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Ugwuegbu O, Shibli F, Kim Y, Rangan V, Kurin M, Ayoub F, Ganocy S, Kavitt R, Fass R. The Impact of Chronic Cannabis Use on Esophageal Motility in Patients Referred for Esophageal Manometry. J Clin Gastroenterol 2024; 58:342-348. [PMID: 37436840 DOI: 10.1097/mcg.0000000000001887] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/21/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Tetrahydrocannabinol, the main psychoactive compound in cannabis, binds with high affinity to the cannabinoid 1 receptor. Small randomized controlled studies using conventional manometry have shown that the cannabinoid 1 receptor can modulate esophageal function, namely transient lower esophageal sphincter relaxation frequency and lower esophageal sphincter tone. The effect of cannabinoids on esophageal motility in patients referred for esophageal manometry has not been fully elucidated using high-resolution esophageal manometry (HREM). We aimed to characterize the clinical effect of chronic cannabis use on esophageal motility utilizing HREM. METHODS Patients who underwent HREM from 2009 to 2019 were identified at 4 academic medical centers. The study group consisted of patients with a noted history of chronic cannabis use, a diagnosis of cannabis-related disorder, or a positive urine toxicology screen. Age and gender-matched patients with no history of cannabis use were selected to form the control group. Data on HREM metrics based on the Chicago classification V3, and the prevalence of esophageal motility disorders were compared. Confounding effects of BMI and medications on esophageal motility were adjusted for. RESULTS Chronic cannabis use was found to be an independent negative predictor of weak swallows (β=-8.02, P =0.0109), but not a predictor of failed swallows ( P =0.6890). The prevalence of ineffective esophageal motility was significantly lower in chronic cannabis users compared with nonusers (OR=0.44, 95% CI 0.19-0.93, P =0.0384). There was no significant difference in the prevalence of other esophageal motility disorders between the 2 cohorts. In patients with dysphagia as their primary indication for HREM, chronic cannabis use was found to be independently associated with increased median integrated relaxation pressure (β=6.638, P =0.0153) and increased mean lower esophageal sphincter resting pressure (β=10.38, P =0.0084). CONCLUSIONS Chronic cannabis use is associated with decreased weak swallows and reduced prevalence of ineffective esophageal motility in patients referred for esophageal manometry. In patients referred for dysphagia, chronic cannabis use is associated with increased integrated relaxation pressure and lower esophageal sphincter resting pressure, though not to levels above the normal range.
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Affiliation(s)
- Obinna Ugwuegbu
- Case Western Reserve University, School of Medicine, Cleveland, OH
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Fahmi Shibli
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Yeseong Kim
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Vikram Rangan
- Beth Israel Deaconess Medical Center. Digestive Disease Center, Harvard University, Boston, MA
| | - Michael Kurin
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
- University Hospitals Cleveland Medical Center Department of Gastroenterology and Hepatology, Case Western Reserve University, Cleveland, OH
| | - Fares Ayoub
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL
| | - Stephen Ganocy
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH
| | - Robert Kavitt
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, IL
| | - Ronnie Fass
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
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Kamionkowski S, Shibli F, Ganocy S, Fass R. The relationship between gastroesophageal reflux disease and autism spectrum disorder in adult patients in the United States. Neurogastroenterol Motil 2022; 34:e14295. [PMID: 34859933 DOI: 10.1111/nmo.14295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) has been associated with psychiatric and neurocognitive disorders. Those with autism spectrum disorder (ASD) are prone to gastrointestinal (GI) diseases, but most research has been done on children. Our aim was to determine the relationship between GERD and autism in adults and assess GERD-related complications in those with autism. METHODS A national cohort of adults aged 18 and above with GERD with and without ASD were compared to those without GERD. Complications of GERD that were studied included Barrett's esophagus, erosive esophagitis, esophageal stricture, ulcer, and malignancy. Conditions associated with GERD were evaluated including chronic cough, wheezing, sore throat, non-cardiac chest pain, and hoarseness. GERD treatment that was evaluated included proton pump inhibitors (PPIs), H2 receptor antagonists (H2RA), and anti-reflux surgery. KEY RESULTS There was an increased risk of GERD in subjects with ASD (p = 0.0001). Erosive esophagitis and esophageal ulcer were more likely to occur in those with GERD and ASD (p = 0.0001). Those with ASD were at higher risk of suffering from wheezing following a diagnosis of GERD compared to those without ASD (p = 0.0001). Those with GERD and ASD were more likely to be treated with an H2RA both as monotherapy and in combination with PPI versus those without ASD (p = 0.0001 and p = 0.0037, respectively). CONCLUSIONS AND INFERENCES Adult patients with ASD are more likely to have GERD as well as complications including erosive esophagitis and esophageal ulcer. Treatment of patients with GERD and ASD is not consistent and may suggest health care disparities.
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Affiliation(s)
- Sara Kamionkowski
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Fahmi Shibli
- Division of Gastroenterology & Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen Ganocy
- Center of Research and Scholarship, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ronnie Fass
- Division of Gastroenterology & Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Treasure M, Thomas A, Ganocy S, Hong A, Krishnamurthi SS, Bajor DL, Berger NA, Meropol NJ. A pilot study of a low glycemic load diet in patients with stage I-III colorectal cancer. J Gastrointest Oncol 2021; 12:910-920. [PMID: 34295544 DOI: 10.21037/jgo-20-330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/28/2021] [Indexed: 01/05/2023] Open
Abstract
Background Consumption of a diet with high glycemic indices has been associated with inferior cancer-specific outcomes in patients with early-stage colorectal cancer, but there is limited prospective evidence that alterations in dietary habits improves cancer outcomes. This study aimed to determine the feasibility and acceptability of following a low glycemic load (GL) diet in patients with stage I-III colorectal cancer. Methods Patients with stage I-III colorectal cancer, who completed definitive therapy, and consumed an average daily GL >150 participated in a 12-week tailored face-to-face dietary intervention with a target GL. This study followed a 2-stage design, with 4 planned cohorts, each with an assigned GL target and dietary intervention intensity. The primary endpoint of feasibility was determined by participant compliance, defined as an individual following the assigned GL ≥75% of the time. Compliance was determined using 24-hour telephone recalls. A cohort was deemed feasible if at least 67% of participants were compliant. Secondary endpoints included acceptability of the diet, nutritional support resources necessary to follow the diet, and evaluation of the effect of the diet on physical measures and correlative laboratories. Results Only cohort 1 was required as the primary endpoint of feasibility was met (stringent GL target, low intensity dietary support). The majority of participants experienced a decrease in body mass index (BMI) and waist circumference, 29% experiencing meaningful weight loss (≥5%). The dietitian spent an average of 6.97 hours (SD 2.18) face-to-face time and 1.58 hours (SD 0.68) by phone with each participant. Significant decreases were seen in total cholesterol, very-low-density lipoprotein (VLDL) and triglycerides (all P<0.05). All participants liked the foods and were satisfied with the diet. All participants felt the in-person meetings were helpful, and 62% did not feel a virtual meeting (e.g., Skype, etc.) could replace in-person meetings. Conclusions Patients with stage I-III colorectal cancer can follow a low GL diet with a 12-week in-person dietary intervention. Significant changes in physical and laboratory measures suggest relevant biologic effects of the dietary intervention. This study establishes feasibility, and warrants a larger scale prospective intervention trial to evaluate the impact of a low GL diet on cancer outcomes.
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Affiliation(s)
- Michelle Treasure
- Department of Medicine, Division of Hematology and Oncology, Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland Clinic Learner College of Medicine, Cleveland, OH, USA
| | - Alicia Thomas
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephen Ganocy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Augustine Hong
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Smitha S Krishnamurthi
- Department of Medicine, Division of Hematology and Oncology, Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland Clinic Learner College of Medicine, Cleveland, OH, USA
| | - David L Bajor
- Department of Medicine, Division of Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nathan A Berger
- Department of Medicine, Division of Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Neal J Meropol
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Flatiron Health, Inc., New York, NY, USA
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Kim Y, Ganocy S, Fass R. Proton-pump inhibitor use and the development of new ischemic heart disease in non-cardiac chest pain patients. Neurogastroenterol Motil 2020; 32:e13844. [PMID: 32281192 DOI: 10.1111/nmo.13844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The growing reports regarding cardiac-related adverse events of chronic proton-pump inhibitors (PPI) treatment, a mainstay therapy of non-cardiac chest pain (NCCP), have raised concerns about alteration of the natural course in NCCP patients using PPI. We aimed to determine if NCCP patients receiving PPI have a higher risk of developing ischemic heart disease (IHD) compared to those not receiving PPI therapy. METHODS Three groups of NCCP patients were included; PPI, histamine-2 receptor antagonist (H2RA), and no antireflux treatment. Diagnosis of NCCP had to precede diagnosis of IHD by at least 30 days, and in those receiving antireflux treatment at 30 days after starting the medication. Data analysis was corrected for 6 known confounding factors for IHD including hyperlipidemia, hypertension, obesity, smoking status, male gender, and diabetes mellitus. KEY RESULTS Of the patients on PPI or H2RA, 1280 and 250, respectively, developed IHD. Patients on PPI therapy displayed an increased odd of developing ischemic heart disease compared to patients never placed on therapy (OR 1.14, 95% CI 1.03-1.25, P-value .0093). Patients placed on H2RA therapy did not show a statistically significant change in risk compared to patients who were not placed on therapy (OR 0.90, 95% CI 0.77-1.06, P-value .2049). Number needed to harm in the PPI and H2RA groups was 17 and 45, respectively. CONCLUSIONS PPIs confer a statistically significant, but marginal effect on the risk of IHD development in NCCP patients. Thus, PPI use in NCCP only minimally alters the overall benign natural course of the disease.
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Affiliation(s)
- Yeseong Kim
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Stephen Ganocy
- Data Management & Statistical Analysis Unit, Mood Disorders Program, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Esophageal and Swallowing Center, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
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Treasure ME, Thomas A, Ganocy S, Hong A, Krishnamurthi SS, Bajor DL, Berger NA, Meropol NJ. A pilot study to determine the feasibility of a customized low glycemic load diet in patients with stage I-III colorectal cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4643 Background: Observational evidence associates energy balance factors, particularly diet, with survival in patients with colorectal cancer (CRC). Consumption of a diet with high glycemic indices has been associated with inferior cancer-specific outcomes, but there is limited prospective evidence that alterations in dietary habits improve cancer outcomes. This was a pilot study to determine the feasibility and acceptability of following a low glycemic load (GL) diet in patients with stage I-III CRC and to assess the nutritional resources necessary to follow the diet. Methods: 18 patients with stage I-III CRC, who completed definitive cancer therapy and consumed an avg daily GL > 150 participated in a 12 week, tailored, in-person dietary intervention with a target GL of ≤102. Compliance was assessed using 24 hour telephone recalls. Acceptability of the diet was assessed using a food acceptability questionnaire, and exploratory correlative laboratories were assessed monthly. Results: 67% of patients were compliant with a low GL diet ≥ 75% of the time, over a 12 week time period. Majority of participants experienced a decrease in BMI and waist circumference, 28% experienced meaningful weight loss defined as ≥ 5%. The nutritionist spent an avg of 6.97 hours (SD 2.18) in-person and 1.58 hours (SD 0.68) by phone with each participant. In the overall group, significant decreases were seen in total cholesterol (7.2% decrease; t = -2.33, p = 0.03), VLDL (26.8% decrease; t = -2.33, p = 0.03) and triglycerides (26.6% decrease; t = -2.29; p = 0.04). All participants were satisfied with the diet; 43% were extremely satisfied. 75% of participants liked the foods they were able to eat “very much” or “extremely”. All participants felt the in-person meetings were helpful. 77% did not feel an online video could replace the in-person meetings. 62% of participants did not feel a virtual meeting (e.g skype, etc.) could replace the in- person meeting while 38% felt it could. Conclusions: Patients with stage I-III CRC are able to follow a low GL diet with an in-person dietary intervention. Significant decreases in laboratory measures confirm the efficacy of the diet in altering metabolic indices. All participants who completed the study were satisfied with the diet, the majority of whom enjoyed the foods and planned to continue to follow the diet after study completion. The majority felt in-person contact with the nutritionist was essential to their success. This study was an essential step in designing a larger scale trial to evaluate the impact of low GL diet on cancer outcomes. Clinical trial information: NCT02129218 .
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Affiliation(s)
| | | | | | - Augustine Hong
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Smitha S. Krishnamurthi
- Cleveland Clinic Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - David Lawrence Bajor
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | - Neal J. Meropol
- Flatiron Health, New York, NY and Case Comprehensive Cancer Center, Cleveland, OH
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Conklin D, Ganocy S, Goto T, Lagrotta C, D’Arcangelo N, Sajatovic M. Manualized cognitive behavioral group therapy (CBGT) to treat vasomotor symptoms (VMS) for black and white women diagnosed with DSM-V mood disorders. Maturitas 2019. [DOI: 10.1016/j.maturitas.2019.04.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abdallah J, George N, Yamasaki T, Ganocy S, Fass R. Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders. Clin Gastroenterol Hepatol 2019; 17:1073-1080.e1. [PMID: 29913281 DOI: 10.1016/j.cgh.2018.06.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/16/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. METHODS Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. RESULTS Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group. CONCLUSIONS We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
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Affiliation(s)
- Jason Abdallah
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nina George
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Takahisa Yamasaki
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Stephen Ganocy
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Ronnie Fass
- Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Zhang AY, Ganocy S, Fu AZ, Kresevic D, Ponsky L, Strauss G, Bodner DR, Zhu H. Mood outcomes of a behavioral treatment for urinary incontinence in prostate cancer survivors. Support Care Cancer 2019; 27:4461-4467. [PMID: 30903368 DOI: 10.1007/s00520-019-04745-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/08/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to assess whether prostate cancer survivors who received a behavioral intervention to urinary incontinence had experienced a significant mood improvement. METHODS One hundred fifty-three prostate cancer survivors with persistent incontinence were included in this secondary data analysis. They were randomly assigned to usual care or interventions that provided pelvic floor muscle exercises and self-management skills. All subjects had measures of anxiety, depression, and anger at baseline, 3 months (post-intervention), and 6 months (follow-up). Negative binomial regression analysis was performed to examine the group status, daily leakage frequency at 3 months, and their interactions at 3 months as predictors for mood outcomes at 6 months, controlling for demographic and medical variables. RESULTS The main effect of daily leakage frequency at 3 months significantly predicted anxiety at 6 months (p < .01). The group main effect on any mood outcomes at 6 months was not statistically significant. The interaction between the group and 3-month leakage had a significant effect on anxiety; intervention subjects achieving a significant leakage reduction at 3 months exhibited significantly less anxiety at 6 months than other subjects (p = .04). Age, employment status, and receiving surgery at baseline were significantly associated with less anxiety, depression, and anger at 6 months. CONCLUSIONS Reduced urinary incontinence significantly predicted less anxiety, especially among the intervention subjects. The findings suggest a significant association between a behavioral therapy of urinary incontinence and anxiety reduction in prostate cancer survivors.
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Affiliation(s)
- Amy Y Zhang
- School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA.
| | - Stephen Ganocy
- School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA
| | - Alex Z Fu
- Cancer Prevention and Control Program, Georgetown University Medical Center, 3300 Whitehaven Street NW, Suite 4100 - Milton Harris Bldg, Washington, DC, 20007, USA
| | - Denise Kresevic
- Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, 10701 East Blvd, Cleveland, OH, 44106, USA
| | - Lee Ponsky
- School of Medicine; University Hospitals Cleveland Medical Center, Department of Urology, Case Western Reserve University, 19019 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Gerald Strauss
- Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, 10701 East Blvd, Cleveland, OH, 44106, USA
| | - Donald R Bodner
- Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, 10701 East Blvd, Cleveland, OH, 44106, USA.,School of Medicine; University Hospitals Cleveland Medical Center, Department of Urology, Case Western Reserve University, 19019 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Hui Zhu
- Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, 10701 East Blvd, Cleveland, OH, 44106, USA
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El Hassan R, Galante A, Kavran M, Ganocy S, Khalifa AO, Hijaz A. The vaginal distention model in mice is not a reliable model of simulated birth trauma-induced stress urinary incontinence. Neurourol Urodyn 2018; 38:599-606. [PMID: 30549310 DOI: 10.1002/nau.23886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022]
Abstract
AIMS Vaginal distention (VD) is a validated model of birth-related trauma in rats. Recently a mouse VD model was reported. Our study was originally conducted to evaluate the impact of age on VD in mice. This manuscript describes the study and reports on the lack of reproducibility of VD models in mice. METHODS We utilized female C57BL/6 mice. A total of 190, 12-weeks old mice, were randomized into VD and sham groups. We inflated a modified Foley's balloon with 0.3 mL for 1 h inside the mice vagina. Afterwards, we measured the leak point pressure (LPP) at defined timepoints (0, 4, 10, 20, or 40 days). We randomized another 190, 40-week old, C57BL/6 mice into either VD or sham groups. We used an extra 20 mice as age - matched controls. RESULTS In both 12 and 40 weeks-old mice, LPP was significantly decreased versus the negative controls at day 0. Additionally, in both 12 and 40 weeks-old mice, the decrease in LPP was significantly higher in the VD group compared to the sham group at day 0. However, the LPP results were comparable between VD and sham at any other time point thereafter. Furthermore, there was no significant change in LPP values between instrumented (VD and sham) mice and control mice at any time after day 0. CONCLUSIONS The VD models previously described is not a reproducible model for the study of VD with large number of mice. Our results, unfortunately, do not support its use to study VD injury in mice.
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Affiliation(s)
- Ramzi El Hassan
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Alex Galante
- Department of Urology, University of Florida, Gainesville, Florida
| | - Michael Kavran
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - Stephen Ganocy
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University,, Cleveland, Ohio
| | - Ahmad O Khalifa
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.,Department of Urology, Menoufia University, Shebin Al Kom, Egypt
| | - Adonis Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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Webel A, Prince-Paul M, Ganocy S, DiFranco E, Wellman C, Avery A, Daly B, Slomka J. Randomized clinical trial of a community navigation intervention to improve well-being in persons living with HIV and other co-morbidities. AIDS Care 2018; 31:529-535. [PMID: 30442033 DOI: 10.1080/09540121.2018.1546819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Long-term survival of people living with HIV (PLWH) is associated with the development of co-morbid conditions and need for symptom management and other efforts to enhance quality of life. We conducted a longitudinal, randomized trial over 36 months to evaluate the effect of a community-based navigator intervention to provide early palliative care to 179 PLWH and other chronic conditions. Outcomes included quality of life, symptom management, coping ability, social support, self-management, and completion of advance directives. Data were analyzed using SAS mixed effects model repeat measurement. Our navigator program showed variable improvement over time of three outcome variables, self-blame, symptom distress, and HIV self-management. However, the program did not improve overall quality of life, social support, or completion of advance directives.
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Affiliation(s)
- Allison Webel
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | - Maryjo Prince-Paul
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | - Stephen Ganocy
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | - Evelina DiFranco
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
| | | | - Ann Avery
- c CWRU School of Medicine , Cleveland , OH , USA.,d MetroHealth Medical Center , Cleveland , OH , USA
| | - Barbara Daly
- a Case Western Reserve University (CWRU) School of Nursing , Cleveland , OH , USA
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Yamasaki T, Hemond C, Eisa M, Ganocy S, Fass R. The Changing Epidemiology of Gastroesophageal Reflux Disease: Are Patients Getting Younger? J Neurogastroenterol Motil 2018; 24:559-569. [PMID: 30347935 PMCID: PMC6175565 DOI: 10.5056/jnm18140] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [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: 08/07/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Gastroesophageal reflux disease (GERD) is a common disease globally with increasing prevalence and consequently greater burden on the Healthcare system. Traditionally, GERD has been considered a disease of middle-aged and older people. Since risk factors for GERD affect a growing number of the adult population, concerns have been raised that increasingly younger people may develop GERD. We aim to determine if the proportion of younger patients has increased among the GERD population. Methods The incidence of GERD as well as several variables were evaluated during an 11-year period. Explorys was used to evaluate datasets at a “Universal” and Healthcare system in northern Ohio to determine if trends at a local level reflected those at a universal level. GERD patients were classified into 7 age groups (15–19, 20–29, 30–39, 40–49, 50–59, 60–69, and ≥70 years). Results The proportion of patients with GERD increased in all age groups, except for those who were ≥70 years in the universal dataset (P < 0.001) and those who were ≥60 years in the Healthcare system (P < 0.001). The greatest rise was seen in 30–39 years in both datasets (P < 0.001). Similarly, the proportion of GERD patients who were using proton pump inhibitors increased in all age groups except for those who were ≥70 years in both datasets (P < 0.001), with the greatest increase being the group 30–39 years (P < 0.001). Conclusion Over the last decade, there has been a significant increase in the proportion of younger patients with GERD, especially those within the age range of 30–39 years.
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Affiliation(s)
- Takahisa Yamasaki
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Colin Hemond
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
| | - Mohamed Eisa
- Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Stephen Ganocy
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ronnie Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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12
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Akinsiku O, Yamasaki T, Brunner S, Ganocy S, Fass R. High resolution vs conventional esophageal manometry in the assessment of esophageal motor disorders in patients with non-cardiac chest pain. Neurogastroenterol Motil 2018; 30:e13282. [PMID: 29286206 DOI: 10.1111/nmo.13282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND High-resolution esophageal manometry (HREM) has become a leading tool in the assessment of esophageal motor disorders, replacing conventional manometry. However, there is limited data about the contribution of HREM as compared with conventional manometry to the assessment of esophageal motor disorders in patients with non-cardiac chest pain (NCCP). The aim of the study was to compare the distribution of esophageal motor disorders in patients with NCCP using HREM as compared with conventional manometry and to determine if HREM improved diagnosis of these disorders. METHODS In this study, we included 300 consecutive patients with NCCP who underwent either HREM or conventional manometry over a period of 10 years. A total of 150 patients had conventional manometry and the other 150 patients HREM. The Chicago 3.0 classification and the Castell and Spechler classification were used to determine the esophageal motor disorder of NCCP patients undergoing HREM and conventional manometry, respectively. KEY RESULTS In both HREM and the conventional manometry groups, normal esophageal motility was the most frequent finding (47% and 36%; respectively, P = .054). Hypotensive lower esophageal sphincter was the most common motility disorder identified by conventional manometry (27.3%), while ineffective esophageal motility was the most common esophageal motor disorder identified by HREM (25.3%). CONCLUSIONS & INFERENCES There is a discrepancy in the type of esophageal motor disorders identified by HREM as compared with conventional manometry in NCCP patients. Hypotensive motility disorders are the most commonly diagnosed by both manometric techniques.
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Affiliation(s)
- O Akinsiku
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - T Yamasaki
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - S Brunner
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - S Ganocy
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - R Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
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13
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Swarer K, Son J, Ganocy S, Singh S, Resnick K. Does Presentation to Medical Care Differ Between African-American And Caucasian Women With High-Grade Epithelial Ovarian Cancer? Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Khan F, Maradey-Romero C, Ganocy S, Frazier R, Fass R. Utilisation of surgical fundoplication for patients with gastro-oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013. Aliment Pharmacol Ther 2016; 43:1124-31. [PMID: 27060607 DOI: 10.1111/apt.13611] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 01/25/2016] [Revised: 02/06/2016] [Accepted: 03/13/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical fundoplication has been considered to be one of the leading therapeutic modalities for gastro-oesophageal reflux disease (GERD) during the last several decades. AIM To determine the trend of surgical fundoplication utilisation in GERD patients during the last decade in the United States. METHODS Population-based study using a large nationwide database, the Explorys database system, to identify patients diagnosed with GERD and those who underwent surgical fundoplication. Using a quadratic regression model, we determined and compared the trends of surgical fundoplication utilisation annually from 2004 to 2013. RESULTS We identified 4 059 060 patients with the diagnosis of GERD, of whom 2343 (0.05%) underwent surgical fundoplication between 2004 and 2013. There was a significant decline in the number of surgical fundoplications performed over the last 5 years from 0.062% in 2009 to 0.047% in 2013 (P < 0.05). Female patients accounted for the majority of those who underwent fundoplication (62.52%). Caucasian patients between the ages of 18 and 65 years were the most likely group to undergo surgical fundoplication (66.28%). The number of overweight patients undergoing surgical fundoplication has been significantly increasing over the last decade (P < 0.05). Importantly, 80% of surgical patients were treated with a proton pump inhibitor (PPI) post surgical fundoplication by 2013 (P < 0.001). CONCLUSIONS Utilisation of surgical fundoplication in GERD patients has been steadily declining over the past 5 years. The vast majority of patients will resume PPI treatment after surgical fundoplication.
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Affiliation(s)
- F Khan
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - C Maradey-Romero
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - S Ganocy
- Center Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
| | - R Frazier
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - R Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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15
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Kannampuzha J, White B, Avula S, Ganocy S, Leo P, Kaufman E. NON-SUSTAINED MICROVOLT LEVEL T-WAVE ALTERNANS IN CONGENITAL LONG QT SYNDROME TYPES 1 AND 2. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30829-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Tamburrino MB, Chan P, Prescott M, Calabrese J, Liberzon I, Slembarski R, Shirley E, Fine T, Goto T, Wilson K, Derus A, Ganocy S, Beth Serrano M, Galea S. Baseline prevalence of Axis I diagnosis in the Ohio Army National Guard. Psychiatry Res 2015; 226:142-8. [PMID: 25623021 DOI: 10.1016/j.psychres.2014.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/12/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
The goal of this study is to determine the pre-existing lifetime and current prevalence of DSM-IV Axis I disorders within the Ohio Army National Guard (OHARNG). Data was analyzed from the clinical subsample of the Ohio Army National Guard Mental Health Initiative (OHARNG MHI). Five hundred participants were provided with an in-depth clinical assessment using the Clinician-Administered PTSD Scale (CAPS) and the Structured Clinical Interview for DSM-IV-TR (SCID). Logistic regression examined the relationship between Axis I disorders and the number of deployments and gender. Prevalence of at least one DSM-IV lifetime disorder was 66.2%; substance use disorders were 52.2%, followed by mood disorders (30.0%) and anxiety disorders (22.0%). Prevalence of at least one current disorder was 24.8%; anxiety disorders (13.2%), mood disorders (7.6%), and substance use disorders (7.0%) were most frequent. Number of deployments was associated with PTSD (OR=8.27, 95% CI 2.10-32.59, p=0.003), alcohol use disorder (OR=1.77, 95% CI 1.07-2.92, p=0.025), and any substance use disorder (OR=1.85, 95% CI 1.12-3.05, p=0.016). Gender (OR=2.02, 95% CI 1.10-3.73, p=0.024) was associated with any mood disorder. The results provide baseline information on the most prevalent mental disorders within the OHARNG.
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Affiliation(s)
| | - Philip Chan
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Marta Prescott
- University of Michigan, Ann Arbor, MI, United States; Columbia University, New York, NY, United States
| | - Joseph Calabrese
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | | | - Renee Slembarski
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Edwin Shirley
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Thomas Fine
- University of Toledo College of Medicine, Toledo, OH, United States
| | - Toyomi Goto
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Kimberly Wilson
- University of Toledo College of Medicine, Toledo, OH, United States
| | - Alphonse Derus
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, MD, United States
| | - Stephen Ganocy
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Mary Beth Serrano
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
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17
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Prescott MR, Tamburrino M, Calabrese JR, Liberzon I, Slembarski R, Shirley E, Fine T, Goto T, Wilson K, Ganocy S, Chan P, Derus A, Serrano MB, Sizemore J, Kauffman J, Galea S. Validation of lay-administered mental health assessments in a large Army National Guard cohort. Int J Methods Psychiatr Res 2014; 23:109-19. [PMID: 24615746 PMCID: PMC6878484 DOI: 10.1002/mpr.1416] [Citation(s) in RCA: 20] [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] [Received: 04/11/2012] [Revised: 12/07/2012] [Accepted: 01/16/2013] [Indexed: 11/05/2022] Open
Abstract
To report the reliability and validity of key mental health assessments in an ongoing study of the Ohio Army National Guard (OHARNG). The 2616 OHARNG soldiers received hour-long structured telephone surveys including the post-traumatic stress disorder (PTSD) checklist (PCV-C) and Patient Health Questionnaire - 9 (PHQ-9). A subset (N = 500) participated in two hour clinical reappraisals, using the Clinician-Administered PTSD Scale (CAPS) and the Structured Clinical Interview for DSM (SCID). The telephone survey assessment for PTSD and for any depressive disorder were both highly specific [92% (standard error, SE 0.01), 83% (SE 0.02)] with moderate sensitivity [54% (SE 0.09), 51% (SE 0.05)]. Other psychopathologies assessed included alcohol abuse [sensitivity 40%, (SE 0.04) and specificity 80% (SE 0.02)] and alcohol dependence [sensitivity, 60% (SE 0.05) and specificity 81% (SE 0.02)].The baseline prevalence estimates from the telephone study suggest alcohol abuse and dependence may be higher in this sample than the general population. Validity and reliability statistics suggest specific, but moderately sensitive instruments.
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Affiliation(s)
- Marta R Prescott
- Columbia University, New York, USA; University of Michigan, Ann Arbor, MI, USA
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18
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Calabrese JR, Prescott M, Tamburrino M, Liberzon I, Slembarski R, Goldmann E, Shirley E, Fine T, Goto T, Wilson K, Ganocy S, Chan P, Serrano MB, Sizemore J, Galea S. PTSD comorbidity and suicidal ideation associated with PTSD within the Ohio Army National Guard. J Clin Psychiatry 2011; 72:1072-8. [PMID: 21899816 DOI: 10.4088/jcp.11m06956] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [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: 02/21/2011] [Accepted: 06/23/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To study the relation between posttraumatic stress disorder (PTSD) psychiatric comorbidity and suicidal ideation in a representative sample of Ohio Army National Guard soldiers. METHOD Using retrospective data collected on the telephone from a random sample of 2,616 National Guard soldiers who enrolled in a 10-year longitudinal study (baseline data collected November 2008-November 2009), we examined (1) the prevalence of other psychopathologies among those with DSM-IV-diagnosed PTSD compared to those without PTSD and (2) the association between PTSD comorbidity and suicidal ideation (reporting thoughts of being better off dead or hurting themselves). All analyses were carried out using logistic regression. RESULTS Of guard members with PTSD in the last year, 61.7% had at least 1 other psychopathology; 20.2% had at least 2 other co-occurring conditions. The most common co-occurring psychopathology was depression. While those with PTSD overall were 5.4 (95% CI, 3.8-7.5) times more likely to report suicidality than those without PTSD, those who had at least 2 additional conditions along with PTSD were 7.5 (95% CI, 3.0-18.3) times more likely to report suicidal ideation at some point in their lifetime than those with PTSD alone. CONCLUSIONS Soldiers with PTSD were at increased risk for suicidality, and, among those with PTSD, those with at least 2 additional conditions were at the highest risk of suicidal ideation. Future research should address the mechanisms that contribute to multimorbidity in this population and the appropriate treatment methods for this high-risk group.
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Affiliation(s)
- Joseph R Calabrese
- Department of Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
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19
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Kemp DE, Calabrese JR, Eudicone JM, Ganocy S, Tran QV, McQuade RD, Marcus RN, Vester-Blokland E, Owen R, Carlson BX. Predictive value of early improvement in bipolar depression trials: a post-hoc pooled analysis of two 8-week aripiprazole studies. Psychopharmacol Bull 2010; 43:5-27. [PMID: 21052040] [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: 05/30/2023]
Abstract
OBJECTIVE To evaluate the value of early improvement to predict treatment outcome in patients with bipolar depression. METHODS Data were pooled from two aripiprazole, 8-week, randomized, double-blind, placebo-controlled trials in patients with bipolar depression without psychotic features to determine whether early improvement (≥20% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) Total score at Week 2 or 3) predicts later response (≥50% MADRS Total score reduction at Week 8) or remission (MADRS Total ≤10 at Week 8). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated (LOCF). Univariate and multivariate logistic regression models were used to evaluate early improvement and baseline demographic/clinical characteristics as predictors of response/remission. RESULTS In total, 311 patients were randomized to placebo and 306 to aripiprazole. Predictive values of early improvement (≥20% MADRS Total score reduction) for remission with aripiprazole at Week 2/3, respectively, were: sensitivity 83%/94%; specificity 41%/33%; PPV 44%/45%; NPV 81%/91%. The corresponding values with placebo were as follows: sensitivity 70%/84%; specificity 60%/51%; PPV 50%/51%; NPV 77%/84%. Univariate linear regression showed that early improvement (≥15%, ≥20%, ≥25%, ≥30% at Week 3) was a significant potential predictor of remission. CONCLUSION Absence of early improvement after 3 weeks of treatment reliably predicted non-response/non-remission at study endpoint with high sensitivity and NPV. In patients with <20% improvement after 21 days of aripiprazole monotherapy, treatment should be modified, as continued use is unlikely to result in response/remission. Clinical decision-making to optimize treatment course in bipolar I depression may be appropriate after as little as 2 weeks and certainly within the first 3 weeks of treatment.
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Affiliation(s)
- D E Kemp
- Case Western Reserve University, Cleveland, OH, USA.
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20
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Syamlal G, Doney B, Bang KM, Greskevitch M, Groce D, Ganocy S, Hoffman W. Medical fitness evaluation for respirator users: results of a national survey of private sector employers. J Occup Environ Med 2007; 49:691-9. [PMID: 17563613 DOI: 10.1097/jom.0b013e318076b7d1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/25/2022]
Abstract
OBJECTIVE To provide information on medical evaluation procedures for respirator use in private sector establishments. METHODS In 2001, data on respirator use and practices were collected in a survey of private sector establishments. RESULTS Of establishments where respirators were required, 46% did not evaluate employees' medical fitness. Evaluations for fitness increased with establishment size, ranging from 35% in small establishments (1-10 workers) to 95% in large establishments (>or=1000 workers). Questionnaire with a follow-up examination, as needed, was the most common method of evaluating medical fitness (48%). CONCLUSIONS Results suggest that about half of all private sector establishments where respirators are required do not comply with Occupational Safety and Health Administration requirements for medical fitness evaluations. Improved awareness among employers and workers and identification of methods to increase medical evaluation practices, especially among smaller establishments, is needed.
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Affiliation(s)
- Girija Syamlal
- National Institute for Occupational Safety and Health (NIOSH), Division of Respiratory Disease Studies, Morgantown, WV 26505, USA.
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