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Davis EP, Demers CH, Deer L, Gallop RJ, Hoffman MC, Grote N, Hankin BL. Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial. EClinicalMedicine 2024; 72:102601. [PMID: 38680516 PMCID: PMC11053273 DOI: 10.1016/j.eclinm.2024.102601] [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: 01/03/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Background Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT). Methods Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801). Findings Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97). Interpretation We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation. Funding This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Catherine H. Demers
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - LillyBelle Deer
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Robert J. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - M. Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Nancy Grote
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Kumar M, Yator O, Nyongesa V, Kagoya M, Mwaniga S, Kathono J, Gitonga I, Grote N, Verdeli H, Huang KY, McKay M, Swartz HA. Interpersonal Psychotherapy's problem areas as an organizing framework to understand depression and sexual and reproductive health needs of Kenyan pregnant and parenting adolescents: a qualitative study. BMC Pregnancy Childbirth 2022; 22:940. [PMID: 36522716 PMCID: PMC9756635 DOI: 10.1186/s12884-022-05193-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Peripartum adolescents experience significant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents' responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy's (IPT) problem areas as a framework to understand depression. METHOD We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16-18 years (n = 23) with experiences of depression, keeping interpersonal psychotherapy framework of problem areas in mind. We explored the nature of their distress, triggers, antecedents of distress associated with an unplanned pregnancy, quality of their relationships with their partner, parents, and other family members, perceived needs, and sources of support. RESULTS We found that the interpersonal psychotherapy (IPT) framework of interpersonal problems covering grief and loss, role transitions, interpersonal disputes, and social isolation was instrumental in conceptualizing adolescent depression, anxiety, and stress in the perinatal period. CONCLUSION Our interviews deepened understanding of peripartum adolescent mental health focusing on four IPT problem areas. The interpersonal framework yields meaningful information about adolescent depression and could help in identifying strategies for addressing their distress.
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Affiliation(s)
- Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya ,grid.470490.eBrain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Obadia Yator
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Vincent Nyongesa
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Martha Kagoya
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya ,grid.12380.380000 0004 1754 9227Vrije University, Amsterdam, Netherlands
| | - Joseph Kathono
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Kenya and Nairobi Metropolitan Services, Nairobi, Kenya
| | - Isaiah Gitonga
- grid.95004.380000 0000 9331 9029Department of Psychology, National University of Ireland, Maynooth, Ireland
| | - Nancy Grote
- grid.34477.330000000122986657School of Social Work, University of Washington, Seattle, USA
| | - Helena Verdeli
- grid.21729.3f0000000419368729Global Mental Health Lab, Columbia University, New York, USA
| | - Keng Yen Huang
- grid.137628.90000 0004 1936 8753New York University, New York, USA
| | - Mary McKay
- grid.4367.60000 0001 2355 7002Vice Provost of Interdisciplinary Initiatives, University of Washington, St Louis, USA
| | - Holly A. Swartz
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburg, USA
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3
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Gonzalez C, Ramirez M, Mata-Greve F, Diaz A, Duran MC, Johnson M, Grote N, Areán PA. Acceptability of virtual therapy for postpartum women during COVID-19: A national mixed methods study. Front Psychiatry 2022; 13:893073. [PMID: 36159918 PMCID: PMC9500288 DOI: 10.3389/fpsyt.2022.893073] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) affects one in eight women in the U.S., with rates increasing due to the COVID-19 pandemic. Given the unique circumstances of COVID-19, virtual therapy might be a unique way to overcome barriers to mental health services. The study sought to explore the acceptability of virtual therapy among women in the postpartum period. METHODS Using an online recruitment mixed methods approach, we collected data from a U.S. national cross-sectional sample of women (N = 479) who gave birth in the last 12 months. FINDINGS Results show that 66% of women endorsed items consistent with possible depression during the COVID-19 pandemic. Only 27% accessed therapy services during the postpartum period. While 88% were open to engaging in virtual therapy services, 12% identified several major concerns with virtual therapy, namely: (1) preference for in-person therapy (2) no perceived need for therapy (3) uncomfortable with virtual therapy, and (4) lack of privacy. Of note, 36% more Latinas reported dissatisfaction with quality of care received during virtual therapy compared to non-Latina participants. Despite a major shift to virtual care with COVID-19, future work is needed to make virtual mental health services more accessible for women with PPD.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Magaly Ramirez
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Felicia Mata-Greve
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Autumn Diaz
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Miriana C Duran
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Morgan Johnson
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Nancy Grote
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Patricia A Areán
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
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4
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Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, Dember LM, Diaz-Linhart Y, Dubovsky A, Greene T, Grote N, Kutner N, Trivedi MH, Quinn DK, Ver Halen N, Weisbord SD, Young BA, Kimmel PL, Hedayati SS. Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Ann Intern Med 2019; 170:369-379. [PMID: 30802897 DOI: 10.7326/m18-2229] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited. OBJECTIVE To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis. DESIGN Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343). SETTING 41 dialysis facilities in 3 U.S. metropolitan areas. PARTICIPANTS Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2. INTERVENTION Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2). MEASUREMENTS The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms-Clinician-Rated (QIDS-C) at 12 weeks. RESULTS The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 [95% CI, -12.1 to 16.4]). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, -1.84 [CI, -3.54 to -0.13]; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group. LIMITATION No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed. CONCLUSION An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- Rajnish Mehrotra
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Daniel Cukor
- State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.)
| | - Mark Unruh
- University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.)
| | - Tessa Rue
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Patrick Heagerty
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Scott D Cohen
- George Washington University, Washington, DC (S.D.C.)
| | - Laura M Dember
- University of Pennsylvania, Philadelphia, Pennsylvania (L.M.D.)
| | | | - Amelia Dubovsky
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Tom Greene
- University of Utah, Salt Lake City, Utah (T.G.)
| | - Nancy Grote
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | | | | | - Davin K Quinn
- University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.)
| | - Nisha Ver Halen
- State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.)
| | - Steven D Weisbord
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania (S.D.W.)
| | - Bessie A Young
- Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (B.A.Y.)
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (P.L.K.)
| | - S Susan Hedayati
- University of Texas Southwestern, Dallas, Texas (M.H.T., S.S.H.)
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5
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Osok J, Kigamwa P, Huang KY, Grote N, Kumar M. Adversities and mental health needs of pregnant adolescents in Kenya: identifying interpersonal, practical, and cultural barriers to care. BMC Womens Health 2018; 18:96. [PMID: 29902989 PMCID: PMC6003032 DOI: 10.1186/s12905-018-0581-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/29/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adolescent pregnancies present a great public health burden in Kenya and Sub-Saharan Africa (UNFPA, Motherhood in Childhood: Facing the challenge of Adolescent Pregnancy, 2013). The disenfranchisement from public institutions and services is further compounded by cultural stigma and gender inequality creating emotional, psychosocial, health, and educational problems in the lives of vulnerable pregnant adolescents (Int J Adolesc Med Health 15(4):321-9, 2003; BMC Public Health 8:83, 2008). In this paper we have applied an engagement interview framework to examine interpersonal, practical, and cultural challenges faced by pregnant adolescents. METHODS Using a qualitative study design, 12 pregnant adolescents (ages 15-19) visiting a health facility's antenatal services in Nairobi were interviewed. All recruited adolescents were pregnant for the first time and screened positive on the nine-item Patient Health Questionnaire (PHQ-9) with 16% of 176 participants interviewed in a descriptive survey in the same Kangemi primary health facility found to be severely depressed (Osok et al., Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi, BMC Psychiatry, 2018 18:136 https://doi.org/10.1186/s12888-018-1706-y). An engagement interview approach (Social Work 52(4):295-308, 2007) was applied to elicit various practical, psychological, interpersonal, and cultural barriers to life adjustment, service access, obtaining resources, and psychosocial support related to pregnancy. Grounded theory method was applied for qualitative data sifting and analysis (Strauss and Corbin, Basics of qualitative research, 1990). RESULTS Findings revealed that pregnant adolescents face four major areas of challenges, including depression, anxiety and stress around the pregnancy, denial of the pregnancy, lack of basic needs provisions and care, and restricted educational or livelihood opportunities for personal development post pregnancy. These challenges were related both to existing social and cultural values/norms on gender and traditional family structure, as well as to service structural barriers (including prenatal care, mental health care, newborn care, parenting support services). More importantly, dealing with these challenges has led to negative mental health consequences in adolescent pregnant girls, including feeling insecure about the future, feeling very defeated and sad to be pregnant, and feeling unsupported and disempowered in providing care for the baby. CONCLUSIONS Findings have implications for service planning, including developing more integrated mental health services for pregnant adolescents. Additionally, we felt a need for developing reproductive education and information dissemination strategies to improve community members' knowledge of pregnant adolescent mental health issues.
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Affiliation(s)
- Judith Osok
- Department of Psychiatry, School of Medicine College of Health Sciences, University of Nairobi, P. O. Box 20386-00100, Nairobi, Kenya
| | - Pius Kigamwa
- Department of Psychiatry, School of Medicine College of Health Sciences, University of Nairobi, P. O. Box19676-00202, Nairobi, Kenya
| | - Keng-Yen Huang
- Department of Public Health and Child and Adolescent Psychiatry, New York University, New York, NY 10016 USA
| | - Nancy Grote
- Department of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105-6250 USA
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O Box 47074-00100, Nairobi, Kenya
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Silverstein M, Diaz-Linhart Y, Grote N, Cadena L, Cabral H, Feinberg E. Harnessing the Capacity of Head Start to Engage Mothers with Depression in Treatment. J Health Care Poor Underserved 2017; 28:14-23. [PMID: 28238982 DOI: 10.1353/hpu.2017.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We assessed dimensions of feasibility of a patient navigation system in the Head Start preschool setting to help low-income mothers with depression engage with mental health care. Forty-seven mothers participated; none refused. Navigators demonstrated excellent model fidelity; we experienced no adverse events. We discuss implications for future evaluation design.
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Diaz-Linhart Y, Silverstein M, Grote N, Cadena L, Feinberg E, Ruth BJ, Cabral H. Patient Navigation for Mothers with Depression who Have Children in Head Start: A Pilot Study. Soc Work Public Health 2016; 31:504-510. [PMID: 27195704 PMCID: PMC6013039 DOI: 10.1080/19371918.2016.1160341] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study assesses the potential of social work-facilitated patient navigation to help mothers with depression engage with mental health care. We conducted a randomized pilot trial (N = 47) in Head Start-a U.S. preschool program for low-income children. Seven lay navigators received training and supervision from professional social workers. After 6 months, more navigated participants engaged with a psychologist, therapist, or social worker (45% vs. 13%, 95% confidence interval [CI] [2, 57]); engaged with any provider, (55% vs. 26%, 95% CI [1, 56]); and reported having a "depression care provider" (80% vs. 41%, 95% CI [9, 65]). Community-based navigation appears feasible; however, more definitive testing is necessary.
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Affiliation(s)
- Yaminette Diaz-Linhart
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael Silverstein
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nancy Grote
- Graduate School of Social Work, University of Washington, Seattle, Washington, USA
| | - Lynn Cadena
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily Feinberg
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Betty J. Ruth
- Graduate School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
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Cukor D, Cohen LM, Cope EL, Ghahramani N, Hedayati SS, Hynes DM, Shah VO, Tentori F, Unruh M, Bobelu J, Cohen S, Dember LM, Faber T, Fischer MJ, Gallardo R, Germain MJ, Ghahate D, Grote N, Hartwell L, Heagerty P, Kimmel PL, Kutner N, Lawson S, Marr L, Nelson RG, Porter AC, Sandy P, Struminger BB, Subramanian L, Weisbord S, Young B, Mehrotra R. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases. Clin J Am Soc Nephrol 2016; 11:1703-1712. [PMID: 27197911 PMCID: PMC5012486 DOI: 10.2215/cjn.09780915] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases.
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Affiliation(s)
- Daniel Cukor
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, Dember LM, Dubovsky A, Greene T, Grote N, Heagerty P, Katon W, Kimmel PL, Kutner N, Linke L, Quinn D, Rue T, Trivedi MH, Unruh M, Weisbord S, Young BA, Mehrotra R. Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND). Contemp Clin Trials 2015; 47:1-11. [PMID: 26621218 DOI: 10.1016/j.cct.2015.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 09/08/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes.
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Affiliation(s)
- S Susan Hedayati
- Renal Section, VA North Texas Health Care System, United States; Division of Nephrology, University of Texas Southwestern Medical Center, United States.
| | - Divya M Daniel
- Kidney Research Institute, University of Washington, United States
| | - Scott Cohen
- Division of Nephrology, George Washington University, United States
| | - Bryan Comstock
- School of Public Health, University of Washington, United States
| | - Daniel Cukor
- Department of Psychiatry, SUNY Downstate Medical Center, United States
| | | | - Laura M Dember
- Division of Nephrology, University of Pennsylvania, United States
| | - Amelia Dubovsky
- Department of Psychiatry, University of Washington, United States
| | | | - Nancy Grote
- School of Social Work, University of Washington, United States
| | - Patrick Heagerty
- School of Public Health, University of Washington, United States
| | - Wayne Katon
- Department of Psychiatry, University of Washington, United States
| | - Paul L Kimmel
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, United States
| | | | - Lori Linke
- Kidney Research Institute, University of Washington, United States
| | - Davin Quinn
- Department of Psychiatry, University of New Mexico, United States
| | - Tessa Rue
- School of Public Health, University of Washington, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States
| | - Mark Unruh
- Division of Nephrology, University of New Mexico, United States
| | - Steven Weisbord
- Division of Nephrology, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, United States
| | - Bessie A Young
- Kidney Research Institute, University of Washington, United States
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, United States
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Arnold DL, Enquobahrie DA, Qiu C, Huang J, Grote N, VanderStoep A, Williams MA. Early pregnancy maternal vitamin D concentrations and risk of gestational diabetes mellitus. Paediatr Perinat Epidemiol 2015; 29:200-10. [PMID: 25808081 PMCID: PMC4400239 DOI: 10.1111/ppe.12182] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND While associations of vitamin D deficiency with type 2 diabetes have been well demonstrated, investigations of vitamin D and risk of gestational diabetes mellitus (GDM) reported inconsistent findings. We examined associations of vitamin D status with GDM. METHODS In a nested case-cohort study (135 GDM cases and 517 non-GDM controls), we measured maternal serum vitamin D status (total 25[OH]D and 25[OH]D3 ) in early pregnancy (16 weeks on average) using liquid chromatography-tandem mass spectroscopy. GDM was diagnosed according to the American Diabetes Association guidelines. We calculated adjusted odds ratios and 95% confidence intervals (CIs) using logistic regression models. RESULTS GDM cases had lower mean total 25[OH]D (27.3 vs. 29.3 ng/mL) and 25[OH]D3 (23.9 vs. 26.7 ng/mL) concentrations compared with women who did not develop GDM (both P-values < 0.05). Overall, 25[OH]D3 concentrations, but not total 25[OH]D concentrations, were significantly associated with GDM risk. A 5-ng/mL increase in 25[OH]D3 concentration was associated with a 14% decrease in GDM risk (P-value = 0.02). Women in the lowest quartile for 25[OH]D3 concentration had a twofold [95% CI 1.15, 3.58] higher risk of GDM compared with women in the highest quartile (P-value for trend < 0.05). CONCLUSIONS Early pregnancy vitamin D status, particularly 25[OH]D3 , is inversely associated with GDM risk.
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Affiliation(s)
- Dodie L. Arnold
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington, United States of America
,Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
,Louisiana Public Health Institute, New Orleans, Louisiana
| | - Daniel A. Enquobahrie
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington, United States of America
,Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
| | - Chungfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
| | - Jonathan Huang
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington, United States of America
| | - Nancy Grote
- School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Ann VanderStoep
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington, United States of America
,Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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Groumas P, Zhang Z, Katopodis V, Kouloumentas C, de Felipe D, Dinu R, Miller E, Mallari J, Cangini G, Keil N, Avramopoulos H, Grote N. Complex monolithic and InP hybrid integration on high bandwidth electro-optic polymer platform. Opt Lett 2012; 37:3465-3467. [PMID: 23381292 DOI: 10.1364/ol.37.003465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report on the monolithic integration of multimode interference couplers, Bragg gratings, and delay-line interferometers on an electro-optic polymer platform capable of modulation directly at 100 Gb/s. We also report on the hybrid integration of InP active components with the polymer structure using the butt-coupling technique. Combining the passive and the active components, we demonstrate a polymer-based, external cavity laser with 17 nm tuning range and the optical assembly of an integrated 100 Gb/s transmitter, and we reveal the potential of the electro-optic polymer technology to provide the next generation integration platform for complex, ultra-high-speed optical transceivers.
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Affiliation(s)
- P Groumas
- School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
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Brown C, Conner KO, Copeland VC, Grote N, Beach S, Battista D, Reynolds CF. DEPRESSION STIGMA, RACE, AND TREATMENT SEEKING BEHAVIOR AND ATTITUDES. J Community Psychol 2010; 38:350-368. [PMID: 21274407 PMCID: PMC3026177 DOI: 10.1002/jcop.20368] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study examined the relationship between internalized and public stigma on treatment-related attitudes and behaviors in a community sample of 449 African American and white adults aged 18 years and older. Telephone surveys were administered to assess level of depressive symptoms, demographic characteristics, stigma, and treatment-related attitudes and behaviors. Multiple regression analysis indicated that internalized stigma mediated the relationship between public stigma and attitudes toward mental health treatment. Within group analyses indicated that the mediating effect of internalized stigma was significant for whites only. Among African Americans, internalized stigma did not mediate public stigma; it was directly related to attitudes toward mental health treatment. The internalization of stigma is key in the development of negative attitudes toward mental health treatment, and future research should focus on this aspect of stigma in both individual and community-based efforts to reduce stigma.
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Linstedt U, Möller F, Grote N, Zenz M, Prengel A. Intubating laryngeal mask as a ventilatory device during percutaneous dilatational tracheostomy: a descriptive study. Br J Anaesth 2007; 99:912-5. [PMID: 17933797 DOI: 10.1093/bja/aem274] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We use an intubating laryngeal mask (ILM) in preference to an endotracheal tube (ETT) as the ventilatory device during percutaneous dilatational tracheostomy (PDT) to overcome potential problems such as difficult ventilation, accidental extubation, damage of the ETT or of the bronchoscope, and need for additional assistant to secure the airway. We report our experience with this method. METHODS In this prospective observational study, PDT was performed using the ILM in 86 patients. The insertion of the ILM, the quality of ventilation, and the view of the tracheal puncture site were rated as: 'very good', 'good', 'difficult', and 'not possible with ILM'. RESULTS The bronchoscope was not damaged during any case, and all PDTs were performed by two physicians, without the need for an additional assistant. PDTs with ILM were successful in 95% of the patients (n=82). The ratings were 'very good' or 'good' in 80% of cases with regards to ventilation, in 90% for identification of relevant structures and tracheal puncture site, and in 85% for the view inside the trachea during PDT. Tracheal re-intubation was required for inadequate ventilation with ILM in four patients. CONCLUSIONS The advantages of this procedure were lack of damage to the bronchoscope, the need for two instead of three persons to perform the PDT, and the excellent view inside the trachea. We recommend the ILM as a standard device for ventilation during bronchoscope-guided PDT.
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Affiliation(s)
- U Linstedt
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Diako Hospital, Flensburg, Academic Teaching Hospital of the University of Kiel, Germany
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Mellberg JR, Petrou ID, Fletcher R, Grote N. Evaluation of the effects of a pyrophosphate-fluoride anticalculus dentifrice on remineralization and fluoride uptake in situ. Caries Res 1991; 25:65-9. [PMID: 1649005 DOI: 10.1159/000261344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 12/28/2022] Open
Abstract
Enamel slabs and thin sections with artificially formed caries lesions were placed in the removable dentures of 15 subjects who brushed them three times daily for 2 weeks with a 1.3% pyrophosphate/1,100 ppm F/1.5% Gantrez dentifrice, a 1,100-ppm F dentifrice without pyrophosphate or Gantrez, or a placebo dentifrice in a double-blind, crossover study. Analysis of the thin sections by quantitative microradiography showed that the pyrophosphate/F dentifrice remineralized the lesions 15.9% (p less than 0.05) and the fluoride dentifrice 11.2%, whereas the placebo produced 4.4% demineralization. Fluoride uptake by the enamel slabs was similar for both fluoride dentifrices and significantly greater from the placebo dentifrice (p less than 0.05). The findings suggest that the anticaries mechanisms of fluoride include not only the prevention of demineralization, but also the promotion of remineralization.
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Affiliation(s)
- J R Mellberg
- Colgate-Palmolive Technology Center, Piscataway, N.J
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Mellberg JR, Petrou ID, Grote N. Effect of two sodium fluoride dentifrices on fluoride uptake and remineralization in situ. Am J Dent 1990; 3:51-5. [PMID: 2076222] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Two dentifrices containing 1100 ppm F from sodium fluoride in silica bases were compared to a placebo dentifrice in an in situ remineralization and fluoride uptake study. Fifteen subjects brushed artificially-formed caries lesions in 60 thin enamel sections and 30 enamel blocks with each dentifrice in a double-blind, randomized, cross-over study design. Analysis of the thin sections by quantitative microradiography before and after exposure to toothbrushing showed that the fluoride dentifrices produced 18.3% and 7.1% remineralization whereas use of the placebo resulted in 10.3% demineralization. The differences between all three dentifrices were statistically significant. Fluoride concentrations at the surface of the lesion increased from approximately 700 ppm F in untreated specimens to approximately 1800 ppm F in specimens treated with either of the two fluoride dentifrices. These data suggest that formulation differences may affect the anticaries activity of a dentifrice without being reflected by fluoride deposition.
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Affiliation(s)
- J R Mellberg
- Colgate-Palmolive Company, Piscataway, New Jersey
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Abstract
We evaluated the potential of a pyrophosphate-fluoride solution to affect the remineralizing-demineralizing equilibrium, i.e., caries-inhibiting/-promoting effects on enamel in vivo. Fifteen subjects carried dentin blocks and enamel thin sections with artificial caries lesions in removable partial dentures for periods of two weeks, during which time they rinsed twice daily in a double-blind, randomized cross-over design with solutions containing (a) 90 ppm F, (b) 90 ppm F and 1% pyrophosphate, or (c) no active agents (placebo). A severe cariogenic challenge provided to the lesions by plaque under a stainless steel mesh cover resulted in the placebo-treated lesions losing 70.2% +/- 72.1% mineral. The pyrophosphate rinse with fluoride held the mineral loss to only 28.1 +/- 52.8%, while the fluoride rinse without pyrophosphate held the loss to 24.2 +/- 50.1%. The differences between the fluoride and placebo results were significant (p less than 0.01), but the difference between the two fluoride groups was not. A large amount of fluoride was deposited in the dentin lesions. In the surface layer, the concentration was increased from 1000 ppm F to more than 2300 ppm F by both fluoride treatments. The concentration of fluoride in both groups of fluoride-treated lesions further increased to more than 3500 ppm F in the approximate center of the lesion before declining in deeper layers toward the level found in the placebo-treated group. The findings from both mineral change and fluoride uptake phases of this study show that in the presence of 90 ppm F, 1% pyrophosphate did not promote demineralization of artificial caries lesions.
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Affiliation(s)
- J R Mellberg
- Colgate-Palmolive Co., Research Center, Piscataway, New Jersey 08854
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