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Llata E, Tromble E, Schumacher C, Huspeni D, Asbel L, Pathela P, Kohn R, Kerani RP, Barbee L, Bachman L. Should we be testing for Mycoplasma genitalium on initial presentation? Trends in persistent/recurrent urethritis among men presenting for care in STD clinics, 2015-2019, STD Surveillance Network (SSuN). Sex Transm Dis 2024:00007435-990000000-00348. [PMID: 38602771 DOI: 10.1097/olq.0000000000001975] [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: 04/13/2024]
Abstract
BACKGROUND Mycoplasma genitalium is a major contributor to persistent/recurrent urethritis cases. However, there are limited published studies on recent trends of persistent/recurrent urethritis. METHODS A retrospective analysis was conducted of men presenting with symptomatic urethritis in 16 STD clinics from 2015-2019. Poisson regression was used to assess trends in the annual proportions of urethritis episodes with follow-up (FU) characterized with persistent/recurrent urethritis symptoms. Results were also stratified by results of chlamydia (CT) and gonorrhea (NG) testing and treatment prescribed. RESULTS There were 99,897 urethritis episodes, from 67,546 unique men. The proportion of episodes with persistent/recurrent symptomatic FU visits increased 50.8% over a 4-year period (annual percentage change (APC) 11.3%, 95% CI, 6.5-16.3). Similar trends were observed in non-chlamydial non-gonococcal urethritis episodes(APC, 12.7%; 95% CI, 6.8-18.9) but increases among those positive for NG (APC, 12.1%; 95% CI, -2.3 -28.5) or for CT (APC, 7.3%; 95% CI, -6.7-23.5) were not statistically significant. Among episodes who received azithromycin as first-line treatment, increases in the proportion of persistent/recurrent FU visits were observed (APC, 12.6%; 95% CI, 8.6-16.7). For episodes where first-line treatment was doxycycline, no significant increases were detected (APC, 4.3%; 95% CI, -0.3-9.2). CONCLUSION We found an increase in the proportion of urethritis episodes with persistent or recurrent symptoms over time. Given these observed trends in episodes negative for NG or CT, an etiology not detectable by routine diagnostics was a likely factor in increased persistence, suggesting patients with urethritis may benefit from diagnostic testing for M. genitalium during an initial symptomatic presentation.
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Affiliation(s)
- Eloisa Llata
- Centers for Disease Control and Prevention, Division of STD Prevention (NCHHSTP)
| | - Erin Tromble
- Centers for Disease Control and Prevention, Division of STD Prevention (NCHHSTP)
| | - Christina Schumacher
- Johns Hopkins University School of Medicine and Baltimore City Health Department, Baltimore, Maryland
| | - Dawn Huspeni
- Minnesota Department of Health, Minneapolis/St. Paul, Minnesota
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Preeti Pathela
- New York City Department of Health & Mental Hygiene, New York City, New York
| | - Robert Kohn
- San Francisco Department of Public Health, San Francisco, California
| | - Roxanne P Kerani
- Public Health - Seattle and King County and Department of Medicine, University of Washington, Seattle, Washington
| | - Lindley Barbee
- Centers for Disease Control and Prevention, Division of STD Prevention (NCHHSTP)
| | - Laura Bachman
- Centers for Disease Control and Prevention, Division of STD Prevention (NCHHSTP)
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2
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Hauser MJ, Kohn R. Forensic psychiatric issues in intellectual disability. Behav Sci Law 2024. [PMID: 38459744 DOI: 10.1002/bsl.2653] [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] [Received: 07/24/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
Forensic psychiatrists and neuropsychiatrists are likely to encounter individuals with intellectual disability as they are over-represented in the judicial system. These individuals may have the full range of mental illnesses and comorbid conditions, including physical infirmity, sensory deficits, language impairment, and maladaptive behaviors. They are frequently disadvantaged in the judicial system due to lack of comprehension, lack of accommodations, and stigmatization. Decision making capacity may need to be assessed for health care, sexual autonomy, marriage, financial management, making a will, and need for guardianship. The usual approach to conducting an evaluation needs adaptation to fit the unique characteristics and circumstances of the individual with intellectual disability. The forensic consultant can assist attorneys, defendants, and victims in recommending accommodations and the expert witness can provide education to juries.
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Affiliation(s)
- Mark J Hauser
- Department of Psychiatry, Harvard Medical School, Newton, Massachusetts, USA
| | - Robert Kohn
- Brown University School of Public Health, Providence, Rhode Island, USA
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3
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Dao VH, Gunawan D, Tran MN, Kohn R, Hawkins GE, Brown SD. Efficient selection between hierarchical cognitive models: Cross-validation with variational Bayes. Psychol Methods 2024; 29:219-241. [PMID: 35446049 DOI: 10.1037/met0000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Model comparison is the cornerstone of theoretical progress in psychological research. Common practice overwhelmingly relies on tools that evaluate competing models by balancing in-sample descriptive adequacy against model flexibility, with modern approaches advocating the use of marginal likelihood for hierarchical cognitive models. Cross-validation is another popular approach but its implementation remains out of reach for cognitive models evaluated in a Bayesian hierarchical framework, with the major hurdle being its prohibitive computational cost. To address this issue, we develop novel algorithms that make variational Bayes (VB) inference for hierarchical models feasible and computationally efficient for complex cognitive models of substantive theoretical interest. It is well known that VB produces good estimates of the first moments of the parameters, which gives good predictive densities estimates. We thus develop a novel VB algorithm with Bayesian prediction as a tool to perform model comparison by cross-validation, which we refer to as CVVB. In particular, CVVB can be used as a model screening device that quickly identifies bad models. We demonstrate the utility of CVVB by revisiting a classic question in decision making research: what latent components of processing drive the ubiquitous speed-accuracy tradeoff? We demonstrate that CVVB strongly agrees with model comparison via marginal likelihood, yet achieves the outcome in much less time. Our approach brings cross-validation within reach of theoretically important psychological models, making it feasible to compare much larger families of hierarchically specified cognitive models than has previously been possible. To enhance the applicability of the algorithm, we provide Matlab code together with a user manual so users can easily implement VB and/or CVVB for the models considered in this article and their variants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - David Gunawan
- Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, University of Melbourne
| | - Minh-Ngoc Tran
- Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, University of Melbourne
| | - Robert Kohn
- School of Economics, University of New South Wales
| | - Guy E Hawkins
- School of Psychological Sciences, University of Newcastle
| | - Scott D Brown
- School of Psychological Sciences, University of Newcastle
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de Figueiredo JM, Zhu B, Patel AS, Kohn R, Koo BB, Louis ED. Differential impact of resilience on demoralization and depression in Parkinson disease. Front Psychiatry 2023; 14:1207019. [PMID: 37559912 PMCID: PMC10408307 DOI: 10.3389/fpsyt.2023.1207019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES The objective of this study was to study the interrelations of demoralization, depression, and resilience in patients with Parkinson disease, and, more specifically, to determine if higher resilience in patients with Parkinson disease is associated with lower demoralization, lower depression, or both. METHODS Outpatients with Parkinson disease (N = 95) were assessed for demoralization, depression, and resilience, as well as sociodemographic, clinical, and treatment-related variables. Bivariable associations, standard regressions, linear regression with copula correction, and correspondence analysis were used to analyze the data. RESULTS Although the bivariable association between resilience and depression was statistically significant, the association ceased to be significant when demoralization was taken into consideration in both standard regressions and linear regression with copula correction. By contrast, the association between resilience and demoralization was significant when depression was not taken into consideration and continued to be significant when depression was taken into consideration. Correspondence analysis revealed that low resilience was strongly related to demoralization combined with depression, whereas normal resilience was closely correlated with depression without demoralization. CONCLUSION These results expand our understanding of resilience by suggesting that it is a mechanism evolved to reduce or prevent demoralization and not just depression. Reducing demoralization and strengthening resilience as part of a comprehensive treatment plan are likely to improve the prognosis of Parkinson disease.
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Affiliation(s)
- John M. de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Boheng Zhu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Amar S. Patel
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Robert Kohn
- Department of Psychiatry, Brown University School of Medicine, Providence, RI, United States
| | - Brian B. Koo
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Elan D. Louis
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
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5
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Llata E, Braxton J, Asbel L, Huspeni D, Laura T, Kerani RP, Cohen S, Kohn R, Schumacher C, Toevs K, Torrone E, Kreisel K. Presumptive and Follow-Up Treatment Associated With Gonorrhea and Chlamydia Testing Episodes in Sexually Transmitted Disease Clinics: Impact of Changing Treatment Guidelines for Gonorrhea, Sexually Transmitted Disease Surveillance Network, 2015-2018. Sex Transm Dis 2023; 50:5-10. [PMID: 36194764 PMCID: PMC10147317 DOI: 10.1097/olq.0000000000001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: CDC recommendation for treatment of uncomplicated gonorrhea (NG) were revised in December 2020 and include ceftriaxone monotherapy when chlamydial infection was excluded. We evaluated the impact of these revised treatment recommendations using data from a network of STD clinics prior to the change in guidelines. Methods: We performed a cross-sectional analysis from 8 STD clinics participating in the STD Surveillance Network from Jan 2015-June 2018 assessing gonorrhea/chlamydia (CT) testing episodes, NAAT results, CT only and NG/CT treatment records, and timing of treatment. We describe the frequency of NG and CT treatment practices and what proportion of patients treated would not have had to receive an anti-chlamydial agent. Results: Of 190,589 episodes that occurred during the study period, 67,895 (35.6%) episodes were associated with a treatment record consistent with gonorrhea and/or chlamydia (CT only (n=37,530) or NG/CT (n=30,365)), most (~86%) were prescribed on the same-day as initial testing. Of the 67,895 episodes with corresponding treatment record(s), 42.1% were positive for either NG or CT compared to 3.7% were positive for NG or CT for those not associated with treatment records (n=122,694 episodes). Among 30,365 episodes associated with NG/CT treatment records, monotherapy would only have been indicated for 10.1% (3,081/30,365) of the episodes as they were treated on follow-up and were NG positive and CT negative. Conclusions: Treatment was prescribed in one third of NG/CT testing episodes, with the majority provided same day. Despite changes in NG treatment guidelines to ceftriaxone monotherapy, majority of patients would continue to receive an anti-chlamydia agent when treated for gonorrhea in these settings. Provision of same-day treatment is common in STD clinic patients being treated for gonorrhea and chlamydia, likely resulting in patients continuing to get dual therapy despite recent treatment guideline changes.
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Affiliation(s)
- Eloisa Llata
- Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
| | - Jim Braxton
- Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, PA
| | - Dawn Huspeni
- Minnesota Department of Health, Minneapolis/St. Paul, MN
| | - Tourdot Laura
- Minnesota Department of Health, Minneapolis/St. Paul, MN
| | - Roxanne P. Kerani
- Public Health – Seattle and King County and Department of Medicine, University of Washington, Seattle, WA
| | - Stephanie Cohen
- San Francisco Department of Public Health, San Francisco, CA
| | - Robert Kohn
- San Francisco Department of Public Health, San Francisco, CA
| | - Christina Schumacher
- Johns Hopkins University School of Medicine and Baltimore City Health Department, Baltimore, MD
| | - Kim Toevs
- Multnomah County Health Department, Portland, OR
| | - Elizabeth Torrone
- Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
| | - Kristen Kreisel
- Centers for Disease Control and Prevention, Surveillance and Data Management Branch, Division of STD Prevention (NCHHSTP)
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Munezero P, Villani M, Kohn R. Dynamic Mixture of Experts Models for Online Prediction. Technometrics 2022. [DOI: 10.1080/00401706.2022.2146755] [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: 11/18/2022]
Affiliation(s)
- Parfait Munezero
- Department of Statistics, Stockholm University
- Data Insights Support Team, Ericsson, Stockholm, Sweden
| | - Mattias Villani
- Department of Statistics, Stockholm University
- Department of Computer and Information Science, Linköping University
| | - Robert Kohn
- UNSW Business School, University of New South Wales
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7
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Frazier DT, Nott DJ, Drovandi C, Kohn R. Bayesian inference using synthetic likelihood: asymptotics and adjustments. J Am Stat Assoc 2022. [DOI: 10.1080/01621459.2022.2086132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- David T. Frazier
- Department of Econometrics and Business Statistics, Monash University, Clayton VIC 3800, Australia
- Australian Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
| | - David J. Nott
- Department of Statistics and Applied Probability, National University of Singapore, Singapore 117546
- Operations Research and Analytics Cluster, National University of Singapore, Singapore 119077
| | - Christopher Drovandi
- School of Mathematical Sciences, Queensland University of Technology, Brisbane 4000 Australia
- Australian Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
| | - Robert Kohn
- Australian School of Business, School of Economics, University of New South Wales, Sydney NSW 2052, Australia
- Australian Centre of Excellence for Mathematical and Statistical Frontiers (ACEMS)
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8
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Abstract
Many psychological experiments have subjects repeat a task to gain the statistical precision required to test quantitative theories of psychological performance. In such experiments, time-on-task can have sizable effects on performance, changing the psychological processes under investigation. Most research has either ignored these changes, treating the underlying process as static, or sacrificed some psychological content of the models for statistical simplicity. We use particle Markov chain Monte-Carlo methods to study psychologically plausible time-varying changes in model parameters. Using data from three highly cited experiments, we find strong evidence in favor of a hidden Markov switching process as an explanation of time-varying effects. This embodies the psychological assumption of "regime switching," with subjects alternating between different cognitive states representing different modes of decision-making. The switching model explains key long- and short-term dynamic effects in the data. The central idea of our approach can be applied quite generally to quantitative psychological theories, beyond the models and datasets that we investigate. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- David Gunawan
- School of Mathematics and Applied Statistics, University of Wollongong
| | - Guy E Hawkins
- School of Psychological Sciences, University of Newcastle
| | - Robert Kohn
- Australian Research Council Center of Excellence in Mathematical and Statistical Frontiers
| | - Minh-Ngoc Tran
- Discipline of Business Analytics, University of Sydney Business School
| | - Scott D Brown
- School of Psychological Sciences, University of Newcastle
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9
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Zhu B, Kohn R, Patel A, Koo BB, Louis ED, de Figueiredo JM. Demoralization and Quality of Life of Patients with Parkinson Disease. Psychother Psychosom 2022; 90:415-421. [PMID: 33601384 DOI: 10.1159/000514270] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Demoralization is quite prevalent in patients with Parkinson disease (PD). Unrecognized or untreated, demoralization may progress, at times, to demands for euthanasia and the desire for suicide. Typically, patients with PD do not complain of being "demoralized"; rather, they report disruptions in the quality of their lives. Hence, early identification of disruptions in health-related quality of life (HRQoL) specifically associated with demoralization may prompt earlier recognition and treatment. Published data on such associations, however, could not be found. Alleviation of demoralization in PD is likely to improve treatment outcomes. OBJECTIVE This research aimed at identifying the disruptions of HRQoL specifically associated with the demoralization of patients with PD. METHODS Consecutive general hospital outpatients with PD (n = 95) were assessed for: demoralization, with the Diagnostic Criteria for Psychosomatic Research Demoralization Scale (DCPR-D) and the Demoralization Scale (DS); depression, with the Patient Health Questionnaire-9 (PHQ-9); HRQoL, with the Parkinson Disease Questionnaire-Short Form (PDQ-8); sociodemographic variables; medical comorbidities; PD severity; and types of treatment. RESULTS The prevalence of demoralization was 19%. Regression analyses showed that demoralization was significantly more likely to be experienced by participants who had difficulty with mobility and felt embarrassed in public due to having PD. Demoralization explained HRQoL over and above depression. CONCLUSIONS Stigma and perceived difficulty with mobility are associated with demoralization of PD patients, and they may signal the need for psychotherapeutic and behavioral interventions to prevent the progression to helplessness, hopelessness, demands for euthanasia, and desire for suicide.
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Affiliation(s)
- Boheng Zhu
- Department of Psychology, University of Bologna, Bologna, Italy.,Formerly at the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Robert Kohn
- Department of Psychiatry, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Amar Patel
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian B Koo
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elan D Louis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Formerly at the Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John M de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA,
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10
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de Figueiredo JM, Zhu B, Patel A, Kohn R, Koo BB, Louis ED. From Perceived Stress to Demoralization in Parkinson Disease: A Path Analysis. Front Psychiatry 2022; 13:876445. [PMID: 35619612 PMCID: PMC9127857 DOI: 10.3389/fpsyt.2022.876445] [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: 02/15/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine whether depression and anxiety are mediators between perceived stress and demoralization via a loss of the cognitive map to get out of the predicament manifesting as subjective incompetence. METHODS Ninety-five consecutive outpatients with Parkinson's disease were evaluated for perceived stress, depression, anxiety, subjective incompetence, and demoralization using reliable and valid scales. Inclusion criteria were ages 40-90, intact cognition, and no current history of substance use. The setting was a Movement Disorders Clinic at a university-affiliated hospital. The outcome variable was demoralization, selected a priori. Mediators between perceived stress and demoralization were examined using path analysis. RESULTS Depression, anxiety, and subjective incompetence were mediators between perceived stress and demoralization. Among all variables, subjective incompetence was the largest contributor to demoralization. Depression connected to demoralization indirectly via subjective incompetence (β = 0.25, p < 0.001), whereas anxiety bypassed subjective incompetence (β = -0.01, p = 0.882), connecting directly to demoralization (β = 0.37, p = 0.008). CONCLUSION Early treatment and reversal of subjective incompetence and anxiety could potentially prevent the escalation of demoralization and the associated disruption in health-related quality of life and eventual suicide.
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Affiliation(s)
- John M de Figueiredo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Boheng Zhu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Amar Patel
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Robert Kohn
- Department of Psychiatry, Brown University School of Medicine, Providence, RI, United States
| | - Brian B Koo
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Elan D Louis
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, United States
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11
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Quilter L, Cyr SS, Hong J, Asbel L, Bautista I, Carter B, Casimir Y, Denny M, Ervin M, Gomez R, Harvey A, Holderman J, Johnson K, Kohn R, Learner E, Mauk K, Menza TW, Mettenbrink C, Nettleton W, Nicosia K, Pham CD, Ried C, Schlanger K, Schneider A, Soge OO, Tabidze I, Taylor SN, Tilghman W, Toler C, Weinstock H, Torrone E. 164. Antimicrobial Susceptibility of Urogenital and Extragenital Neisseria gonorrhoeae Isolates Among Men Who Have Sex with Men – SURRG and eGISP, 2018–2019. Open Forum Infect Dis 2021. [PMCID: PMC8644847 DOI: 10.1093/ofid/ofab466.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Extragenital gonococcal infections are common among men who have sex with men (MSM); however, data comparing antimicrobial susceptibilities of urogenital and extragenital Neisseria gonorrhoeae isolates are limited. We investigated differences in gonococcal antimicrobial susceptibility by anatomic site among cisgender MSM using specimens collected through CDC’s enhanced Gonococcal Isolate Surveillance Project (eGISP) and Strengthening the U.S. Response to Resistant Gonorrhea (SURRG). Methods During January 1, 2018–December 31, 2019, 12 eGISP and 8 SURRG sites collected urogenital, pharyngeal, and rectal isolates from cisgender MSM in STD clinics. Gonococcal isolates were sent to regional laboratories for antimicrobial susceptibility testing by agar dilution. To account for correlated observations, linear mixed-effects models were used to calculate geometric mean minimum inhibitory concentrations (MICs) and mixed-effects logistic regression models were used to calculate the proportion of isolates with elevated or resistant MICs; comparisons were made across anatomic sites. Results Participating clinics collected 3,974 urethral, 1,553 rectal, and 1,049 pharyngeal isolates from 5,456 unique cisgender MSM. There were no significant differences in the geometric mean MICs for azithromycin, ciprofloxacin, penicillin, and tetracycline by anatomic site. For cefixime and ceftriaxone, geometric mean MICs for pharyngeal isolates were higher compared to anogenital isolates (p< 0.05). The proportion of isolates with elevated ceftriaxone MICs (≥ 0.125 µg/ml) at the pharynx (0.67%) was higher than at rectal (0.13%) and urethral (0.18%) sites (p< 0.05). ![]()
Conclusion Based on data collected from multi-jurisdictional sentinel surveillance projects, antimicrobial susceptibility patterns of N. gonorrhoeae isolates may differ among MSM at extragenital sites, particularly at the pharynx. Continued investigation into gonococcal susceptibility patterns by anatomic site may be an important strategy to monitor and detect the emergence of antimicrobial resistant gonorrhea over time. Disclosures Olusegun O. Soge, PhD, Hologic Inc. (Grant/Research Support)SpeeDx Inc. (Grant/Research Support) Stephanie N. Taylor, MD, GARDP - GC Antibiotic Development (Scientific Research Study Investigator, To my institution.)GlaxoSmithKline (Grant/Research Support, Funds to my institution.)
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Affiliation(s)
- Laura Quilter
- Division of STD Prevention / Centers for Disease Control and Prevention, Atlanta, GA
| | - Sancta St Cyr
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Jaeyoung Hong
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Raquel Gomez
- Milwaukee Health Department, Milwaukee, Wisconsin
| | - Alesia Harvey
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Kimberly Johnson
- New York City Department of Mental Health and Hygiene, New York City, New York
| | - Robert Kohn
- San Francisco Department of Public Health, San Francisco, California
| | - Emily Learner
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Kerry Mauk
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - William Nettleton
- Kalamazoo County Health and Community Services Department, Kalamazoo, Michigan
| | | | - Cau D Pham
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | - Irina Tabidze
- Chicago Department of Public Health, Chicago, Illinois
| | - Stephanie N Taylor
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Winston Tilghman
- County of San Diego Health & Human Services Agency, San Diego, California
| | - Cindy Toler
- Guilford County Public Health, Greensboro, North Carolina
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12
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Schlanger K, Mauk K, Learner ER, Schillinger JA, Nishiyama M, Kohn R, Thibault C, Hermus H, Dewater J, Pabon V, Black J, Cyr SS, Pham CR, Kirkcaldy RD. Test of Cure Return Rate and Test Positivity, Strengthening the US Response to Resistant Gonorrhea, United States, 2018-2019. Sex Transm Dis 2021; 48:S167-S173. [PMID: 34433793 PMCID: PMC10280133 DOI: 10.1097/olq.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reduced antibiotic susceptibility (RS) in Neisseria gonorrhoeae (GC) may increase treatment failure. Conducting tests of cure (TOC) for patients with RS-GC may facilitate identification of treatment failures. METHODS We examined 2018 to 2019 data from 8 jurisdictions participating in the US Centers for Disease Control and Prevention's Strengthening US Response to Resistant Gonorrhea project. Jurisdictions collected GC isolates and epidemiological data from patients and performed antimicrobial susceptibility testing. Minimum inhibitory concentrations of ceftriaxone, 0.125 μg/mL or greater; cefixime, 0.250 μg/mL or greater; or azithromycin, 2.0 μg/mL or greater were defined as RS. Patients with RS infections were asked to return for a TOC 8 to 10 days posttreatment. We calculated a weighted TOC return rate and described time to TOC and suspected reasons for any positive TOC results. RESULTS Overall, 1165 patients were diagnosed with RS infections. Over half returned for TOC (weighted TOC, 61%; 95% confidence interval, 50.1%-72.6%; range by jurisdiction, 32%-80%). Test of cure rates were higher among asymptomatic (68%) than symptomatic patients (53%, P = 0.001), and men who have sex with men (62%) compared with men who have sex with women (50%; P < 0.001). Median time between treatment and TOC was 12 days (interquartile range, 9-16). Of the 31 (4.5%) TOC patients with positive results, 13 (42%) were suspected because of reinfection and 11 (36%) because of false-positive results. There were no treatment failures suspected to be due to RS-GC. CONCLUSIONS Most patients with a RS infection returned for a TOC, though return rates varied by jurisdiction and patient characteristics. Test of cure can identify and facilitate treatment of reinfections, but false-positive TOC results may complicate interpretation and clinical management.
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Affiliation(s)
| | - Kerry Mauk
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Julia A. Schillinger
- Centers for Disease Control and Prevention, Atlanta, GA
- New York City Department of Health and Mental Hygiene, Long Island City, NY
| | | | - Robert Kohn
- San Francisco Department of Public Health, San Francisco, CA
| | | | | | | | - Vonda Pabon
- Guilford County Department of Health, Greensboro, NC
| | - Jamie Black
- Indiana Department of Health, Indianapolis, IN
| | | | - Cau R. Pham
- Centers for Disease Control and Prevention, Atlanta, GA
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Quiroz M, Tran MN, Villani M, Kohn R, Dang KD. The Block-Poisson Estimator for Optimally Tuned Exact Subsampling MCMC. J Comput Graph Stat 2021. [DOI: 10.1080/10618600.2021.1917420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Matias Quiroz
- School of Mathematical and Physical Sciences, University of Technology Sydney, Ultimo, Australia
- Research Division, Sveriges Riksbank, Stockholm, Sweden
| | - Minh-Ngoc Tran
- Discipline of Business Analytics, University of Sydney, Sydney, Australia
| | - Mattias Villani
- Department of Statistics, Stockholm University, Stockholm, Sweden
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Robert Kohn
- School of Economics, UNSW Business School, University of New South Wales, Kensington, Australia
| | - Khue-Dung Dang
- School of Mathematical and Physical Sciences, University of Technology Sydney, Ultimo, Australia
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Johnson KA, Chen MJ, Kohn R, Sachdev D, Bacon O, Lee S, Cohen SE. Acute HIV at the Time of Initiation of Pre-exposure or Post-exposure Prophylaxis: Impact on Drug Resistance and Clinical Outcomes. J Acquir Immune Defic Syndr 2021; 87:818-825. [PMID: 33512849 DOI: 10.1097/qai.0000000000002638] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Initiating pre-exposure or post-exposure prophylaxis (PrEP/PEP) in the setting of undiagnosed acute HIV (AHI) could cause antiretroviral resistance. We sought to characterize clinical outcomes and drug resistance mutations among individuals prescribed PrEP/PEP with undiagnosed AHI at a San Francisco sexually transmitted disease clinic. SETTING In our PrEP/PEP program, patients are tested for HIV using a point-of-care antibody test. If negative, patients are started on prophylaxis and screened for AHI using pooled HIV RNA (5-10 days turn-around). We used 2-drug PEP until 05/2016. METHODS We identified patients who had as-yet-undiagnosed AHI on the day of PrEP/PEP start between 2011 and 2018, then used our clinical record and surveillance data to describe HIV resistance and clinical outcomes. RESULTS Of 1758 PrEP and 2242 PEP starts, there were 7 AHI cases among PrEP users (0.40%) and 6 among PEP users (0.30%). Median times for linkage to HIV care, initiation of HIV treatment, and viral suppression were 7, 12, and 43 days. On initiation of HIV care, 3 patients (23%) were found to have an M184 mutation 7-12 days after starting PrEP/PEP. All 3 had genotyping performed on stored serum available from the date of PrEP/PEP start, each of which demonstrated wild-type virus. All 3 patients achieved durable viral suppression. CONCLUSIONS Although rare (occurring <0.5% of the time), AHI in the setting of PrEP/2-drug PEP can result in an M184 within days. Even with M184, persons with AHI achieve viral suppression when rapidly linked to care and initiated on antiretroviral therapy. Providers should consider AHI screening when starting PrEP/PEP.
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Affiliation(s)
- Kelly A Johnson
- Department of Medicine, University of California San Francisco, San Francisco, CA; and
- San Francisco Department of Public Health, Population Health Division, San Francisco, CA
| | - Miao-Jung Chen
- San Francisco Department of Public Health, Population Health Division, San Francisco, CA
| | - Robert Kohn
- San Francisco Department of Public Health, Population Health Division, San Francisco, CA
| | - Darpun Sachdev
- Department of Medicine, University of California San Francisco, San Francisco, CA; and
- San Francisco Department of Public Health, Population Health Division, San Francisco, CA
| | - Oliver Bacon
- Department of Medicine, University of California San Francisco, San Francisco, CA; and
- San Francisco Department of Public Health, Population Health Division, San Francisco, CA
| | - Sulggi Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA; and
| | - Stephanie E Cohen
- Department of Medicine, University of California San Francisco, San Francisco, CA; and
- San Francisco Department of Public Health, Population Health Division, San Francisco, CA
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15
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Fernandez CA, Choi KW, Marshall BDL, Vicente B, Saldivia S, Kohn R, Koenen KC, Arheart KL, Buka SL. Assessing the relationship between psychosocial stressors and psychiatric resilience among Chilean disaster survivors. Br J Psychiatry 2020; 217:630-637. [PMID: 32522300 PMCID: PMC8268117 DOI: 10.1192/bjp.2020.88] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND According to the stress inoculation hypothesis, successfully navigating life stressors may improve one's ability to cope with subsequent stressors, thereby increasing psychiatric resilience. AIMS Among individuals with no baseline history of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), to determine whether a history of a stressful life event protected participants against the development of PTSD and/or MDD after a natural disaster. METHOD Analyses utilised data from a multiwave, prospective cohort study of adult Chilean primary care attendees (years 2003-2011; n = 1160). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument, and the List of Threatening Experiences, a 12-item questionnaire that measures major stressful life events. During the study (2010), the sixth most powerful earthquake on record struck Chile. One year later (2011), the CIDI was re-administered to assess post-disaster PTSD and/or MDD. RESULTS Marginal structural logistic regressions indicated that for every one-unit increase in the number of pre-disaster stressors, the odds of developing post-disaster PTSD or MDD increased (OR = 1.21, 95% CI 1.08-1.37, and OR = 1.16, 95% CI 1.06-1.27 respectively). When categorising pre-disaster stressors, individuals with four or more stressors (compared with no stressors) had higher odds of developing post-disaster PTSD (OR = 2.77, 95% CI 1.52-5.04), and a dose-response relationship between pre-disaster stressors and post-disaster MDD was found. CONCLUSIONS In contrast to the stress inoculation hypothesis, results indicated that experiencing multiple stressors increased the vulnerability to developing PTSD and/or MDD after a natural disaster. Increased knowledge regarding the individual variations of these disorders is essential to inform targeted mental health interventions after a natural disaster, especially in under-studied populations.
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Affiliation(s)
- Cristina A. Fernandez
- Department of Epidemiology, Harvard T. H. School of Public Health, Boston, MA, USA,Department of Epi demiology, Brown School of Public Health, Providence, RI USA
| | - Karmel W. Choi
- Department of Epidemiology, Harvard T. H. School of Public Health, Boston, MA, USA
| | - Brandon DL Marshall
- Department of Epi demiology, Brown School of Public Health, Providence, RI USA
| | - Benjamin Vicente
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Robert Kohn
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence RI, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T. H. School of Public Health, Boston, MA, USA
| | - Kristopher L. Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen L. Buka
- Department of Epi demiology, Brown School of Public Health, Providence, RI USA
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16
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Sachdev DD, Mara E, Hughes AJ, Antunez E, Kohn R, Cohen S, Scheer S. "Is a Bird in the Hand Worth 5 in the Bush?": A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco. Open Forum Infect Dis 2020; 7:ofaa369. [PMID: 32995350 PMCID: PMC7505526 DOI: 10.1093/ofid/ofaa369] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background Health departments utilize HIV surveillance data to identify people with HIV (PWH) who need re-linkage to HIV care as part of an approach known as Data to Care (D2C.) The most accurate, effective, and efficient method of identifying PWH for re-linkage is unknown. Methods We evaluated referral and care continuum outcomes among PWH identified using 3 D2C referral strategies: health care providers, surveillance, and a combination list derived by matching an electronic medical record registry to HIV surveillance. PWH who were enrolled in the re-linkage intervention received short-term case management for up to 90 days. Relative risks and 95% confidence intervals were calculated to compare proportions of PWH retained and virally suppressed before and after re-linkage. Durable viral suppression was defined as having suppressed viral loads at all viral load measurements in the 12 months after re-linkage. Results After initial investigation, 233 (24%) of 954 referrals were located and enrolled in navigation. Although the numbers of surveillance and provider referrals were similar, 72% of enrolled PWH were identified by providers, 16% by surveillance, and 12% by combination list. Overall, retention and viral suppression improved, although relative increases in retention and viral suppression were only significant among individuals identified by surveillance or providers. Seventy percent of PWH who achieved viral suppression after the intervention remained durably virally suppressed. Conclusions PWH referred by providers were more likely to be located and enrolled in navigation than PWH identified by surveillance or combination lists. Overall, D2C re-linkage efforts improved retention, viral suppression, and durable viral suppression.
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Affiliation(s)
- Darpun D Sachdev
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Elise Mara
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
| | - Alison J Hughes
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
| | - Erin Antunez
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Robert Kohn
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Stephanie Cohen
- Disease Prevention and Control Branch, San Francisco Department of Public Health, San Francisco, California, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, California, USA
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17
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Chin V, Gunawan D, Fiebig DG, Kohn R, Sisson SA. Efficient data augmentation for multivariate probit models with panel data: an application to general practitioner decision making about contraceptives. J R Stat Soc Ser C Appl Stat 2020. [DOI: 10.1111/rssc.12393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vincent Chin
- University of New South Wales Sydney
- Australian Centre of Excellence for Mathematical and Statistical Frontiers Parkville Australia
| | - David Gunawan
- Australian Centre of Excellence for Mathematical and Statistical Frontiers Parkville Australia
- University of Wollongong Parkville Australia
| | - Denzil G. Fiebig
- University of New South Wales Sydney
- Australian Centre of Excellence for Mathematical and Statistical Frontiers Parkville Australia
| | - Robert Kohn
- University of New South Wales Sydney
- Australian Centre of Excellence for Mathematical and Statistical Frontiers Parkville Australia
| | - Scott A. Sisson
- University of New South Wales Sydney
- Australian Centre of Excellence for Mathematical and Statistical Frontiers Parkville Australia
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18
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Mann LM, Llata E, Flagg EW, Hong J, Asbel L, Carlos-Henderson J, Kerani RP, Kohn R, Pathela P, Schumacher C, Torrone EA. Trends in the Prevalence of Anogenital Warts Among Patients at Sexually Transmitted Disease Clinics-Sexually Transmitted Disease Surveillance Network, United States, 2010-2016. J Infect Dis 2020; 219:1389-1397. [PMID: 30500908 DOI: 10.1093/infdis/jiy684] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/08/2018] [Accepted: 11/27/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Approximately 90% of genital warts are caused by human papillomavirus (HPV) types 6 and 11. In the United States, HPV vaccination has been recommended for girls and women aged ≤26 years, and since 2011, for boys and men aged ≤21 years and for gay, bisexual, and other men who have sex with men (MSM) aged ≤26 years. METHODS Data were obtained from 27 clinics participating in the STD Surveillance Network. Trends in the annual prevalence of anogenital warts (AGW) from 2010-2016 were described by sex and by the sex of sex partners. RESULTS During 2010-2016, significant declines in the prevalence of AGW were observed in women aged <40 years, men who have sex with women only (MSW) aged <40 years, and MSM of all age categories. An inflection in trend in 2012 was noted for MSW aged 20-24 or 25-29 years and for MSM aged 20-24 years. CONCLUSIONS The observed declines in the prevalence of AGW suggest that HPV morbidity is declining among populations attending STD clinics, including MSW, MSM, and women. Declines in younger age groups are consistent with what would be expected following the implementation of HPV vaccination. However, declines were also observed in older age groups and are not likely to be the result of vaccination.
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Affiliation(s)
- Laura M Mann
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eloisa Llata
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elaine W Flagg
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jaeyoung Hong
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lenore Asbel
- City of Philadelphia Department of Public Health, Pennsylvania
| | | | | | - Robert Kohn
- San Francisco Department of Public Health, California
| | - Preeti Pathela
- New York City Department of Health and Mental Hygiene, New York
| | | | - Elizabeth A Torrone
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention, Atlanta, GA
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Affiliation(s)
- M.-N. Tran
- Discipline of Business Analytics, The University of Sydney Business School and ACEMS, Sydney, Australia
| | - N. Nguyen
- Discipline of Business Analytics, The University of Sydney Business School and ACEMS, Sydney, Australia
| | - D. Nott
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - R. Kohn
- School of Economics, UNSW Business School and ACEMS, Sydney, Australia
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Kohn R, Ali AA, Puac-Polanco V, Figueroa C, López-Soto V, Morgan K, Saldivia S, Vicente B. Mental health in the Americas: an overview of the treatment gap. Rev Panam Salud Publica 2018; 42:e165. [PMID: 31093193 PMCID: PMC6386160 DOI: 10.26633/rpsp.2018.165] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [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: 05/03/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Methods Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Results Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% - 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. Conclusion The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease.
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Affiliation(s)
- Robert Kohn
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
| | - Ali Ahsan Ali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York, United States
| | - Victor Puac-Polanco
- Department of Epidemiology, Columbia University, New York, New York, United States
| | - Chantal Figueroa
- Global Heath Program, Colorado College, Colorado Springs, Colorado, United States
| | | | - Kristen Morgan
- Brown University School of Public Health, Providence, Rhode Island, United States
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Región del Bío Bío, Chile
| | - Benjamín Vicente
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Región del Bío Bío, Chile
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22
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Affiliation(s)
- Matias Quiroz
- Australian School of Business, University of New South Wales, Sydney, Australia
| | - Robert Kohn
- Australian School of Business, University of New South Wales, Sydney, Australia
| | - Mattias Villani
- Division of Statistics and Machine Learning, Department of Computer and Information Science, Linköping University, Linköping, Sweden
| | - Minh-Ngoc Tran
- Discipline of Business Analytics, University of Sydney, Sydney, Australia
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23
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Abstract
SummaryThe incorporation of P32 orthophosphate into phosphatide by isolated human platelets in an artificial medium was studied. The addition of homologous plasma increased the incorporation and the formation of labelled phosphatide was significantly reduced in the absence of oxygen or in the presence of cyanide, and by varying the pH from 7.4 to 5.6 and 8.6. The enzymatic character of the incorporation and the role of platelet respiration are briefly discussed.
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Fernandez CA, Vicente B, Marshall BD, Koenen KC, Arheart KL, Kohn R, Saldivia S, Buka SL. Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors. Int J Epidemiol 2018; 46:440-452. [PMID: 27283159 DOI: 10.1093/ije/dyw094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 11/14/2022] Open
Abstract
Background With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that pre-existing psychopathology plays in developing PTSD after a disaster. Methods This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres ( N = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD. Results The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65). Conclusions This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.
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Affiliation(s)
- Cristina A Fernandez
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Benjamin Vicente
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Brandon Dl Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Karestan C Koenen
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Kohn
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
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25
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Brown LA, Fernandez CA, Kohn R, Saldivia S, Vicente B. Pre-disaster PTSD as a moderator of the relationship between natural disaster and suicidal ideation over time. J Affect Disord 2018; 230:7-14. [PMID: 29355729 PMCID: PMC6576262 DOI: 10.1016/j.jad.2017.12.096] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/23/2017] [Accepted: 12/31/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Natural disasters are associated with a variety of negative health consequences, including enhanced suicide risk. Factors that moderate the relationship between disaster exposure and enhanced suicide risk are unknown. The aim of the current study was to determine whether pre-disaster PTSD moderates the association between change over time in thoughts of death, suicidal ideation (SI), suicide plans, and suicide attempts (SA) from pre- to post-disaster. METHODS Participants (n = 2832) were recruited from Chile as part of the larger PREDICT study and completed a measure of lifetime PTSD and panic disorder at baseline and a lifetime death/suicide measure at baseline in 2003 and again 6, 12, and 24 months later (i.e. "pre-disaster"). One year following a major earthquake and tsunami in 2010 (i.e., "post-disaster"), participants completed another death/suicide measure. RESULTS Both those with and without pre-disaster PTSD experienced significant increases in SI from pre- to post-disaster. However, pre-disaster PTSD was associated with significantly accelerated increases in thoughts of death and SI from pre-to post-disaster. At nearly all time-points, pre-disaster PTSD was associated with higher thoughts of death and SI, suicide planning, and SA. In contrast, panic disorder did not moderate the association between time and changes in SI. LIMITATIONS There was a long time-gap between pre-disaster and post-disaster, with limited data about what occurred during this time. CONCLUSION Pre-disaster PTSD is an important predictor of increased SI following a natural disaster, and groups with pre-disaster PTSD should be prioritized for receipt of mental health resources following a natural disaster.
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Affiliation(s)
- Lily A Brown
- University of Pennsylvania, Department of Psychiatry, United States
| | - Cristina A Fernandez
- Harvard University, T.H. Chan School of Public Health, United States; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
| | - Robert Kohn
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
| | - Sandra Saldivia
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile
| | - Benjamin Vicente
- Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile.
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Affiliation(s)
- Minh-Ngoc Tran
- University of Sydney Business School, University of Sydney, NSW, Australia
| | - David J. Nott
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Robert Kohn
- UNSW Business School, University of New South Wales, Sydney NSW, Australia
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27
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Affiliation(s)
- Matias Quiroz
- Division of Statistics and Machine Learning, Linköping University, Linköping, Sweden
- Research Division, Sveriges Riksbank, Stockholm, Sweden
| | - Minh-Ngoc Tran
- Discipline of Business Analytics, University of Sydney, Camperdown NSW, Australia
| | - Mattias Villani
- Division of Statistics and Machine Learning, Linköping University, Linköping, Sweden
| | - Robert Kohn
- Australian School of Business, University of New South Wales, Sydney NSW, Australia
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28
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Juher D, Saldaña J, Kohn R, Bernstein K, Scoglio C. Network-Centric Interventions to Contain the Syphilis Epidemic in San Francisco. Sci Rep 2017; 7:6464. [PMID: 28743879 PMCID: PMC5527084 DOI: 10.1038/s41598-017-06619-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/26/2017] [Indexed: 11/26/2022] Open
Abstract
The number of reported early syphilis cases in San Francisco has increased steadily since 2005. It is not yet clear what factors are responsible for such an increase. A recent analysis of the sexual contact network of men who have sex with men with syphilis in San Francisco has discovered a large connected component, members of which have a significantly higher chance of syphilis and HIV compared to non-member individuals. This study investigates whether it is possible to exploit the existence of the largest connected component to design new notification strategies that can potentially contribute to reducing the number of cases. We develop a model capable of incorporating multiple types of notification strategies and compare the corresponding incidence of syphilis. Through extensive simulations, we show that notifying the community of the infection state of few central nodes appears to be the most effective approach, balancing the cost of notification and the reduction of syphilis incidence. Additionally, among the different measures of centrality, the eigenvector centrality reveals to be the best to reduce the incidence in the long term as long as the number of missing links (non-disclosed contacts) is not very large.
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Affiliation(s)
- David Juher
- Universitat de Girona, Girona, Catalunya, Spain
| | | | - Robert Kohn
- San Francisco Public Health Department, San Francisco, California, USA
| | - Kyle Bernstein
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jain J, Santos GM, Scheer S, Gibson S, Crouch PC, Kohn R, Chang W, Carrico AW. Rates and Correlates of Syphilis Reinfection in Men Who Have Sex with Men. LGBT Health 2016; 4:232-236. [PMID: 27991843 DOI: 10.1089/lgbt.2016.0095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/13/2022] Open
Abstract
PURPOSE This study examined rates and correlates of syphilis reinfection in men who have sex with men (MSM). METHODS From 2012 to 2015, time to reinfection was assessed in 323 MSM receiving initial treatment for syphilis in San Francisco. RESULTS One in five men was reinfected (71/323; 22%). The rate of syphilis reinfection was greater among HIV-infected men (adjusted hazard ratio [aHR] = 1.96; 95% confidence interval [95% CI] = 1.16-3.31) and ketamine users (aHR = 2.76; 95% CI = 1.09-7.00). CONCLUSION Expanded prevention efforts are needed with HIV-infected and substance-using MSM to reduce the burden of reinfection in this population.
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Affiliation(s)
- Jennifer Jain
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California
| | - Glenn-Milo Santos
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California.,2 San Francisco Department of Public Health , San Francisco, California
| | - Susan Scheer
- 2 San Francisco Department of Public Health , San Francisco, California
| | - Steve Gibson
- 3 San Francisco AIDS Foundation , San Francisco, California
| | | | - Robert Kohn
- 2 San Francisco Department of Public Health , San Francisco, California
| | - Walter Chang
- 1 Department of Community Health Systems, University of California , San Francisco, San Francisco, California
| | - Adam W Carrico
- 4 Department of Public Health Sciences, University of Miami School of Medicine , Miami, Florida
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Abstract
Wahba (1978) and Weinert et al. (1980), using different models, show that an optimal smoothing spline can be thought of as the conditional expectation of a stochastic process observed with noise. This observation leads to efficient computational algorithms. By going back to the Hilbert space formulation of the spline minimization problem, we provide a framework for linking the two different stochastic models. The last part of the paper reviews some new efficient algorithms for spline smoothing.
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Abstract
The paper looks at the asymptotic properties of the finite Walsh–Fourier transform applied to a discrete-time stationary time series, and shows that in many ways we have analogous results to those obtained when using the finite trigonometric Fourier transform.
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Abstract
The paper derives the asymptotic properties of a class of estimators of the Walsh–Fourier spectral density of a stationary time series. The spectral density is defined in Kohn (1980).
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Abstract
We consider a general non-linear multivariate time series model which can be parameterized by a finite and fixed number of parameters and which can be rewritten, if necessary, in a form such that the disturbances are stationary martingale differences. Given a series of discrete, equally spaced observations we prove the strong consistency and asymptotic normality of the Gaussian estimators of the parameters, the parameters possibly being subject to non-linear constraints. Because the normal equations are usually highly non-linear it may be difficult to obtain explicit expressions for the Gaussian estimates. To overcome this problem we use a Gauss–Newton type algorithm to obtain a sequence of iterates which converge to, and have the same asymptotic properties as, the Gaussian estimates.
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Tran MN, Nott DJ, Kuk AYC, Kohn R. Parallel Variational Bayes for Large Datasets With an Application to Generalized Linear Mixed Models. J Comput Graph Stat 2016. [DOI: 10.1080/10618600.2015.1012293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fernandez CA, Loucks EB, Arheart KL, Hickson DA, Kohn R, Buka SL, Gjelsvik A. Evaluating the Effects of Coping Style on Allostatic Load, by Sex: The Jackson Heart Study, 2000-2004. Prev Chronic Dis 2015; 12:E165. [PMID: 26425869 PMCID: PMC4591617 DOI: 10.5888/pcd12.150166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The objective of this study was to examine the cross-sectional association between coping styles and allostatic load among African American adults in the Jackson Heart Study (2000–2004). Coping styles were assessed using the Coping Strategies Inventory-Short Form; allostatic load was measured by using 9 biomarkers standardized into z-scores. Sex-stratified multivariable linear regressions indicated that females who used disengagement coping styles had significantly higher allostatic load scores (β = 0.016; 95% CI, 0.001–0.032); no such associations were found in males. Future longitudinal investigations should examine why disengagement coping style is linked to increased allostatic load to better inform effective interventions and reduce health disparities among African American women.
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Affiliation(s)
- Cristina A Fernandez
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, Providence, RI 02912.
| | - Eric B Loucks
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - DeMarc A Hickson
- Department of Medicine, University of Mississippi Medical Center and Center for Research, Evaluation, and Environmental and Policy Change, My Brother's Keeper, Inc, Jackson, Mississippi
| | - Robert Kohn
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior , Providence, Rhode Island
| | - Stephen L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Annie Gjelsvik
- Department of Epidemiology, Brown University School of Public Health and Department of Pediatrics and Hasbro Children's Hospital, Providence, Rhode Island
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Silva D, Vicente B, Saldivia S, Kohn R. [Suicidal behavior and psychiatric disorders in Chile. A population-based study]. Rev Med Chil 2015; 141:1275-82. [PMID: 24522355 DOI: 10.4067/s0034-98872013001000006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 07/09/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicidal behavior ranges from ideation to consummation of suicide. In Chile, rates of suicide increased from 4.8 to 12.7/100,000 in the period 1992-2009. AIM To evaluate the prevalence of suicidal behavior and its relationship with sociodemographic factors and psychiatric diseases. MATERIAL AND METHODS The Composite International Diagnostic Interview (CIDI), was applied to a representative sample of 2,978 Chilean participants. The prevalence of four suicidal behaviors (thinking about or wishing death, suicide ideation and suicide attempts) and of psychiatric diseases according to the revised third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), was calculated. RESULTS The lifetime prevalence of suicidal conception was 14.3% and the suicide attempt 7.7%, the latest associated with sex, age, school years, smoking habits, being married or having a relationship, depressive disorders, dysthymia, and alcohol, drug and tobacco dependence. CONCLUSIONS Rates founded exceed international prevalence data and extrapolated to current rates of completed suicide, higher levels of suicidal behavior should be expected. Considering the associated disorders we can infer that it is essential a correct diagnosis and treatment of mood disorders and substance consumption to any other specific interventions.
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Doucet A, Pitt MK, Deligiannidis G, Kohn R. Efficient implementation of Markov chain Monte Carlo when using an unbiased likelihood estimator. Biometrika 2015. [DOI: 10.1093/biomet/asu075] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Puac-Polanco VD, Lopez-Soto VA, Kohn R, Xie D, Richmond TS, Branas CC. Previous violent events and mental health outcomes in Guatemala. Am J Public Health 2015; 105:764-71. [PMID: 25713973 DOI: 10.2105/ajph.2014.302328] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War. METHODS We used regression modeling, an interaction test, and complex survey design adjustments to estimate prevalences and test potential relationships between previous violent events and mental health. RESULTS Many (20.6%) participants experienced at least 1 previous serious violent event. Witnessing someone severely injured or killed was the most common event. Depression was experienced by 4.2% of participants, with 6.5% experiencing anxiety, 6.4% an alcohol-related disorder, and 1.9% posttraumatic stress disorder (PTSD). Persons who experienced violence during the war had 4.3 times the adjusted odds of alcohol-related disorders (P < .05) and 4.0 times the adjusted odds of PTSD (P < .05) compared with the postwar period. Women, indigenous Maya, and urban dwellers had greater odds of experiencing postviolence mental health outcomes. CONCLUSIONS Violence that began during the civil war and continues today has had a significant effect on the mental health of Guatemalans. However, mental health outcomes resulting from violent events decreased in the postwar period, suggesting a nation in recovery.
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Affiliation(s)
- Victor D Puac-Polanco
- Victor D. Puac-Polanco is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Victor A. Lopez-Soto is with the Universidad de San Carlos de Guatemala Facultad de Medicina, Guatemala City. Robert Kohn is with the Department of Psychiatry and Human Behavior, Brown University, Providence, RI. Dawei Xie and Charles C. Branas are with the Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia. Therese S. Richmond is with the School of Nursing, University of Pennsylvania, Philadelphia
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Affiliation(s)
- Benjamín Vicente
- a Department of Psychiatry and Mental Health, University of Concepción, Concepción, Chile
| | - Sandra Saldivia
- a Department of Psychiatry and Mental Health, University of Concepción, Concepción, Chile
| | - Robert Kohn
- b Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Kohn R, Levav I, Liphshitz I, Barchana M, Keinan-Boker L. Cancer incidence and mortality following exposures to distal and proximal major stressors. Soc Psychiatry Psychiatr Epidemiol 2014; 49:703-9. [PMID: 24318123 DOI: 10.1007/s00127-013-0805-9] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Severe psychological trauma has been shown to leave psychological and biological sequelae, including compromise of the neuro-hormonal and immunological systems. Despite much research, the putative effect of such stressor on cancer remains ambiguous. This study maximized the exploration of cancer incidence and mortality by combining a proximal (parental bereavement) with a distal major stressor (Holocaust exposure) on both risks. METHODS Subjects were bereaved Holocaust survivors (n = 904) and comparison individuals (n = 933) selected from the total cohort of 6,284 Jewish-Israeli parents who lost an adult son in war or from non-self-inflicted external causes. Cox regression was used to examine the differential risk for cancer between the two bereaved samples, adjusting for potential confounders. RESULTS No difference in cancer incidence or mortality was observed between both groups of bereaved parents. However, prior to bereavement, Holocaust survivors had an increased cancer risk compared with their counterparts in the general population. CONCLUSIONS Individuals who faced both a proximal (bereavement) and distal (Holocaust) major stressors had no additive risk for cancer incidence and mortality.
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Affiliation(s)
- Robert Kohn
- Department of Psychiatry and Human Behavior, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
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Bernstein KT, Kohn R, Wolf W, Strona F, Fann C, Philip S. O08.1 Assessing the Added Value of Internet Partner Services For Syphilis and HIV. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaufmann CN, Canham SL, Mojtabai R, Gum AM, Dautovich ND, Kohn R, Spira AP. Insomnia and health services utilization in middle-aged and older adults: results from the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2013; 68:1512-7. [PMID: 23666943 DOI: 10.1093/gerona/glt050] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults. METHODS We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or ≥ 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics. RESULTS Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [CI] = 1.15-1.43, p < .001), use of home health care services (AOR = 1.29, 95% CI = 1.09-1.52, p = .004), and any health service use (AOR = 1.28, 95% CI = 1.15-1.41, p < .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95% CI = 1.50-1.96, p < .001), use of home health care services (AOR = 1.64, 95% CI = 1.32-2.04, p < .001), nursing home use (AOR = 1.45, 95% CI = 1.10-1.90, p = .009), and any health service use (AOR = 1.72, 95% CI = 1.51-1.95, p < .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates. CONCLUSIONS In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.
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Affiliation(s)
- Christopher N Kaufmann
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, Room 794, 624 North Broadway, Baltimore, MD 21205.
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Vicente B, Saldivia S, de la Barra F, Melipillán R, Valdivia M, Kohn R. [Prevalence of psychiatric disorders among Chilean children and adolescents]. Rev Med Chil 2013; 140:447-57. [PMID: 22854690 DOI: 10.4067/s0034-98872012000400005] [Citation(s) in RCA: 25] [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] [Received: 09/14/2011] [Accepted: 12/20/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychiatric disorders that appear during childhood or adolescence should be a public health priority. AIM To report the results of a national representative survey in the Latin American region examining the prevalence of DSM-IV psychiatric disorders in children and adolescents. MATERIAL AND METHODS Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family risk factors, socioeconomic status and service use. RESULTS A sample of 1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. CONCLUSIONS The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country.
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Affiliation(s)
- Benjamín Vicente
- Departmento de Psiquiatría y Salud Mental, Universidad de Concepción, Concepción, Chile.
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Vicente B, Saldivia S, de la Barra F, Kohn R, Pihan R, Valdivia M, Rioseco P, Melipillan R. Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study. J Child Psychol Psychiatry 2012; 53:1026-35. [PMID: 22646991 DOI: 10.1111/j.1469-7610.2012.02566.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of diagnostic and statistical manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents. METHODS Subjects aged 4-18 were selected using a stratified multistage design. The diagnostic interview schedule for children version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4-11, using the DISC-IV; however, adolescents, aged 12-18, were directly interviewed. RESULTS A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4-11, in comparison with adolescents, aged 12-18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% had three or more diagnoses. CONCLUSIONS The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to reevaluate mental health services provided to children and adolescents in Latin America.
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Affiliation(s)
- Benjamín Vicente
- Department of Psychiatry of Mental Health, University of Concepción, Concepción, Chile Mental Health Department, Medical School of the University of Chile, Santiago, Chile.
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Gal G, Goral A, Murad H, Gross R, Pugachova I, Barchana M, Kohn R, Levav I. Cancer in parents of persons with schizophrenia: is there a genetic protection? Schizophr Res 2012; 139:189-93. [PMID: 22622179 DOI: 10.1016/j.schres.2012.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 03/28/2012] [Accepted: 04/29/2012] [Indexed: 02/02/2023]
Abstract
A reduced risk for cancer has been noted among persons with schizophrenia as well as their first degree relatives. One explanation for these findings suggests that genes associated with schizophrenia confer reduced cancer susceptibility. Given the well documented genetic factor in schizophrenia it could thus be expected that cancer incidence rates should be lower in persons with schizophrenia with a known family history of schizophrenia compared to persons with sporadic schizophrenia, as well as their first degree relatives. This study investigated the risk for cancer among the biological parents of persons with schizophrenia accounting for the familial aggregation. Linkage was conducted between national population, psychiatric and cancer databases. Standardized incidence rates for all cancer sites were calculated by comparing the parents' rates with those of the general population. In addition, the association between familial aggregation of schizophrenia and risk for cancer was calculated among the parents. A reduced cancer risk was found among the parents compared to the general population (SIR 0.8, 95% CI 0.8-0.9). However, no evidence of decreased risk was associated with familial schizophrenia. Thus, no association between familial aggregation and cancer incidents was found with regard to most cancer sites. Moreover, a small, but not statistically significant increased risk of colon cancer was associated with familial aggregation scores among the parents (OR 1.2, 95% CI 1.0-1.5). These findings undermine the support to the genetic explanation for the reduced risk for cancer in schizophrenia among patients and their biological parents.
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Affiliation(s)
- Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel.
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