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Sacherl J, Kosinska AD, Kemter K, Kächele M, Laumen SC, Kerth HA, Öz EA, Wolff LS, Su J, Essbauer S, Sutter G, Scholz M, Singethan K, Altrichter J, Protzer U. Efficient stabilization of therapeutic hepatitis B vaccine components by amino-acid formulation maintains its potential to break immune tolerance. JHEP Rep 2022; 5:100603. [PMID: 36714793 PMCID: PMC9880034 DOI: 10.1016/j.jhepr.2022.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/05/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background & Aims Induction of potent, HBV-specific immune responses is crucial to control and finally cure HBV. The therapeutic hepatitis B vaccine TherVacB combines protein priming with a Modified Vaccinia virus Ankara (MVA)-vector boost to break immune tolerance in chronic HBV infection. Particulate protein and vector vaccine components, however, require a constant cooling chain for storage and transport, posing logistic and financial challenges to vaccine applications. We aimed to identify an optimal formulation to maintain stability and immunogenicity of the protein and vector components of the vaccine using a systematic approach. Methods We used stabilizing amino acid (SAA)-based formulations to stabilize HBsAg and HBV core particles (HBcAg), and the MVA-vector. We then investigated the effect of lyophilization and short- and long-term high-temperature storage on their integrity. Immunogenicity and safety of the formulated vaccine was validated in HBV-naïve and adeno-associated virus (AAV)-HBV-infected mice. Results In vitro analysis proved the vaccine's stability against thermal stress during lyophilization and the long-term stability of SAA-formulated HBsAg, HBcAg and MVA during thermal stress at 40 °C for 3 months and at 25 °C for 12 months. Vaccination of HBV-naïve and AAV-HBV-infected mice demonstrated that the stabilized vaccine was well tolerated and able to brake immune tolerance established in AAV-HBV mice as efficiently as vaccine components constantly stored at 4 °C/-80 °C. Even after long-term exposure to elevated temperatures, stabilized TherVacB induced high titre HBV-specific antibodies and strong CD8+ T-cell responses, resulting in anti-HBs seroconversion and strong suppression of the virus in HBV-replicating mice. Conclusion SAA-formulation resulted in highly functional and thermostable HBsAg, HBcAg and MVA vaccine components. This will facilitate global vaccine application without the need for cooling chains and is important for the development of prophylactic as well as therapeutic vaccines supporting vaccination campaigns worldwide. Impact and implications Therapeutic vaccination is a promising therapeutic option for chronic hepatitis B that may enable its cure. However, its application requires functional cooling chains during transport and storage that can hardly be guaranteed in many countries with high demand. In this study, the authors developed thermostable vaccine components that are well tolerated and that induce immune responses and control the virus in preclinical mouse models, even after long-term exposure to high surrounding temperatures. This will lower costs and ease application of a therapeutic vaccine and thus be beneficial for the many people affected by hepatitis B around the world.
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Key Words
- AAV, adeno-associated virus
- ALT, alanine aminotransferase
- CHB, chronic hepatitis B
- CTC, controlled temperature chain
- Ctrl, control
- DLS, dynamic light scattering
- HBcAg
- HBcAg, hepatitis B core antigen
- HBeAg, hepatitis B e antigen
- HBsAg
- HBsAg, hepatitis B surface antigen
- Heat-stable vaccine
- ICS, intracellular cytokine staining
- IFNα, interferon alpha
- MVA
- MVA, Modified Vaccinia virus Ankara
- NAGE, native agarose gel electrophoresis
- RH, relative humidity
- RT, room temperature
- SAA, stabilizing amino acids
- SEC-HPLC, size exclusion-high performance liquid chromatography
- SPS®
- TCID50, median tissue culture infection dose
- TherVacBCtrl, non-lyophilized
- WHO, World Health Organization
- anti-HBc, hepatitis B core antibodies
- anti-HBs, hepatitis B surface antibodies
- cccDNA, covalently closed circular DNA
- formulation
- hepatitis B virus
- heterologous prime/boost vaccination
- lyophilization
- non-stressed, non-stabilized TherVacB
- stabilization
- stabilizing amino acid-based formulation
- stabilizing excipients
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Affiliation(s)
- Julia Sacherl
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
| | - Anna D. Kosinska
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | | | - Martin Kächele
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
| | - Sabine C. Laumen
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
| | - Hélène A. Kerth
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | - Edanur Ates Öz
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
| | - Lisa S. Wolff
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
| | - Jinpeng Su
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
| | | | - Gerd Sutter
- Institute of Infectious Diseases and Zoonoses, Department of Veterinary Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
| | | | - Katrin Singethan
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
- Bundeswehr Institute of Microbiology, Munich, Germany
| | | | - Ulrike Protzer
- Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, Munich, Germany
- Corresponding author. Address: Institute of Virology, Trogerstr. 30, 81675 Munich, Germany; Tel.: +49-89-4140-6821, fax: +49-89-4140-6823.
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Fischer DS, Ansari M, Wagner KI, Jarosch S, Huang Y, Mayr CH, Strunz M, Lang NJ, D’Ippolito E, Hammel M, Mateyka L, Weber S, Wolff LS, Witter K, Fernandez IE, Leuschner G, Milger K, Frankenberger M, Nowak L, Heinig-Menhard K, Koch I, Stoleriu MG, Hilgendorff A, Behr J, Pichlmair A, Schubert B, Theis FJ, Busch DH, Schiller HB, Schober K. Single-cell RNA sequencing reveals ex vivo signatures of SARS-CoV-2-reactive T cells through 'reverse phenotyping'. Nat Commun 2021; 12:4515. [PMID: 34312385 PMCID: PMC8313584 DOI: 10.1038/s41467-021-24730-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
The in vivo phenotypic profile of T cells reactive to severe acute respiratory syndrome (SARS)-CoV-2 antigens remains poorly understood. Conventional methods to detect antigen-reactive T cells require in vitro antigenic re-stimulation or highly individualized peptide-human leukocyte antigen (pHLA) multimers. Here, we use single-cell RNA sequencing to identify and profile SARS-CoV-2-reactive T cells from Coronavirus Disease 2019 (COVID-19) patients. To do so, we induce transcriptional shifts by antigenic stimulation in vitro and take advantage of natural T cell receptor (TCR) sequences of clonally expanded T cells as barcodes for 'reverse phenotyping'. This allows identification of SARS-CoV-2-reactive TCRs and reveals phenotypic effects introduced by antigen-specific stimulation. We characterize transcriptional signatures of currently and previously activated SARS-CoV-2-reactive T cells, and show correspondence with phenotypes of T cells from the respiratory tract of patients with severe disease in the presence or absence of virus in independent cohorts. Reverse phenotyping is a powerful tool to provide an integrated insight into cellular states of SARS-CoV-2-reactive T cells across tissues and activation states.
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Affiliation(s)
- David S. Fischer
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.6936.a0000000123222966TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Meshal Ansari
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Karolin I. Wagner
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Sebastian Jarosch
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Yiqi Huang
- grid.6936.a0000000123222966Institute of Virology, Technische Universität München (TUM), Munich, Germany
| | - Christoph H. Mayr
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Maximilian Strunz
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Niklas J. Lang
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Elvira D’Ippolito
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Monika Hammel
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Laura Mateyka
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Simone Weber
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Lisa S. Wolff
- grid.6936.a0000000123222966Institute of Virology, Technische Universität München (TUM), Munich, Germany
| | - Klaus Witter
- grid.5252.00000 0004 1936 973XLaboratory of Immunogenetics and Molecular Diagnostics, Department of Transfusion Medicine, Cell Therapeutic Agents and Hemostaseology, LMU Munich, Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Isis E. Fernandez
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Gabriela Leuschner
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Katrin Milger
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Marion Frankenberger
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Lorenz Nowak
- grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Katharina Heinig-Menhard
- grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Ina Koch
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,Asklepios Biobank for pulmonary diseases, Gauting, Germany ,grid.452624.3Member of the German Center for Lung Research (DZL), Center for Comprehensive Developmental Care (CDeCLMU), Department of Neonatology, Perinatal Center, Munich, Germany
| | - Mircea G. Stoleriu
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,Asklepios Biobank for pulmonary diseases, Gauting, Germany ,grid.452624.3Member of the German Center for Lung Research (DZL), Center for Comprehensive Developmental Care (CDeCLMU), Department of Neonatology, Perinatal Center, Munich, Germany
| | - Anne Hilgendorff
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Jürgen Behr
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany ,grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Andreas Pichlmair
- grid.6936.a0000000123222966Institute of Virology, Technische Universität München (TUM), Munich, Germany ,grid.6936.a0000000123222966Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Benjamin Schubert
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.6936.a0000000123222966Focus Group ‘Clinical Cell Processing and Purification”, Institute for Advanced Study, TUM, Munich, Germany
| | - Fabian J. Theis
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.6936.a0000000123222966Focus Group ‘Clinical Cell Processing and Purification”, Institute for Advanced Study, TUM, Munich, Germany
| | - Dirk H. Busch
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany ,grid.6936.a0000000123222966Department of Mathematics, Technical University of Munich, Garching, Germany ,grid.5252.00000 0004 1936 973XGrosshadern, Hospital of the Ludwig-Maximilians University (LMU), Munich, Germany
| | - Herbert B. Schiller
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,grid.4567.00000 0004 0483 2525Present Address: Institute of Lung Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum München, Neuherberg, München, Germany
| | - Kilian Schober
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany ,grid.411668.c0000 0000 9935 6525Present Address: Microbiological Institute—Institute of Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen, Erlangen, Germany
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Wolff LS, Flynn A, Xuan Z, Errichetti KS, Tapia Walker S, Brodesky MK. The Effect of Integrating Primary Care and Mental Health Services on Diabetes and Depression: A Multi-site Impact Evaluation on the US-Mexico Border. Med Care 2021; 59:67-76. [PMID: 33017341 DOI: 10.1097/mlr.0000000000001429] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health care delivery systems are increasingly integrating physical and mental health services to address patients' complex needs, contain costs, and improve satisfaction. Therefore, it is critical to understand whether adoption of integrated care models is effective in diverse settings. OBJECTIVE This study examined the effect of integrated care on physical and mental health outcomes among low-income Latino participants on the US-Mexico border. RESEARCH DESIGN In this quasi-experimental multisite study, individual-level data were pooled from 8 studies of locally adapted integrated care models. SUBJECTS Participants were 18 years or older and had 1 or more chronic conditions: diabetes, depression, hypertension, or obesity. The study enrolled 4226 participants with 2254 participants in the intervention group and 1972 in the comparison group. MEASURES Primary outcomes were depressive symptoms as measured by the Patient Health Questionnaire-9 score and blood glucose measured by hemoglobin A1c (HbA1c). Blood pressure, body mass index, and quality of life were secondary outcomes. RESULTS Multivariable linear regression analyses indicated intervention participants had significantly lower Patient Health Questionnaire-9 scores (β=-0.39, P=0.03) and HbA1c (β=-0.14, P=0.02) at 12 months compared with comparison group participants. Stratified analyses showed improvements in HbA1c were even greater among intervention participants who had diabetes, depression, severe and persistent mental illness, were older or female compared with their counterparts in the comparison group. CONCLUSIONS Health care is constantly transforming, making it critical to study these changes across populations and settings. Findings from this study indicate that integrated care can significantly improve mental and physical health in an underserved Latino population.
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Wolff LS, Errichetti KS, Tapia Walker S, Davis MV, Brodesky MK. Striking a Balance between Program-Specific and Portfolio-Level Evaluation: Lessons Learned from a Multi-Site Evaluation on the Texas-Mexico Border. Eval Program Plann 2020; 83:101858. [PMID: 32828063 DOI: 10.1016/j.evalprogplan.2020.101858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/10/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Funders are increasingly making strategic investments across multiple grantees, aiming for their portfolio to improve targeted outcomes in a specific issue area. To this end, funders might use multi-site evaluation (MSE) approaches to examine the impact of their collective investments. However, it is important to recognize that each program-and its own program evaluation-must be tailored to its setting, population, and local context to best meet the needs of its target population. Therefore, multi-site evaluations need to account for this complexity. This paper describes the Sí Texas project, a large initiative of eight grantees implementing different integrated behavioral health models to improve physical and mental health outcomes along the Texas-Mexico border. With over 4,200 MSE study participants, the evaluation for Sí Texas used a partnership-centered approach to both enhance the evidence base and build local organizational capacity. This paper describes this approach, the process of tailoring evaluation practices to the grantees' context, and the challenge of balancing consistency at the grantee-level for the portfolio multi-site evaluation. Successes, challenges, and lessons learned related to study design, data collection, grantee partnership, and capacity building are discussed.
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Affiliation(s)
- Lisa S Wolff
- Health Resources in Action, 2 Boylston Street, Boston, MA, 02116, United States.
| | | | | | - Mary V Davis
- Project Y Evaluation Services, LLC, Steamboat Springs, CO
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Katz JN, Lyons N, Wolff LS, Silverman J, Emrani P, Holt HL, Corbett KL, Escalante A, Losina E. Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: a qualitative study. BMC Musculoskelet Disord 2011; 12:78. [PMID: 21510880 PMCID: PMC3098215 DOI: 10.1186/1471-2474-12-78] [Citation(s) in RCA: 37] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/21/2011] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. METHODS We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. RESULTS The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. CONCLUSIONS These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.
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Affiliation(s)
- Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
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Wolff LS, El Ayadi AM, Lyons NJ, Herr-Zaya K, Noll D, Perfas F, Rots G. Improving the alcohol retail environment to reduce youth access: a randomized community trial of a best practices toolkit intervention. J Community Health 2010; 36:357-66. [PMID: 20927574 DOI: 10.1007/s10900-010-9316-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Underage alcohol use remains a significant public health problem throughout the United States and has important consequences for the health of individuals and communities. The objective of this study was to assess the impact of distributing an alcohol retailer toolkit via direct mail on increasing positive alcohol retailer attitudes towards checking IDs, encouraging retail managers to formalize ID checking procedures with their employees, and promoting consumers to be prepared to show ID when purchasing alcohol. This community randomized study included five matched Massachusetts community pairs. Our analysis sample consisted of 209 retailers (77 intervention; 132 control). In models adjusted for baseline response and matching community and establishment characteristics, intervention communities reported posting, on average, one additional sign or wall decal in their establishments (β = 0.937, P = 0.0069), and a twofold higher odds of handing out written materials on ID checking to staff (OR: 2.074, 95%CI: 1.003-4.288) compared to control establishments. However, the intervention was not found to have an effect on changing establishment policies, retailer attitudes, or other establishment practices. Intervention retailers perceived all components of the toolkit to be very useful for their establishments, and nearly all reported having shared materials with their employees and customers. These results suggest that some significant changes in alcohol retailer establishment practices can be achieved among motivated owners or managers through the distribution of a toolkit targeting best retailer practices. We do, however, recommend that future program planners consider alternative dissemination and marketing strategies beyond direct mail to encourage greater utilization.
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Affiliation(s)
- Lisa S Wolff
- Research and Evaluation Department, Health Resources in Action, 95 Berkeley Street, Boston, MA 02116, USA.
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Wolff LS, Acevedo-Garcia D, Subramanian SV, Weber D, Kawachi I. Subjective social status, a new measure in health disparities research: do race/ethnicity and choice of referent group matter? J Health Psychol 2010; 15:560-74. [PMID: 20460413 DOI: 10.1177/1359105309354345] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Studies have shown subjective social status (SSS) is associated with multiple health outcomes. This article examines the predictors of SSS, whether these associations vary by race/ethnicity, and whether SSS is sensitive to different referents used for social comparison. Data were from a national US mail survey. Income was strongly associated with SSS only among Whites and Hispanics. While there were no SSS differences by race/ethnicity using a distal referent, Blacks had higher SSS than Whites when using more proximal referents, even after controlling for objective status indicators. Findings indicate SSS measurement may be sensitive to race/ethnicity and the comparison referent.
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Affiliation(s)
- Lisa S Wolff
- Research and Evaluation, Health Resources in Action, 95 Berkeley Street, Boston, MA 02116, USA.
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Wolff LS, Subramanian SV, Acevedo-Garcia D, Weber D, Kawachi I. Compared to whom? Subjective social status, self-rated health, and referent group sensitivity in a diverse US sample. Soc Sci Med 2010; 70:2019-2028. [PMID: 20381225 DOI: 10.1016/j.socscimed.2010.02.033] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 12/24/2009] [Accepted: 02/28/2010] [Indexed: 11/29/2022]
Abstract
Emerging research has revealed that subjective social status (SSS), or how people perceive their position in the social hierarchy, is significantly associated with multiple health outcomes. Yet few studies have examined how this association is affected by the person or group to whom respondents are comparing themselves. While previous studies have used distal referent groups when assessing SSS, scholars have suggested that individuals may prefer to make comparisons to those who share similar characteristics to themselves. Overall, there has been little empirical analysis assessing the health impact of comparing oneself to one referent group over another. Using a diverse, national US sample (n=3644), this study explores whether the relationship between SSS and self-rated health is sensitive to the referent used for social comparison. Data are from respondents who completed the ConsumerStyles and HealthStyles mail surveys and who have assessed their SSS against four referents: others in American society, others of the same race or ethnicity, neighbors, and parents at the same age. Self-rated health was the dependent variable, while we controlled for household income, education, home ownership, race/ethnicity, and other covariates. In logistic regression models, SSS using each of the four referents was significantly associated with self-rated health, but the model using the referent of others in American society had the strongest association with self-rated health and was the most parsimonious. Findings validate previous studies which typically have used a more distal referent such as others in American society in exploring the SSS-health relationship. However, future work should explore whether this referent is salient to diverse population groups when making social comparisons. Researchers may also want to consider using SSS as an additional status measure since it may capture more subtle differences in the status hierarchy than traditional economic measures.
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Affiliation(s)
- Lisa S Wolff
- Health Resources in Action, Research and Evaluation Department, Boston, MA, United States.
| | - S V Subramanian
- Harvard School of Public Health, Department of Society, Human Development, and Health, Boston, MA, United States
| | | | - Deanne Weber
- Porter Novelli, Strategic Planning and Research, Washington, DC, United States
| | - Ichiro Kawachi
- Harvard School of Public Health, Department of Society, Human Development, and Health, Boston, MA, United States
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Wolff LS, Massett HA, Maibach EW, Weber D, Hassmiller S, Mockenhaupt RE. Validating a health consumer segmentation model: behavioral and attitudinal differences in disease prevention-related practices. J Health Commun 2010; 15:167-188. [PMID: 20390985 DOI: 10.1080/10810730903528041] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
While researchers typically have segmented audiences by demographic or behavioral characteristics, psychobehavioral segmentation schemes may be more useful for developing targeted health information and programs. Previous research described a four segment psychobehavioral segmentation scheme-and a 10-item screening instrument used to identify the segments-based predominantly on people's orientation to their health (active vs. passive) and their degree of independence in health care decision making (independent vs. dependent). This study builds on this prior research by assessing the screening instrument's validity with an independent dataset and exploring whether people with distinct psychobehavioral orientations have different disease prevention attitudes and preferences for receiving information in the primary care setting. Data come from 1,650 respondents to a national mail panel survey. Using the screening instrument, respondents were segmented into four groups-independent actives, doctor-dependent actives, independent passives, and doctor-dependent passives. Consistent with the earlier research, there were clear differences in health-related attitudes and behaviors among the four segments. Members of three segments appear quite receptive to receiving disease prevention information and assistance from professionals in the primary care setting. Our findings provide further indication that the screening instrument and corresponding segmentation strategy may offer a simple, effective tool for targeting and tailoring information and other health programming to the unique characteristics of distinct audience segments.
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Affiliation(s)
- Lisa S Wolff
- Research and Evaluation, Health Resources in Action, 95 Berkeley Street, Boston, MA 02116, USA.
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Van Duyn MAS, McCrae T, Wingrove BK, Henderson KM, Boyd JK, Kagawa-Singer M, Ramirez AG, Scarinci-Searles I, Wolff LS, Penalosa TL, Maibach EW. Adapting evidence-based strategies to increase physical activity among African Americans, Hispanics, Hmong, and Native Hawaiians: a social marketing approach. Prev Chronic Dis 2007; 4:A102. [PMID: 17875246 PMCID: PMC2099267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Using a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups. METHODS We conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities. Topics of discussion were participants' perceptions about 1) the benefits of engaging in physical activity, 2) the proposed evidence-based strategies for increasing each community's level of physical activity, and 3) the benefits and barriers to following the proposed interventions for increasing physical activity. A total of 292 individuals participated in the study. RESULTS All groups considered that being physically active was part of their culture, and participants found culturally relevant suggestions for physical activities appealing. Overwhelmingly, strategies that aimed to create or improve social support and increase access to physical activity venues received the most positive feedback from all groups. Barriers to physical activity were not culturally specific; they are common to all underserved people (lack of time, transportation, access, neighborhood safety, or economic resources). CONCLUSION Results indicate that evidence-based strategies to increase physical activity need to be adapted for cultural relevance for each racial or ethnic group. Our research shows that members of four underserved populations are likely to respond to strategies that increase social support for physical activity and improve access to venues where they can be physically active. Further research is needed to test how to implement such strategies in ways that are embraced by community members.
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Affiliation(s)
- Mary Ann S Van Duyn
- National Cancer Institute, Center to Reduce Cancer Health Disparities, 6116 Executive Blvd., Suite 602, Rockville, MD 20852, USA.
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Weber D, Wolff LS, Orleans T, Mockenhaupt RE, Massett HA, Vose KK. Smokers' attitudes and behaviors related to consumer demand for cessation counseling in the medical care setting. Nicotine Tob Res 2007; 9:571-80. [PMID: 17454713 DOI: 10.1080/14622200701189024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study describes a new segmentation strategy exploring smokers' interest levels in counseling in the medical care setting in order to understand how public health communications can be designed to increase consumer demand for cessation services within this population. A subsample of 431 smokers from a large, nationally representative mail survey was analyzed and categorized into three cessation-demand groups: Low demand (LD), medium demand (MD), and high demand (HD). HD smokers were most likely to be heavy smokers, to make quitting a high priority, and to have self-efficacy in quitting. MD and LD smokers were less likely than HD smokers to have been told to quit smoking by a health care provider in the past or to believe that counseling is effective. The first step in the regression analysis revealed that age, cigarettes smoked per month, whether smokers were currently trying to quit, and whether they were ever told to quit smoking by their health care provider accounted for 21% of the variance in smokers' interest in smoking cessation counseling, F(4, 234) = 16.49, p<.001. When additional variables on attitudes toward smoking and quitting and perceived effectiveness of receiving counseling in the medical care setting were added to the model, an additional 11% of the variance in smokers' interest in cessation counseling was explained, F(12, 234) = 10.07, p<.001. Results suggest that by categorizing smokers by interest level in cessation counseling, we emerge with three distinct portraits of smokers who might be activated in different ways to increase consumer demand for cessation counseling.
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Abstract
Misbehaviors occur at a high rate during the toddler years, and parents use a variety of methods to control these behaviors. The present investigation compared the effectiveness of two commonly used strategies, distraction and reprimands. Twenty mothers and their 17- to 39-month-old children were observed in a laboratory setting in which mothers used either distraction then reprimands or reprimands followed by distraction in response to their children's transgressions. When reprimands were used as the initial strategy, they were significantly more effective than distraction in controlling children's transgressions. Distraction was effective in maintaining low rates of transgression when preceded by a period of reprimands. However, when reprimands were instituted following a period of distraction, children's rates of negative affect increased significantly. Implications for the etiology and management of child behavior problems are discussed.
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Affiliation(s)
- M J Reid
- Department of Psychology, State University of New York at Stony Brook 11794-2500
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Wolff LS, Orchansky E, Jiménez MG, Paolasso RW. [Production of slime by coagulase-negative staphylococci as a marker of systemic infection in newborn infants]. Enferm Infecc Microbiol Clin 1991; 9:551-3. [PMID: 1822707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We studied 310 strains of Staphylococcus spp. from neonates admitted in intensive care unit from june 1988 to may 1990, with the purpose of establishing a relationship between the slime production and the occurrence of sepsis. The original technique for its determination was modified; this facilitated the performance and the reading of results. Of 105 neonates with isolation in blood, spinal fluid and/or intravascular catheter of negative-coagulase Staphylococcus (CNS), the incidence of sepsis was 57.9% when the strain was a slime-producer, and only 11.6% when the strain did not produce slime (p less than 0.001). The risk of infection was five-fold increased when the isolated was slime-producer CNS. We proved a high predictive value when the strains were identical and isolated from two samples, one of which was blood. These results show that the production of slime is a factor which strongly support the diagnosis of neonatal sepsis due to negative-coagulase Staphylococcus.
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Affiliation(s)
- L S Wolff
- Servicio de Neonatología, Hospital Universitario de Maternidad y Neonatología, Universidad Nacional de Córdoba, Argentina
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Abstract
Childhood obsessive-compulsive disorder was believed to be very rare and, until quite recently, little effort was directed toward assessment or treatment. Today, typical assessment procedures include clinical and structured interviews, self-report and therapist or staff completed inventories, self-monitoring, and direct observation. No single method has demonstrated superiority, and each has had limitations. Multiple measures are therefore recommended. The treatment literature is composed largely of uncontrolled case studies presenting combinations of three or more treatments. Although all treatment-outcome reports illustrate positive effects, no one method has been superior treating either a single facet of the disorder or the disorder in its entirety.
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Affiliation(s)
- R P Wolff
- Children's National Medical Center, Washington, DC
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Jakob EJ, Wolff LS. [Transient bacteremia and bacterial endocarditis (prophylaxis)]. Rev Fac Cien Med Univ Nac Cordoba 1981; 39:64-72. [PMID: 7347873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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