM, Teri L. Training Area Agencies on Aging Case Managers to Improve Physical Function, Mood, and Behavior in Persons With Dementia and Caregivers: Examples from the RDAD-Northwest Study. J Gerontol Soc Work 2018; 61:45-60. [PMID: 29135358 PMCID: PMC5939562 DOI: 10.1080/01634372.2017.1400486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Reducing Disability in Alzheimer's Disease (RDAD) program has been shown to be an effective tool for teaching caregivers strategies to improve mood, behavior, and physical function in persons with dementia. This paper describes how RDAD has been translated and implemented for use by Area Agencies on Aging (AAA) case managers across Washington and Oregon. Modifications to the original RDAD program as part of its community translation included decreasing the number of in-person sessions while preserving all educational content; involving caregivers in exercise activities for themselves as well as acting as exercise coaches for care-receivers; and enrolling persons with cognitive impairment due to mixed etiologies. This paper describes these changes and their rationale, the challenges faced by community agencies recruiting for and delivering evidence-based programs, and illustrates the actual RDAD implementation process through several brief case examples. Case examples also illustrate how RDAD-Northwest can be useful with care-receivers with a range of cognitive impairment severity, family caregiving situations, and levels of mood and behavioral challenges.
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Affiliation(s)
- Susan M McCurry
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - Rebecca G Logsdon
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - Kenneth C Pike
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - David M LaFazia
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - Linda Teri
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
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Abstract
BACKGROUND Pain management is a challenging task for family caregivers in home hospice care. However, there are limited studies that examine the challenges regarding pain management in hospice care from family caregivers' perspectives. OBJECTIVES To identify the challenges related to pain management faced by family caregivers in hospice care and to examine the validity of an existing framework that outlines pain management challenges for hospice family caregivers. DESIGN We conducted a theory-driven, deductive content analysis of secondary data obtained from hospice family caregivers' interviews from a randomized clinical trial. SETTING/PARTICIPANTS We included baseline interviews of 15 hospice caregivers of patients from hospice agencies in the States of Washington. The majority of the participants were white and female caregivers. They were spouse/partner or adult child living with the patient. RESULTS The study identified 5 out of the 6 major themes in the original framework and confirmed that hospice family caregivers face a variety of challenges: caregiver-centric issues, caregiver's medication skills and knowledge, communication and teamwork, organizational skill, and patient-centric issues. A couple of the subthemes in the original framework were not present in our findings. We also expanded the original framework by adding 1 subtheme and revised 2 definitions in the original framework. CONCLUSION The study provided an investigation on hospice family caregivers' difficulties in pain management. The results can inform health-care providers and researchers of family caregivers' challenges and provide insights for future designs of educational tools targeting pain management strategies, so that family caregivers can perform pain management effectively at home.
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Affiliation(s)
- Nai-Ching Chi
- 1 College of Nursing, University of Iowa, Iowa City, IA, USA
| | - George Demiris
- 2 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.,3 Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth C Pike
- 4 Department of Psychosocial and Community Health, School of Nursing, Universality of Washington, Seattle, WA, USA
| | - Karla Washington
- 5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Debra Parker Oliver
- 5 Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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Tang HY(J, McCurry SM, Pike KC, Von Korff M, Vitiello MV. Differential predictors of nighttime and daytime sleep complaints in older adults with comorbid insomnia and osteoarthritis pain. J Psychosom Res 2017; 100:22-28. [PMID: 28789789 PMCID: PMC5599170 DOI: 10.1016/j.jpsychores.2017.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Osteoarthritis (OA) is extremely common in older adults, affecting 50% of people aged 65 or older, and more than half of older adults with OA complain of significantly disturbed sleep. This study compared predictors of nighttime sleep complaints and daytime sleep-related consequences as measured by the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) in older adults with comorbid OA pain and insomnia. METHODS A secondary analysis of baseline data from a large longitudinal randomized controlled trial. Multivariate regression analyses were performed to test two sets of predictive models. RESULTS 367 older adults (mean age 72.9±8.2years; female 78.5%) with OA and insomnia were included in this analysis. In Model 1, fatigue and depression predicted daytime sleep-related consequences for both ISI and PSQI. When measures of sleep and pain beliefs/attitudes were added (Model 2), fatigue, and sleep and pain beliefs/attitudes predicted nighttime sleep complaints for both ISI and PSQI; depression was no longer a significant predictor of ISI daytime consequences, but remained in the model for PSQI daytime consequences. CONCLUSIONS This study found both similarities and differences in factors predicting nighttime sleep complaints and daytime sleep-related consequences. Individual beliefs/attitudes about sleep and pain were stronger predictors of sleep difficulties than were depression and pain. Fatigue was the strongest and most consistent predictor associated with both nighttime sleep complaints and daytime sleep-related consequences regardless of the scale used to measure these concepts.
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Affiliation(s)
- Hsin-Yi (Jean) Tang
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA
| | - Susan M. McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA
| | - Kenneth C. Pike
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA
| | | | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Kasatpibal N, Whitney JD, Dellinger EP, Nair BG, Pike KC. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection. Surg Infect (Larchmt) 2017; 18:474-484. [DOI: 10.1089/sur.2016.164] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Nongyao Kasatpibal
- Division of Nursing Science, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington
| | - Joanne D. Whitney
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington
| | | | - Bala G. Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Kenneth C. Pike
- Department of Psychosocial Nursing and Community Health, School of Nursing, University of Washington, Seattle, Washington
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Tang J, McCurry SM, Riegel B, Pike KC, Vitiello MV. 0368 OPEN LOOP AUDIO VISUAL STIMULATION INDUCES DELTA ACTIVITY IN OLDER ADULTS WITH PAIN AND INSOMNIA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.367] [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: 11/13/2022] Open
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Ward TM, Chen ML, Landis CA, Ringold S, Beebe DW, Pike KC, Wallace CA. Congruence between polysomnography obstructive sleep apnea and the pediatric sleep questionnaire: fatigue and health-related quality of life in juvenile idiopathic arthritis. Qual Life Res 2016; 26:779-788. [PMID: 27987106 DOI: 10.1007/s11136-016-1475-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the congruence between polysomnography obstructive apnea hypopnea index (OAHI) and parent-reported obstructive sleep apnea (OSA) symptoms in 6- to 11-year-old children with juvenile idiopathic arthritis (JIA) and controls; and to compare fatigue and quality of life in JIA and control children based on OAHI and OSA symptoms. METHODS Sixty-eight children with JIA and 75 controls and a parent participated. Children underwent one night of polysomnography in a sleep laboratory. Parents completed the sleep-related breathing disorders scale-pediatric sleep questionnaire (PSQ), and both children and parents completed the Pediatric Quality of Life Generic Core Scale and the Multidimensional Fatigue Scale. RESULTS In JIA, 86% who met the OAHI clinical criteria for OSA (≥1.5) were above the PSQ OSA symptom cut-off score with a sensitivity of 0.86 and a specificity of 0.28. In the control group, 63% who met the OAHI clinical criteria for OSA were above the PSQ OSA symptom cut-off score, with a sensitivity of 0.63 and a specificity of 0.42. All children above both the clinical criteria for OAHI and OSA symptom cut-off score had the most impaired quality of life and greater fatigue compared to those below both the clinical criteria for OAHI and the OSA symptom cut-off score. CONCLUSION Children who meet clinical criteria for OSA and also scored high on a parent-reported screening tool for OSA symptoms had the most impaired quality of life and more fatigue. The PSQ has potential to identify children at risk for OSA.
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Affiliation(s)
- Teresa M Ward
- Department of Family and Child Nursing, School of Nursing, University of Washington, Box 357262, Seattle, WA, 98195-7266, USA.
| | - Maida Lynn Chen
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Carol A Landis
- Department of Family and Child Nursing, School of Nursing, University of Washington, Box 357262, Seattle, WA, 98195-7266, USA
| | - Sarah Ringold
- Division of Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Dean W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kenneth C Pike
- Department of Family and Child Nursing, School of Nursing, University of Washington, Box 357262, Seattle, WA, 98195-7266, USA
| | - Carol A Wallace
- Division of Rheumatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Nguyen HQ, Herting JR, Pike KC, Gharib SA, Matute-Bello G, Borson S, Kohen R, Adams SG, Fan VS. Symptom profiles and inflammatory markers in moderate to severe COPD. BMC Pulm Med 2016; 16:173. [PMID: 27914470 PMCID: PMC5135800 DOI: 10.1186/s12890-016-0330-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/22/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Physical and psychological symptoms are the hallmark of patients' subjective perception of their illness. The purpose of this analysis was to determine if patients with COPD have distinctive symptom profiles and to examine the association of symptom profiles with systemic biomarkers of inflammation. METHODS We conducted latent class analyses of three physical (dyspnea, fatigue, and pain) and two psychological symptoms (depression and anxiety) in 302 patients with moderate to severe COPD using baseline data from a longitudinal observational study of depression in COPD. Systemic inflammatory markers included IL1, IL8, IL10, IL12, IL13, INF, GM-CSF, TNF-α (levels >75thcentile was considered high); and CRP (levels >3 mg/L was considered high). Multinominal logistic regression models were used to examine the association between symptom classes and inflammation while adjusting for key socio-demographic and disease characteristics. RESULTS We found that a 4-class model best fit the data: 1) low physical and psychological symptoms (26%, Low-Phys/Low-Psych), 2) low physical but moderate psychological symptoms (18%, Low-Phys/Mod Psych), 3) high physical but moderate psychological symptoms (25%, High-Phys/Mod Psych), and 4) high physical and psychological symptoms (30%, High-Phys/High Psych). Unadjusted analyses showed associations between symptom class with high levels of IL7, IL-8 (p ≤ .10) and CRP (p < .01). In the adjusted model, those with a high CRP level were less likely to be in the High-Phys/Mod-Psych class compared to the Low-Phys/Low-Psych (OR: 0.41, 95%CI 0.19, 0.90) and Low-Phys/Mod-Psych classes (OR: 0.35, 95%CI 0.16, 0.78); elevated CRP was associated with in increased odds of being in the High-Phys/High-Psych compared to the High-Phys/Mod-Psych class (OR: 2.22, 95%CI 1.08, 4.58). Younger age, having at least a college education, oxygen use and depression history were more prominent predictors of membership in the higher symptom classes. CONCLUSIONS Patients with COPD can be classified into four distinct symptom classes based on five commonly co-occurring physical and psychological symptoms. Systemic biomarkers of inflammation were not associated with symptom class. Additional work to test the reliability of these symptom classes, their biological drivers and their validity for prognostication and tailoring therapy in larger and more diverse samples is needed. TRIAL REGISTRATION Clinicaltrials.gov, NCT01074515 .
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Affiliation(s)
- Huong Q Nguyen
- Kaiser Permanente Southern California, 100 S. Los Robles, Pasadena, CA, 91101, USA.
| | | | | | | | | | | | | | - Sandra G Adams
- University of Texas Health Science Center at San Antonio and The South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Vincent S Fan
- University of Washington & Puget Sound Veterans Administration, Seattle, USA
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Kasatpibal N, Whitney JD, Dellinger PE, Nair BG, Pike KC. Failure to Redose of Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nongyao Kasatpibal
- -, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
| | - Joanne D. Whitney
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
| | | | - Bala G. Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Kenneth C. Pike
- Department of Psychosocial Nursing and Community Health, School of Nursing, University of Washington, Seattle, WA
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Schure MB, Borson S, Nguyen HQ, Trittschuh EH, Thielke SM, Pike KC, Adams SG, Fan VS. Associations of cognition with physical functioning and health-related quality of life among COPD patients. Respir Med 2016; 114:46-52. [DOI: 10.1016/j.rmed.2016.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 02/02/2023]
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Washington KT, Pike KC, Demiris G, Parker Oliver D, Albright DL, Lewis AM. Gender Differences in Caregiving at End of Life: Implications for Hospice Teams. J Palliat Med 2015; 18:1048-53. [PMID: 26484426 DOI: 10.1089/jpm.2015.0214] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Researchers have identified important gender differences in the experience of caring for a family member or friend living with advanced disease; however, trends suggest that these differences may be diminishing over time in response to changing gender roles. In addition, while many studies have found caregiving experiences and outcomes to be poorer among female caregivers, noteworthy exceptions exist. OBJECTIVE The primary aim of this exploratory study was to determine how, if at all, current day caregiving at end of life varies by gender. METHODS We conducted a secondary analysis of data from a multisite randomized controlled trial of a family caregiving intervention performed between 2010 and 2014. We compared female and male hospice family caregivers on baseline variables using χ(2) tests for association of categorical variables and t-tests for continuous variables. Our sample included 289 family caregivers of individuals receiving services from one of two hospice agencies located in the northwestern United States. Demographic data and other categorical variables of interest were provided via caregiver self-report using an instrument created specifically for this study. Reaction to caregiving and caregiving burden were measured using the Caregiver Reaction Assessment (CRA). RESULTS As it related to caregiving, females had significantly lower self-esteem and more negative impact on their schedule, health, and family support than males. No gender differences were detected with regard to the impact of caregiving on individuals' finances. CONCLUSIONS Despite changing social expectations, pronounced gender differences persist in caregiving at the end of life.
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Affiliation(s)
- Karla T Washington
- 1 Department of Family and Community Medicine, School of Medicine, University of Missouri , Columbia, Missouri
| | - Kenneth C Pike
- 2 Department of Psychosocial Nursing and Community Health, University of Washington , Seattle, Washington
| | - George Demiris
- 3 Department of Biobehavioral Nursing and Health Services, School of Nursing, University of Washington , Seattle, Washington.,4 Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington , Seattle, Washington
| | - Debra Parker Oliver
- 1 Department of Family and Community Medicine, School of Medicine, University of Missouri , Columbia, Missouri
| | - David L Albright
- 5 School of Social Work, University of Alabama , Tuscaloosa, Alabama
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McCurry SM, Logsdon RG, Mead J, Pike KC, La Fazia DM, Stevens L, Teri L. Adopting Evidence-Based Caregiver Training Programs in the Real World: Outcomes and Lessons Learned From the STAR-C Oregon Translation Study. J Appl Gerontol 2015; 36:519-536. [DOI: 10.1177/0733464815581483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: This article describes the translation and evaluation of STAR–Community Consultants program (STAR-C), an evidence-based dementia caregiver training program, within the Oregon Department of Human Services. Method: Staff from two regional Area Agencies on Aging (AAAs) were trained to implement all aspects of STAR-C, including screening, recruitment of caregiver/care-receiver dyads, and treatment delivery. Mailed assessments of caregiver depression, burden, and care-receiver mood, behavior, and quality of life were collected at pre-treatment, post-treatment, and 6-month follow-up. Results: One hundred fifty-one dyads entered the program; 96 completed the 8-week intervention. Significant positive post-treatment effects were obtained for caregiver depression, burden, and reactivity to behavior problems, and care-receiver depression and quality of life. At 6-month follow-up, improvements in caregiver reactivity and care-receiver depression were maintained. Caregivers reported high levels of satisfaction with the program. Discussion: STAR-C was successfully and effectively implemented by participating AAAs. Recommendations for replication, including training, recruitment, and assessment procedures are provided.
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Affiliation(s)
| | | | | | | | | | - Laura Stevens
- Multnomah County Aging & Disability Services, Portland, OR, USA
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Washington KT, Pike KC, Demiris G, Oliver DP. Unique characteristics of informal hospice cancer caregiving. Support Care Cancer 2014; 23:2121-8. [PMID: 25547480 DOI: 10.1007/s00520-014-2570-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to describe the unique characteristics of informal hospice cancer caregiving. METHODS Researchers conducted a secondary analysis of data drawn from a randomized clinical trial of an informal hospice caregiving intervention (N = 348). Demographic characteristics and measures of the informal caregiving experience of hospice patients and their informal caregivers were compared based on the patient's diagnosis using chi-square tests for association of categorical variables and t tests for continuous variables. RESULTS Informal caregivers of cancer patients differed from their non-cancer counterparts in a number of respects including patient age, caregiver age, patient residence, relationship between patient and caregiver, amount and duration of care provided, likelihood to incur out-of-pocket expenses related to patient care, caregiver problem-solving style, and impact on caregiver daily schedule. There were no statistically significant differences between cancer and non-cancer caregivers in terms of gender, race, employment status, anxiety, and quality of life. CONCLUSIONS While cancer and non-cancer caregivers are similar in many respects, a number of unique features characterize the informal hospice cancer caregiving experience. Attention to these unique features will allow hospice providers to tailor supportive care interventions to better address cancer caregivers' needs.
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Affiliation(s)
- Karla T Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO, 65212, USA,
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Logsdon RG, Pike KC, Korte L, Goehring C. Memory Care and Wellness Services: Efficacy of Specialized Dementia Care in Adult Day Services. Gerontologist 2014; 56:318-25. [PMID: 24615230 DOI: 10.1093/geront/gnu012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/30/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY This investigation evaluated participant and caregiver outcomes of a program of specialized dementia adult day services (ADS; Memory Care and Wellness Services: MCWS). DESIGN AND METHODS One hundred eighty-seven participant-caregiver dyads were enrolled in a quasiexperimental research investigation; 162 attended MCWS and 25 were comparison dyads that met eligibility criteria but did not have access to ADS within their communities. The objectives of this investigation were to evaluate whether MCWS improved quality of life, mood, behavior, or functional status for participants with dementia and whether caregivers experienced decreased stress, burden, or depression, compared with comparison dyads. RESULTS No significant differences were seen between MCWS and comparison dyads at 3 months. However, after 6 months, MCWS participants exhibited significantly fewer depressive behaviors (p < .05) and a trend toward fewer total behavior problems (p < .10) than comparison participants, and MCWS caregivers exhibited significantly less distress over behavior problems (total behavior problems, memory problems, depressive problems, all p < .05) than comparison caregivers. IMPLICATIONS Although modest, outcomes represent a reversal of the typical direction of change in both behavior problems and caregiver distress, despite the progression of cognitive and functional impairment. Caregivers were highly satisfied with the services. The MCWS program provides a model of a community-based dementia ADS and results provide support for further development of the program.
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Affiliation(s)
- Rebecca G Logsdon
- Psychosocial & Community Health, University of Washington School of Nursing, Seattle.
| | - Kenneth C Pike
- Psychosocial & Community Health, University of Washington School of Nursing, Seattle
| | - Lynne Korte
- Washington Department of Social and Health Services, Aging and Long-Term Support Administration, Olympia
| | - Candace Goehring
- Washington Department of Social and Health Services, Aging and Long-Term Support Administration, Olympia
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McGough EL, Cochrane BB, Pike KC, Logsdon RG, McCurry SM, Teri L. Dimensions of physical frailty and cognitive function in older adults with amnestic mild cognitive impairment. Ann Phys Rehabil Med 2013; 56:329-41. [PMID: 23602402 DOI: 10.1016/j.rehab.2013.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 02/20/2013] [Accepted: 02/26/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study was to examine relationships between dimensions of physical frailty and severity of cognitive impairment in older adults with amnestic mild cognitive impairment (aMCI). PATIENTS AND METHODS The prevalence of physical frailty dimensions including slow gait speed, low physical activity, and low grip strength was examined among 201 sedentary older adults with aMCI. Associations between dimensions of physical frailty and severity of cognitive impairment, as measured with the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and individual dimensions of cognitive function were examined using multiple linear regression models. RESULTS Greater than 50% of participants met physical frailty criteria on dimensions of slow gait speed, low physical activity and low grip strength. Slower gait speed was associated with elevated severity of cognitive impairment. Both gait speed and physical activity were associated with individual dimensions cognitive function. CONCLUSIONS Dimensions of physical frailty, particularly gait speed, were associated with severity of cognitive impairment, after adjusting for age, sex and age-related factors. Further studies are needed to investigate mechanisms and early intervention strategies that assist older adults with aMCI to maintain function and independence.
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Affiliation(s)
- E L McGough
- Department of Rehabilitation Medicine, University of Washington, 1959, NE Pacific Street, Box 356490, Seattle, WA 98195, USA.
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Collins SA, Pike KC, Inskip HM, Godfrey KM, Roberts G, Holloway JW, Lucas JS. S32 Childhood Wheeze Phenotypes Can Be Usefully Sub-Classified Using Longitudinal Lung Function and Atopic Sensitisation Data. Evidence from the Southampton Women’s Survey. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.038] [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: 11/03/2022]
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Petley E, Pike KC, Inskip HM, Godfrey KM, Lucas JSA, Roberts G. S35 Different Early Life Factors Are Important in the Development of Atopic and Non-Atopic Asthma. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.041] [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: 11/03/2022]
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Abstract
This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an "intervention as usual" (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group.
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Affiliation(s)
- Carole Hooven
- Reconnecting Youth Prevention Research Program, Psychosocial and Community Health Department, University of Washington School of Nursing, Seattle, WA 98195, USA.
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McCurry SM, LaFazia DM, Pike KC, Logsdon RG, Teri L. Development and evaluation of a sleep education program for older adults with dementia living in adult family homes. Am J Geriatr Psychiatry 2012; 20:494-504. [PMID: 22367233 PMCID: PMC3358539 DOI: 10.1097/jgp.0b013e318248ae79] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
OBJECTIVES To investigate the feasibility of implementing a Sleep Education Program (SEP) for improving sleep in adult family home (AFH) residents with dementia, and the relative efficacy of SEP compared with usual care control in a pilot randomized controlled trial. PARTICIPANTS Thirty-seven AFH staff-caregivers and 47 residents with comorbid dementia and sleep disturbances. INTERVENTION SEP consisted of four training sessions with staff-caregivers to develop and implement individualized resident behavioral sleep plans. MEASUREMENTS Treatment fidelity to the SEP was assessed following the National Institutes of Health (NIH) Behavior Change Consortium model utilizing trainer observations and staff-caregiver reports. Resident sleep was assessed by wrist actigraphy at baseline, 1-month posttreatment, and 6-month follow-up. Caregiver reports of resident daytime sleepiness, depression, and disruptive behaviors were also collected. RESULTS Each key area of treatment fidelity (SEP delivery, receipt, enactment) was identified, measured, and yielded significant outcomes. Staff-caregivers learned how to identify sleep scheduling, daily activity, and environmental factors that could contribute to nocturnal disturbances and developed and implemented strategies for modifying these factors. SEP decreased the frequency and disturbance level of target resident nocturnal behaviors and improved actigraphically measured sleep percent and total sleep time over the 6-month follow-up period compared with the control condition. CONCLUSION Results suggest behavioral interventions to improve sleep are feasible to implement in adult family homes and merit further investigation as a promising intervention for use with AFH residents with dementia.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, WA 98115, USA.
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McCurry SM, Pike KC, Vitiello MV, Logsdon RG, Larson EB, Teri L. Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer's disease: results of a randomized, controlled trial. J Am Geriatr Soc 2011; 59:1393-402. [PMID: 21797835 DOI: 10.1111/j.1532-5415.2011.03519.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To test the effects of walking, light exposure, and a combination intervention (walking, light, and sleep education) on the sleep of persons with Alzheimer's disease (AD). DESIGN Randomized, controlled trial with blinded assessors. SETTING Independent community living. PARTICIPANTS One hundred thirty-two people with AD and their in-home caregivers. INTERVENTIONS Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control and received three or six in-home visits. MEASUREMENTS Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of sleep percentage, number of awakenings, and total sleep time. RESULTS Participants in walking (P=.05), light (P=.04), and combination treatment (P=.01) had significantly greater improvements in total wake time at posttest (effect size 0.51-0.63) than controls but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants. There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months. Participants with better adherence (4 d/wk) to walking and light exposure recommendations had significantly less total wake time (P=.006) and better sleep efficiency (P=.005) at posttest than those with poorer adherence. CONCLUSION Walking, light exposure, and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA.
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Pike KC, Rose-Zerilli MJ, Osvald EC, Inskip HM, Godfrey KM, Crozier SR, Roberts G, Clough JB, Holloway JW, Lucas JS. The relationship between infant lung function and the risk of wheeze in the preschool years. Pediatr Pulmonol 2011; 46:75-82. [PMID: 20848581 PMCID: PMC3685268 DOI: 10.1002/ppul.21327] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/18/2010] [Accepted: 06/19/2010] [Indexed: 01/09/2023]
Abstract
RATIONALE There is evidence that perinatal lung development predicts childhood wheeze. However, very few studies have examined whether preschool wheeze is associated with lower premorbid lung function in early infancy, and as yet there is no information relating atopic and non-atopic preschool wheeze to early lung development. OBJECTIVE To examine the association between premorbid infant lung function and preschool wheeze, and to explore associations with atopic and non-atopic wheeze phenotypes. METHODS Infant lung function was measured in 147 healthy term infants aged 5-14 weeks. Rapid thoracoabdominal compression was performed during tidal breathing and at raised volume to measure maximal expiratory flow at functional residual capacity (V' max FRC) and forced expiratory volume in 0.4 sec (FEV(0.4)). Atopic status was determined by skin prick testing at 3 years and wheeze ascertained from parental questionnaires (1 and 3 years). MEASUREMENTS AND MAIN RESULTS Lower early infancy V' max FRC was associated with wheeze in both the first and third years of life (P=0.002 and 0.006, respectively). Lower early infancy FEV(0.4) was associated with wheeze in the first year (P=0.03). Compared to non-atopic children who did not wheeze, non-atopic children who wheezed in their third year of life had lower FEV(0.4) (P=0.02), while FEV(0.4) values of atopic children who wheezed were not significantly different (P=0.4). CONCLUSIONS Lower premorbid infant lung function was present in infants who subsequently wheezed during the first and third years of life. Lower FEV(0.4) in early infancy was associated with non-atopic wheeze but not atopic wheeze at 3 years of age.
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Affiliation(s)
- K C Pike
- Developmental Origins of Health and Disease Division, School of Medicine, University of Southampton, Southampton, UK
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Logsdon RG, Pike KC, McCurry SM, Hunter P, Maher J, Snyder L, Teri L. Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 2010; 65:691-7. [PMID: 20693265 DOI: 10.1093/geronb/gbq054] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimer's Association chapter to a wait-list (WL) control condition. METHODS One hundred and forty-two dyads were randomized in blocks to ESML (n = 96) or WL (n = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participant's quality of life; secondary outcomes included mood, family communication, and perceived stress. RESULTS On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (p < .001), depression (p < .01), and family communication (p < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (p < .05), improved family communication (p < .05), self-efficacy (p < .01), Medical Outcomes Study short form (SF-36) role-emotional (p < .05), SF-36 social functioning (p < .05), and SF-36 mental health components (p < .01) in improvers. DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia.
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Affiliation(s)
- Rebecca G Logsdon
- Department of Psychosocial & Community Health, University of Washington School of Nursing, 9709 3rd Avenue NE, Suite 507, Seattle, WA 98155-2053, USA.
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McCurry SM, Pike KC, Logsdon RG, Vitiello MV, Larson EB, Teri L. Predictors of short- and long-term adherence to a daily walking program in persons with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2010; 25:505-12. [PMID: 20660515 DOI: 10.1177/1533317510376173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine factors associated with adherence to a walking program in community-dwelling individuals with Alzheimer's disease (AD). METHODS Data were analyzed for 66 participants with AD asked to walk 30 continuous minutes per day. Adherence data (number of days walked, minutes walked, days walked 30+ minutes) were obtained from daily logs. Predictor variables included age, spousal relationship, health limitations, depression, participant dementia severity and behavioral disturbance, and caregiver stress and dementia management style. RESULTS During week 1, participants significantly (P < .0001) increased number of days walked/week compared to baseline. However, walking frequency and duration declined over 6 months. Nonwalkers had higher behavioral disruption scores. Regression analyses indicated that participants who walked more were less depressed. Caregivers of walking participants tended to be spouses, and reported less stress. CONCLUSIONS Both participant and caregiver factors (participant behavioral disruption and depression; caregiver stress and spousal relationship) impacted whether community-dwelling individuals with AD adhered to a walking program.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, 98115, USA.
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Logsdon RG, McCurry SM, Pike KC, Teri L. Making physical activity accessible to older adults with memory loss: a feasibility study. Gerontologist 2009; 49 Suppl 1:S94-9. [PMID: 19525222 DOI: 10.1093/geront/gnp082] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE For individuals with mild cognitive impairment (MCI), memory loss may prevent successful engagement in exercise, a key factor in preventing additional disability. The Resources and Activities for Life Long Independence (RALLI) program uses behavioral principles to make exercise more accessible for these individuals. Exercises are broken into small steps, sequenced, and linked with cues to help participants remember them. Memory aids, easy-to-follow instructions, and tracking forms to facilitate adherence and proper technique are provided to enhance exercise training and compensate for memory loss. DESIGN AND METHODS Thirty-seven individuals (M age = 81.9, SD = 5.8, range 70%-96; 78% women) participated in RALLI pilot groups held in retirement residences. Attendance was excellent, with participants attending 90% of classes. RESULTS At post-test (12 weeks), 84% of participants had exercised at least once during the prior week, compared with 62% who had exercised at least once during the week prior to baseline (p < .001), mean exercise time increased by 156 min per week (p < .0001), and SF-36 physical components scale significantly improved (p < .002). After 6 months, 76% of participants continued exercising (p < .003) and mean exercise time remained significantly improved (p < .0001). IMPLICATIONS Persons with MCI can significantly benefit from an exercise program specifically designed to address their cognitive needs. Participants' ratings indicate improvement in perceived physical health and emotional well-being as a result of the intervention. Thus, RALLI is a promising intervention to promote exercise in individuals with MCI.
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Affiliation(s)
- Rebecca G Logsdon
- Northwest Research Group on Aging, University of Washington School of Nursing, Box 358733, Seattle, WA 98195-8733, USA.
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Teri L, McKenzie GL, LaFazia D, Farran CJ, Beck C, Huda P, van Leynseele J, Pike KC. Improving dementia care in assisted living residences: addressing staff reactions to training. Geriatr Nurs 2009; 30:153-63. [PMID: 19520226 DOI: 10.1016/j.gerinurse.2008.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 07/10/2008] [Accepted: 07/14/2008] [Indexed: 11/26/2022]
Abstract
More than 1 million older adults, many with significant cognitive impairment, receive care in assisted living residences (ALRs), and their numbers are increasing. Despite this, ALR staff are often inadequately trained to manage the complex emotional, behavioral, and functional impairments characteristic of these residents. Nurses are in a unique position to improve this situation by training and supervising ALR staff. To facilitate such training, an understanding of staff reactions to receiving training as well as a systematic yet flexible method for training is needed. This article provides information on one such program (STAR-Staff Training in Assisted-living Residences), discusses challenges that arose when offering this program across 3 states in 6 diverse ALRs (rural, urban, for-profit, and not-for-profit sites), and describes how these challenges were addressed. We illustrate how nurses can successfully train ALR staff to improve resident and staff outcomes and offer guidance for those interested in providing such training.
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Affiliation(s)
- Linda Teri
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA 98195-8733, USA.
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McCurry SM, LaFazia DM, Pike KC, Logsdon RG, Teri L. Managing sleep disturbances in adult family homes: recruitment and implementation of a behavioral treatment program. Geriatr Nurs 2008; 30:36-44. [PMID: 19215811 DOI: 10.1016/j.gerinurse.2008.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 05/15/2008] [Accepted: 05/17/2008] [Indexed: 11/16/2022]
Abstract
This article describes a sleep education program (SEP) designed to teach owner/operators and direct-care staff working in adult family homes (AFHs) how to improve the sleep and nighttime behavior of older residents with dementia. There have been no sleep intervention studies conducted in AFHs, and strategies that are known to improve sleep in community-dwelling older adults or nursing home residents may not be feasible or effective in AFHs because of their unique care environment. The SEP was developed on the basis of experiences treating sleep disturbances in community-dwelling older adults with dementia (the Nighttime Insomnia Treatment and Education in Alzheimer's Disease study). In this article, we address both the clinical and empirical challenges faced by researchers recruiting and intervening in AFHs, raise issues pertinent to assessment of residents and staff, and discuss implications for evaluating the impact of behavioral treatments for sleep-wake disturbances in AFH residents.
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Affiliation(s)
- Susan M McCurry
- Psychosocial & Community Health, University of Washington School of Nursing, Seattle, WA, USA
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McCurry SM, Pike KC, Vitiello MV, Logsdon RG, Teri L. Factors associated with concordance and variability of sleep quality in persons with Alzheimer's disease and their caregivers. Sleep 2008; 31:741-8. [PMID: 18517044 DOI: 10.1093/sleep/31.5.741] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To describe the day-to-day variation in sleep characteristics and the concordance between nighttime sleep of persons with Alzheimer's disease (AD) and their family caregivers. PARTICIPANTS N = 44 community-dwelling older adults with probable or possible AD and their co-residing family caregivers. DESIGN Participants wore an Actillume (Ambulatory Monitoring, Inc) for one week and completed an assessment battery to evaluate patient and caregiver mood, physical function, medication use, caregiver behavior management style, and patient cognitive status. MEASUREMENTS AND RESULTS Actigraphically derived sleep measures included bedtime, rising time, total time in bed, total sleep time, number of awakenings, total wake time, and sleep percent (efficiency). For each sleep parameter, total variance was determined for between-subject variance and within-subject variance from day-to-day. Sleep concordance was examined using multinomial logistic regression to compare trichotomous patient-caregiver combinations of good and bad sleepers. For both patients and caregivers, between-subject daily variability accounted for more of the variance in sleep than within-subject variability. Patient depression and caregiver management style were significant predictors both for concordant poor sleep (both patient and caregiver with sleep efficiency < or =85%) and patient-caregiver sleep discordance. CONCLUSIONS This study provides data that sleep disturbances for persons with AD and their family caregivers vary considerably night to night, and that poor sleep in one member of the caregiving dyad is not necessarily linked to disturbed sleep in the other. Understanding the complex interrelationship of sleep in AD patients and caregivers is an important first step towards the development of individualized and effective treatment strategies.
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Abstract
Clinical and epidemiological studies have established that people who were small at birth and had poor infant growth have an increased risk of adult cardiovascular and respiratory disease, particularly if their restricted early growth is followed by accelerated childhood weight gain. This relationship extends across the normal range of infant size in a graded manner. The 'mismatch hypothesis' proposes that ill health in later life originates through developmental plastic responses made by the fetus and infant; these responses increase the risk of adult disease if the environment in childhood and adult life differs from that predicted during early development.
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Affiliation(s)
- K C Pike
- Child Health, University of Southampton, Southampton, UK
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Eggert LL, Thompson EA, Randell BP, Pike KC. Preliminary effects of brief school-based prevention approaches for reducing youth suicide--risk behaviors, depression, and drug involvement. J Child Adolesc Psychiatr Nurs 2002; 15:48-64. [PMID: 12083753 DOI: 10.1111/j.1744-6171.2002.tb00326.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PROBLEM Few empirically tested, school-based, suicide-prevention programs exist. The purpose of this study was to evaluate the postintervention efficacy of Counselors-CARE (C-CAST) and Coping and Support Training (CAST) vs. "usual care" controls for reducing suicide risk. METHODS A randomized prevention trial; 341 potential dropouts, 14 to 19 years old, from seven high schools (52% female, 56% minorities) participated. Trend analyses using data from three time points assessed over time changes. FINDINGS Significant decreases occurred for all youth in suicide-risk behaviors, depression, and drug involvement. Intervention-specific effects occurred for decreases in depression. CONCLUSIONS School-based prevention approaches are feasible and show promise for reducing suicidal behaviors and related depression.
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Affiliation(s)
- Leona L Eggert
- Psychosocial and Community Health, University of Washington School of Nursing, Seattle, USA.
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Abstract
This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview--Counselors CARE (C-CARE)--and C-CARE plus a 12-session Coping and Support Training (CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from seven high schools (N = 341). Students were assigned randomly to C-CARE plus CAST, C-CARE only, or "intervention as usual." The predicted patterns of change were assessed using trend analyses on data available from three repeated measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.
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Affiliation(s)
- B P Randell
- Reconnecting Youth Prevention Research Program, Psychosocial and Community Health Department, University of Washington School of Nursing, Box 357263, Seattle, WA 98195, USA.
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Abstract
OBJECTIVES This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up. METHODS Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up. RESULTS Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. CONCLUSIONS School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.
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Affiliation(s)
- E A Thompson
- Reconnecting Youth Prevention Research Program, Psychosocial and Community Health, Campus Box 357263, University of Washington School of Nursing, Seattle, WA 98195-7263, USA.
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