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López R, Esposito-Smythers C, Defayette AB, Harris KM, Seibel L, Whitmyre ED. Relations between discrimination, rejection sensitivity, negative affect, and decrements in problem-solving ability following social rejection: An experimental investigation. Suicide Life Threat Behav 2024; 54:233-249. [PMID: 38180127 DOI: 10.1111/sltb.13036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION While negative affect and problem-solving deficits have been consistently linked to suicidal thoughts and behaviors, the latter are often conceptualized and studied as time- and/or context-invariant. Though requiring additional empirical support, theory suggests that discrimination may strengthen the relation between rejection sensitivity and increases in negative affect as well as declines in problem-solving abilities following rejection. The aim of the current study was to test this claim using a social rejection paradigm (i.e., Cyberball) with young adults experiencing past-month suicidal ideation. METHODS The sample consisted of 50 participants. Lifetime discrimination and rejection sensitivity were assessed prior to Cyberball. Negative affect and problem-solving abilities were assessed pre- and post-Cyberball. SPSS and the PROCESS macro were used to test relations among variables of interest. RESULTS Rejection sensitivity predicted greater problem-solving decrements, but not negative affect, following rejection among individuals who had experienced higher (vs. lower) levels of lifetime discrimination. CONCLUSION Addressing rejection sensitivity and sources of discrimination within the context of treatment may reduce the impact of social rejection on problem-solving abilities among young adults at risk for suicide.
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Affiliation(s)
| | | | | | | | | | - Emma D Whitmyre
- Children's National Hospital, Washington, District of Columbia, USA
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Defayette AB, Esposito-Smythers C, Cero I, Kleiman EM, López R, Harris KM, Whitmyre ED. Examination of proinflammatory activity as a moderator of the relation between momentary interpersonal stress and suicidal ideation. Suicide Life Threat Behav 2023; 53:922-939. [PMID: 37578098 PMCID: PMC10840613 DOI: 10.1111/sltb.12993] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Peer-related interpersonal stress can increase risk for suicidal thoughts among adolescents and young adults. However, not all individuals who undergo peer-related interpersonal stressors experience suicidal thoughts. Heightened proinflammatory activity is one factor that may amplify the relation between interpersonal stress and suicidal thinking. METHODS This pilot study examined the relation between interpersonal stress and suicidal ideation in real time, as well as whether proinflammatory cytokine (IL-6 and TNF-α) activity across a laboratory social stressor moderated this association in a sample of 42 emerging adults with recent suicidal ideation. Participants completed 28 days of 6×/daily ecological momentary assessment that assessed for suicidal ideation (presence vs. absence, ideation intensity), occurrence of negative peer events, and feelings of exclusion. RESULTS There was a trend for within-person increases in feelings of exclusion to be associated with increases in concurrent suicidal ideation intensity. Additionally, within-person increases in negative peer events were associated with increased odds of subsequent suicidal ideation among individuals with very low IL-6 activity. However, this finding is considered preliminary. CONCLUSION Interventions targeting perceptions of exclusion and increasing social support may be of benefit. However, findings require replication in larger samples, and thus must be interpreted with caution.
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Affiliation(s)
- Annamarie B. Defayette
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA
| | | | - Ian Cero
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA
| | - Evan M. Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, 53 Avenue E., Room 627, Piscataway, NJ 08854, USA
| | - Roberto López
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
| | - Katherine M. Harris
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
| | - Emma D. Whitmyre
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
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López R, Esposito-Smythers C, Defayette AB, Harris KM, Seibel LF, Whitmyre ED. Facets of social problem-solving as moderators of the real-time relation between social rejection and negative affect in an at-risk sample. Behav Res Ther 2023; 169:104398. [PMID: 37708724 DOI: 10.1016/j.brat.2023.104398] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
Social rejection predicts negative affect, and theoretical work suggests that problem-solving deficits strengthen this relation in real-time. Nevertheless, few studies have explicitly tested this relation, particularly in samples at risk for suicide. This may be particularly important as social rejection and negative affect are significant predictors of suicide. The aim of the current study was to examine whether cognitive (i.e., perceiving problems as threats) and behavioral (i.e., avoidance) facets of problem-solving deficits moderated the real-time relation between social rejection and negative affect. The sample consisted of 49 young adults with past-month suicidal ideation. Demographic information, social problem-solving deficits, as well as depressive/anxiety symptoms and stress levels were assessed at baseline. Social rejection and negative affect were assessed using ecological momentary assessment over the following 28 days. Dynamic structural equation modeling was used to assess relations among study variables. After accounting for depressive/anxiety symptoms, stress levels, sex, and age, only avoidance of problems bolstered the real-time positive relation between social rejection severity and negative affect (b = 0.04, 95% credibility interval [0.003, 0.072]). Individuals with suicidal ideation who possess an avoidant problem-solving style may be particularly likely to experience heightened negative affect following social rejection and may benefit from instruction in problem-solving skills.
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López R, Harris KM, Seibel L, Thomas SC, Leichtweis RN, Esposito-Smythers C. Trajectories of adolescent suicidal ideation and depressive symptoms during partial hospitalization: Clinical and demographic characteristics as predictors of change. Psychol Serv 2023:2024-00759-001. [PMID: 37602983 DOI: 10.1037/ser0000796] [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: 08/22/2023]
Abstract
Partial hospital programs (PHPs) are a vital mental health service for youth at risk for suicide. Yet, few studies have examined trajectories of suicidal ideation and depressive symptoms, two important risk factors for suicidal behavior, over the course of care. Moreover, little is known about factors that may impact these trajectories among youth in PHPs. The present study examined trajectories of suicidal ideation and depressive symptoms, as well as clinical and demographic predictors of these changes, among youth enrolled in two PHPs. A sample of 253 youth (Mage = 15.3; SD = 1.4; range = 12-18; 68.8% female; 63.2% White; 75.1% non-Hispanic/Latino/a/x) completed repeated measures of suicidal ideation severity and depressive symptoms during treatment. Trajectories of these outcomes were examined using two separate latent growth models. Recent history of self-injurious behaviors and demographics were tested as predictors of trajectories using a taxonomic approach. Overall, suicidal ideation and depressive symptoms declined over the course of care. Sex, history of self-injury, and sexual identity were associated with variability in one or both trajectories of change. Results suggest individual variability in the rate of change among youth in PHPs. Such information may be used to aid in treatment planning and quality improvement efforts within PHPs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Defayette AB, Esposito-Smythers C, Cero I, Harris KM, Whitmyre ED, López R. Interpersonal stress and proinflammatory activity in emerging adults with a history of suicide risk: A pilot study. J Mood Anxiety Disord 2023; 2:100016. [PMID: 37693104 PMCID: PMC10486198 DOI: 10.1016/j.xjmad.2023.100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Interpersonal stress during adolescence and young adulthood can threaten healthy developmental trajectories. A "primed" proinflammatory response to acute stress may serve as an underlying process that results in negative outcomes for youth. The present pilot study examined the relation between interpersonal stress and two proinflammatory cytokines in a sample of 42 university-recruited emerging adults with recent suicidal thoughts and behaviors. Participants completed self-report measures of mood, suicidal thoughts and behaviors, recent peer-related stressors, and interpersonal sensitivity. They also participated in an acute laboratory social stress task and provided three saliva samples to measure their proinflammatory responses (IL-6 and TNF-α) to the stressor. Participants reported significant increases in sadness and exclusion, and significant decreases in inclusion, following task participation. Importantly, no participants reported an increase in or onset of suicidal thoughts. No significant associations between interpersonal stress and proinflammatory cytokines were found. Changes in affect during the task coupled with lack of increased suicidal thoughts indicate it is acceptable to use this exclusion and rejection paradigm with this population, with proper debriefing and positive mood induction procedures. Given all other nonsignificant associations, future research considerations are discussed, including impact of COVID-19 on task potency and incorporation of multiple stress response systems.
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Affiliation(s)
- Annamarie B. Defayette
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA
| | | | - Ian Cero
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA
| | - Katherine M. Harris
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
| | - Emma D. Whitmyre
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
| | - Roberto López
- Department of Psychology, George Mason University, 4400 University Drive, 3F5, Fairfax, VA 22030, USA
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LEW, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 DOI: 10.15585/mmwr.mm7013e3externalicon] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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7
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LE, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 PMCID: PMC8022879 DOI: 10.15585/mmwr.mm7013e3] [Citation(s) in RCA: 488] [Impact Index Per Article: 162.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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8
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Ramdzan SN, Suhaimi J, Harris KM, Khoo EM, Liew SM, Cunningham S, Pinnock H. School-based self-management interventions for asthma among primary school children: a systematic review. NPJ Prim Care Respir Med 2021; 31:18. [PMID: 33795691 PMCID: PMC8016947 DOI: 10.1038/s41533-021-00230-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/26/2021] [Indexed: 11/09/2022] Open
Abstract
A Cochrane review of school-based asthma interventions (combining all ages) found improved health outcomes. Self-management skills, however, vary according to age. We assessed effectiveness of primary school-based self-management interventions and identified components associated with successful programmes in children aged 6-12 years. We updated the Cochrane search (March 2020) and included the Global Health database. Two reviewers screened, assessed risk-of-bias and extracted data. We included 23 studies (10,682 participants); four at low risk-of-bias. Twelve studies reported at least one positive result for an outcome of interest. All 12 positive studies reported parental involvement in the intervention, compared to two-thirds of ineffective studies. In 10 of the 12 positive studies, parental involvement was substantial (e.g. attending sessions; phone/video communication) rather than being provided with written information. School-based self-management intervention can improve health outcomes and substantial parental involvement in school-based programmes seemed important for positive outcomes among primary school children.
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Affiliation(s)
- Siti Nurkamilla Ramdzan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Suhaimi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Katherine M Harris
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Steve Cunningham
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.
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Keller MD, Harris KM, Jensen-Wachspress MA, Kankate VV, Lang H, Lazarski CA, Durkee-Shock J, Lee PH, Chaudhry K, Webber K, Datar A, Terpilowski M, Reynolds EK, Stevenson EM, Val S, Shancer Z, Zhang N, Ulrey R, Ekanem U, Stanojevic M, Geiger A, Liang H, Hoq F, Abraham AA, Hanley PJ, Cruz CR, Ferrer K, Dropulic L, Gangler K, Burbelo PD, Jones RB, Cohen JI, Bollard CM. SARS-CoV-2-specific T cells are rapidly expanded for therapeutic use and target conserved regions of the membrane protein. Blood 2020; 136:2905-2917. [PMID: 33331927 PMCID: PMC7746091 DOI: 10.1182/blood.2020008488] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022] Open
Abstract
T-cell responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been described in recovered patients, and may be important for immunity following infection and vaccination as well as for the development of an adoptive immunotherapy for the treatment of immunocompromised individuals. In this report, we demonstrate that SARS-CoV-2-specific T cells can be expanded from convalescent donors and recognize immunodominant viral epitopes in conserved regions of membrane, spike, and nucleocapsid. Following in vitro expansion using a good manufacturing practice-compliant methodology (designed to allow the rapid translation of this novel SARS-CoV-2 T-cell therapy to the clinic), membrane, spike, and nucleocapsid peptides elicited interferon-γ production, in 27 (59%), 12 (26%), and 10 (22%) convalescent donors (respectively), as well as in 2 of 15 unexposed controls. We identified multiple polyfunctional CD4-restricted T-cell epitopes within a highly conserved region of membrane protein, which induced polyfunctional T-cell responses, which may be critical for the development of effective vaccine and T-cell therapies. Hence, our study shows that SARS-CoV-2 directed T-cell immunotherapy targeting structural proteins, most importantly membrane protein, should be feasible for the prevention or early treatment of SARS-CoV-2 infection in immunocompromised patients with blood disorders or after bone marrow transplantation to achieve antiviral control while mitigating uncontrolled inflammation.
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Affiliation(s)
- Michael D Keller
- Center for Cancer and Immunology Research and
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
- GW Cancer Center, George Washington University, Washington, DC
| | | | | | | | - Haili Lang
- Center for Cancer and Immunology Research and
| | | | - Jessica Durkee-Shock
- Center for Cancer and Immunology Research and
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | - Eva M Stevenson
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | | | - Zoe Shancer
- Center for Cancer and Immunology Research and
| | - Nan Zhang
- Center for Cancer and Immunology Research and
| | | | | | | | | | - Hua Liang
- Department of Statistics, George Washington University, Washington, DC
| | - Fahmida Hoq
- Center for Cancer and Immunology Research and
| | - Allistair A Abraham
- Center for Cancer and Immunology Research and
- GW Cancer Center, George Washington University, Washington, DC
- Division of Blood and Marrow Transplantation and
| | - Patrick J Hanley
- Center for Cancer and Immunology Research and
- GW Cancer Center, George Washington University, Washington, DC
- Division of Blood and Marrow Transplantation and
| | - C Russell Cruz
- Center for Cancer and Immunology Research and
- GW Cancer Center, George Washington University, Washington, DC
| | - Kathleen Ferrer
- Division of Infectious Diseases, Children's National Hospital, Washington, DC
| | - Lesia Dropulic
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Krista Gangler
- Leidos Biomedical Research, Inc, Frederick National Laboratory, Frederick, MD; and
| | - Peter D Burbelo
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - R Brad Jones
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY
| | - Jeffrey I Cohen
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Catherine M Bollard
- Center for Cancer and Immunology Research and
- GW Cancer Center, George Washington University, Washington, DC
- Division of Blood and Marrow Transplantation and
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Harris KM, Horn SE, Grant ML, Lang H, Sani G, Jensen-Wachspress MA, Kankate VV, Datar A, Lazarski CA, Bollard CM, Keller MD. T-Cell Therapeutics Targeting Human Parainfluenza Virus 3 Are Broadly Epitope Specific and Are Cross Reactive With Human Parainfluenza Virus 1. Front Immunol 2020; 11:575977. [PMID: 33123159 PMCID: PMC7573487 DOI: 10.3389/fimmu.2020.575977] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
Human Parainfluenza Virus-3 (HPIV3) causes severe respiratory illness in immunocompromised patients and lacks approved anti-viral therapies. A phase I study of adoptively transferred virus-specific T-cells (VSTs) targeting HPIV3 following bone marrow transplantation is underway (NCT03180216). We sought to identify immunodominant epitopes within HPIV3 Matrix protein and their cross-reactivity against related viral proteins. VSTs were generated from peripheral blood of healthy donors by ex-vivo expansion after stimulation with a 15-mer peptide library encompassing HPIV3 matrix protein. Epitope mapping was performed using IFN-γ ELIspot with combinatorial peptide pools. Flow cytometry was used to characterize products with intracellular cytokine staining. In 10 VST products tested, we discovered 12 novel immunodominant epitopes. All products recognized an epitope at the C-terminus. On IFN-γ ELISpot, individual peptides eliciting activity demonstrated mean IFN-γ spot forming units per well (SFU)/1x105 cells of 115.5 (range 24.5-247.5). VST products were polyfunctional, releasing IFN-γ and TNF-α in response to identified epitopes, which were primarily HLA Class II restricted. Peptides from Human Parainfluenza Virus-1 corresponding to the HPIV3 epitopes showed cross-reactivity for HPIV1 in 11 of 12 tested epitopes (mean cross reactivity index: 1.19). Characterization of HPIV3 epitopes may enable development of third-party VSTs to treat immune suppressed patients with HPIV infection.
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Affiliation(s)
- Katherine M Harris
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States.,Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, United States
| | - Sarah E Horn
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | - Melanie L Grant
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | - Haili Lang
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | - Gelina Sani
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | | | - Vaishnavi V Kankate
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | - Anushree Datar
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | - Christopher A Lazarski
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States.,Center for Cancer and Blood Disorders, Children's National Hospital, Washington, DC, United States.,GW Cancer Center, George Washington University, Washington, DC, United States
| | - Michael D Keller
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, DC, United States.,GW Cancer Center, George Washington University, Washington, DC, United States.,Division of Allergy and Immunology, Children's National Hospital, Washington, DC, United States
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Sharma A, Brooke RJ, Bhatt NS, Li Y, Allewelt HB, Bies JJ, Brondon JE, Gloude NJ, Goeckerman ES, Harris KM, Ho RH, Hudspeth M, Huo JS, Jacobsohn DA, Kasow KA, Katsanis E, Kaviany S, Ktena YP, Lauhan C, Lopez-Hernandez G, Myers KC, Naik S, Olaya-Vargas A, Onishi T, Ramos KN, Rangarajan HG, Roehrs PA, Sampson ME, Shook DR, Skiles JL, Somers KM, Spiegel C, Symons HJ, Uber A, Triplett BM. Reduced Intensity Vs Myeloablative Conditioning Regimen for Pediatric Therapy-Related Myelodysplastic Syndrome/Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.081] [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: 10/27/2022]
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12
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Harris KM, Hanley PJ, Zhang N, Sani GM, Lang H, Bollard CM, Keller MD. Hexaviral Specific T-Cells Used for Prophylaxis and Treatment of Viral Infections in Patients Post Stem Cell Transplant. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.546] [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: 11/27/2022]
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Harris KM, Davila BJ, Bollard CM, Keller MD. Virus-Specific T Cells: Current and Future Use in Primary Immunodeficiency Disorders. J Allergy Clin Immunol Pract 2018; 7:809-818. [PMID: 30581131 DOI: 10.1016/j.jaip.2018.10.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
Abstract
Viral infections are common and can be potentially fatal in patients with primary immunodeficiency disorders (PIDDs). Because viral susceptibility stems from poor to absent T-cell function in most patients with moderate to severe forms of PIDD, adoptive immunotherapy with virus-specific T cells (VSTs) has been used to combat viral infections in the setting of hematopoietic stem cell transplantation in multiple clinical trials. Most trials to date have targeted cytomegalovirus, EBV, and adenovirus either alone or in combination, although newer trials have expanded the number of targeted pathogens. Use of banked VSTs produced from third-party donors has also been studied as a method of expanding access to this therapy. Here we review the clinical experience with VST therapy for patients with PIDDs as well as future potential targets and approaches for the use of VSTs to improve clinical outcomes for this specific patient population.
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Affiliation(s)
- Katherine M Harris
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC
| | - Blachy J Davila
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - Michael D Keller
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC; Division of Allergy and Immunology, Children's National Health System, Washington, DC.
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14
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Abstract
BACKGROUND Asthma exacerbations in school-aged children peak in autumn, shortly after children return to school following the summer holiday. This might reflect a combination of risk factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. Since this peak is predictable, interventions targeting modifiable risk factors might reduce exacerbation-associated morbidity and strain upon health resources. The peak occurs in September in the Northern Hemisphere and in February in the Southern Hemisphere. OBJECTIVES To assess the effects of pharmacotherapy and behavioural interventions enacted in anticipation of school return during autumn that are designed to reduce asthma exacerbations in children during this period. SEARCH METHODS We searched the Cochrane Airways Group Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, reference lists of primary studies and existing reviews, and manufacturers' trial registries (Merck, Novartis and Ono Parmaceuticals). We searched databases from their inception to 1 December 2017, and imposed no restriction on language of publication. SELECTION CRITERIA We included all randomised controlled trials comparing interventions aimed specifically at reducing autumn exacerbations with usual care, (no systematic change in management in preparation for school return). We included studies providing data on children aged 18 years or younger. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened records identified by the search and then extracted data and assessed bias for trials meeting the inclusion criteria. A third review author checked for accuracy and mediated consensus on disagreements. The primary outcome was proportion of children experiencing one or more asthma exacerbations requiring hospitalisation or oral corticosteroids during the autumn period. MAIN RESULTS Our searches returned 546 trials, of which five met our inclusion criteria. These studies randomised 14,252 children to receive either an intervention or usual care. All studies were conducted in the Northern Hemisphere. Three interventions used a leukotriene receptor antagonist, one used omalizumab or a boost of inhaled corticosteroids, and the largest study, (12,179 children), used a medication reminder letter. Whilst the risk of bias within individual studies was generally low, we downgraded the evidence quality due to imprecision associated with low participant numbers, poor consistency between studies, and indirect outcome ascertainment.A US study of 513 children with mild/severe asthma and allergic sensitisation was the only study to provide data for our primary outcome. In this study, the proportion of participants experiencing an exacerbation requiring oral corticosteroids or hospital admission in the 90 days after school return was significantly reduced to 11.3% in those receiving omalizumab compared to 21.0% in those receiving placebo (odds ratio 0.48, 95% confidence interval 0.25 to 0.92, moderate-quality evidence). The remaining studies used alternative exacerbation definitions. When data from two leukotriene receptor antagonist studies with comparable outcomes were combined in a random-effects model, there was no evidence of an effect upon exacerbations. There was no evidence that a seasonal medication reminder letter decreased unscheduled contacts for a respiratory diagnosis between September and December.Four studies recorded adverse events. There was no evidence that the proportion of participants experiencing at least one adverse event differed between intervention and usual care groups. Lack of data prevented planned subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS Seasonal omalizumab treatment from four to six weeks before school return might reduce autumn asthma exacerbations. We found no evidence that this strategy is associated with increased adverse effects other than injection site pain, but it is costly. There were no data upon which to judge the effect of this or other seasonal interventions on asthma control, quality of life, or asthma-related death. In future studies definitions of exacerbations should be provided, and standardised where possible. To investigate possible differential effects according to subgroup, participants in future trials should be well characterised with respect to baseline asthma severity and exacerbation history in addition to age and gender.
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Affiliation(s)
- Katharine C Pike
- UCL Great Ormond Street Institute of Child HealthRespiratory, Critical Care & AnaesthesiaLondonUK
| | - Melika Akhbari
- King's College LondonGKT School of Medical EducationLondonUK
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Katherine M Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
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15
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Karnell FG, Lin D, Motley S, Duhen T, Lim N, Campbell DJ, Turka LA, Maecker HT, Harris KM. Reconstitution of immune cell populations in multiple sclerosis patients after autologous stem cell transplantation. Clin Exp Immunol 2017; 189:268-278. [PMID: 28498568 DOI: 10.1111/cei.12985] [Citation(s) in RCA: 46] [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] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis is an inflammatory T cell-mediated autoimmune disease. In a Phase II clinical trial, high-dose immunosuppressive therapy combined with autologous CD34+ haematopoietic stem cell transplant resulted in 69·2% of subjects remaining disease-free without evidence of relapse, loss of neurological function or new magnetic resonance imaging (MRI) lesions to year 5 post-treatment. A combination of CyTOF mass cytometry and multi-parameter flow cytometry was used to explore the reconstitution kinetics of immune cell subsets in the periphery post-haematopoietic cell transplant (HSCT) and the impact of treatment on the phenotype of circulating T cells in this study population. Repopulation of immune cell subsets progressed similarly for all patients studied 2 years post-therapy, regardless of clinical outcome. At month 2, monocytes and natural killer (NK) cells were proportionally more abundant, while CD4 T cells and B cells were reduced, relative to baseline. In contrast to the changes observed at earlier time-points in the T cell compartment, B cells were proportionally more abundant and expansion in the proportion of naive B cells was observed 1 and 2 years post-therapy. Within the T cell compartment, the proportion of effector memory and late effector subsets of CD4 and CD8 T cells was increased, together with transient increases in proportions of CD45RA-regulatory T cells (Tregs ) and T helper type 1 (Th1 cells) and a decrease in Th17·1 cells. While none of the treatment effects studied correlated with clinical outcome, patients who remained healthy throughout the 5-year study had significantly higher absolute numbers of memory CD4 and CD8 T cells in the periphery prior to stem cell transplantation.
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Affiliation(s)
| | - D Lin
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - S Motley
- Benaroya Research Institute, Seattle, WA, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, WA, USA
| | - T Duhen
- Benaroya Research Institute, Seattle, WA, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, WA, USA
| | - N Lim
- Immune Tolerance Network, Bethesda, MD, USA
| | - D J Campbell
- Benaroya Research Institute, Seattle, WA, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, WA, USA
| | - L A Turka
- Immune Tolerance Network, Bethesda, MD, USA.,Massachusetts General Hospital, Center for Transplantation Sciences, Boston, MA, USA
| | - H T Maecker
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - K M Harris
- Immune Tolerance Network, Bethesda, MD, USA
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16
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Graff M, Richardson AS, Young KL, Mazul AL, Highland H, North KE, Mohlke KL, Lange LA, Lange EM, Harris KM, Gordon-Larsen P. The interaction between physical activity and obesity gene variants in association with BMI: Does the obesogenic environment matter? Health Place 2016; 42:159-165. [PMID: 27771443 PMCID: PMC5116401 DOI: 10.1016/j.healthplace.2016.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/10/2015] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
Abstract
Little is known about how obesity susceptibility single nucleotide polymorphisms (SNPs) interact with moderate to vigorous physical activity (MVPA) in relation to BMI during adolescence, once obesogenic neighborhood factors are accounted for. In race stratified models, including European (EA; N=4977), African (AA; N=1726), and Hispanic Americans (HA; N=1270) from the National Longitudinal Study of Adolescent to Adult Health (1996; ages 12-21), we assessed the evidence for a SNPxMVPA interaction with BMI-for-age Z score, once accounting for obesogenic neighborhood factors including physical activity amenities, transportation and recreation infrastructure, poverty and crime. Eight SNPxMVPA interactions with suggestive significance (p<0.10; three in each EA, and AA, two in HA) were observed showing attenuation on BMI-for-age Z score in adolescents with ≥5 versus <5 bouts/week MVPA, except for rs10146997 (near NRXN3). Findings were robust to the inclusion of neighborhood-level variables as covariates. These findings suggest that any attenuation from MVPA on a genetic susceptibility to obesity during adolescence is likely not operating through obesogenic neighborhood factors.
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Affiliation(s)
- M Graff
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514 USA.
| | | | - K L Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514 USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514 USA
| | - A L Mazul
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514 USA
| | - Heather Highland
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514 USA
| | - K E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514 USA; Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC 27514 USA
| | - K L Mohlke
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC 27514 USA; Department of Genetics, University of North Carolina, Chapel Hill, NC 27514 USA
| | - L A Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC 27514 USA; Department of Genetics, University of North Carolina, Chapel Hill, NC 27514 USA
| | - E M Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC 27514 USA; Department of Genetics, University of North Carolina, Chapel Hill, NC 27514 USA
| | - K M Harris
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514 USA; Department of Sociology, Univlersity of North Carolina, Chapel Hill, NC 27514 USA
| | - P Gordon-Larsen
- Carolina Population Center, University of North Carolina, Chapel Hill, NC 27514 USA; Department of Nutrition Gillings School of Global Public Health & School of Medicine, University of North Carolina, Chapel Hill, NC 27514 USA
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17
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Maurer J, Harris KM. Learning to Trust Flu Shots: Quasi-Experimental Evidence from the 2009 Swine Flu Pandemic. Health Econ 2016; 25:1148-62. [PMID: 27381724 DOI: 10.1002/hec.3379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 05/22/2023]
Abstract
This paper studies consumer learning in influenza vaccination decisions. We examine consumer learning in influenza vaccine demand within a reduced form instrumental variable framework that exploits differences in risk characteristics of different influenza viruses as a natural experiment to distinguish the effects of learning based on previous influenza vaccination experiences from unobserved heterogeneity. The emergence of a new virus strain (influenza A H1N1/09) during the 2009 'Swine flu' pandemic resulted in two different vaccines being recommended for distinct population subgroups with some people, who were not usually targeted by seasonal vaccination programs, being specifically recommended for the new Swine flu vaccine. We use these differences in vaccination targeting to construct instrumental variables for estimating the effect of past influenza vaccination experiences on the demand for pandemic vaccine. We find large causal effects of previous seasonal vaccination on pandemic vaccination. Causal effects of past influenza vaccination experiences on perceived vaccination safety are likely to be an important pathway linking past vaccination experiences with future vaccine uptake. Our results suggest a significant role of learning in vaccination decisions. Current efforts to expand seasonal vaccination may thus have potentially important long-term effects on future influenza vaccination levels and pandemic preparedness. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jürgen Maurer
- Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
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18
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Young KL, Graff M, North KE, Richardson AS, Bradfield JP, Grant SFA, Lange LA, Lange EM, Harris KM, Gordon-Larsen P. Influence of SNP*SNP interaction on BMI in European American adolescents: findings from the National Longitudinal Study of Adolescent Health. Pediatr Obes 2016; 11:95-101. [PMID: 25893265 PMCID: PMC4615264 DOI: 10.1111/ijpo.12026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/31/2014] [Revised: 02/05/2015] [Accepted: 02/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adolescent obesity is predictive of future weight gain, obesity and adult onset severe obesity (body mass index [BMI] ≥40 kg m(-2) ). Despite successful efforts to identify Single Nucleotide Polymorphisms (SNPs) influencing BMI, <5% of the 40-80% heritability of the phenotype has been explained. Identification of gene-gene (G-G) interactions between known variants can help explain this hidden heritability as well as identify potential biological mechanisms affecting weight gain during this critical developmental period. OBJECTIVE We have recently shown distinct genetic effects on BMI across the life course, and thus it is important to examine the evidence for epistasis in adolescence. METHODS In adolescent participants of European descent from wave II of the National Longitudinal Study of Adolescent Health (Add Health, n = 5072, ages 12-21, 52.5% female), we tested 34 established BMI-related SNPs for G-G interaction effects on BMI z-score. We used mixed-effects regression, assuming multiplicative interaction models adjusting for age, sex and geographic region, with random effects for family and school. RESULTS For 28 G-G interactions that were nominally significant (P < 0.05), we attempted to replicate our results in an adolescent sample from the Childhood European American Cohort from Philadelphia. In the replication study, one interaction (PRKD1-FTO) was significant after correction for multiple testing. CONCLUSIONS Our results are suggestive of epistatic effects on BMI during adolescence and point to potentially interactive effects between genes in biological pathways important in obesity.
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Affiliation(s)
- KL Young
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M Graff
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA,Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - KE North
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA,Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA
| | - AS Richardson
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Deptartment of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
| | - JP Bradfield
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - SFA Grant
- Department of Pediatrics, Children’s Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
| | - LA Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - EM Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - KM Harris
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Sociology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - P Gordon-Larsen
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Deptartment of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
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19
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Barrett TJ, Hille KA, Sharpe RL, Harris KM, Machtans HM, Chapman PM. Quantifying natural variability as a method to detect environmental change: Definitions of the normal range for a single observation and the mean of m observations. Environ Toxicol Chem 2015; 34:1185-1195. [PMID: 25655985 DOI: 10.1002/etc.2915] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/14/2014] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
The normal range has been defined as the range that encloses 95% of reference values; in practice this range has been defined as the reference mean ± 2 standard deviations (SD). When sample sizes are small and reference data are not normally distributed, the mean ± 2 SDs do not enclose 95% of data values. Prediction intervals (PI) calculated using sample statistics are used in the present study to define the normal range for a single observation and the mean of m observations. The PIs provide confidence limits for the next randomly selected observation (or mean of m observations) from a population. The PIs are defined using normally distributed reference data; normality can typically be achieved with transformations of the data. Covariates can be used to explain some of the variability in the reference distribution, increasing the ability to detect change. When assumptions of normality are not met, alternative methods of defining the normal range are provided. The normal range can be used to quantify natural variability and assess change from the reference distribution. It can be used as an early warning indicator of change in environmental monitoring to identify the need for further investigation.
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20
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Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database of Systematic Reviews 2015. [DOI: 10.1002/14651858.cd011651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine M Harris
- Queen Mary University of London; Centre for Paediatrics, Blizard Institute; Barts and the London School of Medicine and Dentistry London UK E1 2AT
| | - Dylan Kneale
- University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 20 Bedford Way London UK WC1H 0AL
| | - Toby J Lasserson
- Cochrane Central Executive; Cochrane Editorial Unit; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Vanessa M McDonald
- The University of Newcastle; School of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory Disease; Locked Bag 1000 New Lambtion Newcastle NSW Australia 2305
| | - Jonathan Grigg
- Queen Mary University of London; Institute of Cell and Molecular Science, Blizzard Institute; London UK E1 2AT
| | - James Thomas
- University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 20 Bedford Way London UK WC1H 0AL
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21
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Maurer J, Harris KM. Issuance of patient reminders for influenza vaccination by US-based primary care physicians during the first year of universal influenza vaccination recommendations. Am J Public Health 2014; 104:e60-2. [PMID: 24825233 DOI: 10.2105/ajph.2014.301888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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
To estimate the number of physician-reported influenza vaccination reminders during the 2010-2011 influenza season, the first influenza season after universal vaccination recommendations for influenza were introduced, we interviewed 493 members of the Physicians Consulting Network. Patient vaccination reminders are a highly effective means of increasing influenza vaccination; nonetheless, only one quarter of the primary care physicians interviewed issued influenza vaccination reminders during the first year of universal vaccination recommendations, highlighting the need to improve office-based promotion of influenza vaccination.
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Affiliation(s)
- Jürgen Maurer
- Jürgen Maurer and Katherine M. Harris are with the RAND Corporation, Arlington, VA. Jürgen Maurer is also with the Institute of Health Economics and Management and the Economics Department, Faculty of Business and Economics (HEC), University of Lausanne, Switzerland. Katherine M. Harris is also with MedStar Health Research Institute, Hyattsville, MD
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22
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Richardson AS, North KE, Graff M, Young KM, Mohlke KL, Lange LA, Lange EM, Harris KM, Gordon-Larsen P. Moderate to vigorous physical activity interactions with genetic variants and body mass index in a large US ethnically diverse cohort. Pediatr Obes 2014; 9:e35-46. [PMID: 23529959 PMCID: PMC3707946 DOI: 10.1111/j.2047-6310.2013.00152.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 08/17/2012] [Revised: 02/06/2013] [Accepted: 01/31/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about the interaction between genetic and behavioural factors during lifecycle risk periods for obesity and how associations vary across race/ethnicity. OBJECTIVE The objective of this study was to examine joint associations of adiposity-related single-nucleotide polymorphisms (SNPs) and moderate to vigorous physical activity (MVPA) with body mass index (BMI) in a diverse adolescent cohort. METHODS Using data from the National Longitudinal Study of Adolescent Health (n = 8113: Wave II 1996; ages 12-21, Wave III; ages 18-27), we assessed interactions of 41 well-established SNPs and MVPA with BMI-for-age Z-scores in European Americans (EA; n = 5077), African-Americans (AA; n = 1736) and Hispanic Americans (HA; n = 1300). RESULTS Of 97 assessed, we found nominally significant SNP-MVPA interactions on BMI-for-age Z-score in EA at GNPDA2 and FTO and in HA at LZTR2/SEC16B. In EA, the estimated effect of the FTO risk allele on BMI-for-age Z-score was lower (β = -0.13; 95% confidence interval [CI]: 0.08, 0.18) in individuals with ≥5 vs. <5 (β = 0.24; CI: 0.16, 0.32) bouts of MVPA per week (P for interaction 0.02). Race/ethnicity-pooled meta-analysis showed nominally significant interactions for SNPs at TFAP2B, POC5 and LYPLAL1. CONCLUSIONS High MVPA may attenuate underlying genetic risk for obesity during adolescence, a high-risk period for adult obesity.
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Affiliation(s)
- AS Richardson
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Nutrition Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - KE North
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M Graff
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - KM Young
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - KL Mohlke
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - LA Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - EM Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - KM Harris
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Sociology, North Carolina, USA
| | - P Gordon-Larsen
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Nutrition Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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23
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Harris KM, Uscher-Pines L, Han B, Lindley MC, Lorick SA. The impact of influenza vaccination requirements for hospital personnel in California: knowledge, attitudes, and vaccine uptake. Am J Infect Control 2014; 42:288-93. [PMID: 24581018 DOI: 10.1016/j.ajic.2013.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Seasonal influenza infections are a leading cause of illness, death, and lost productivity. Vaccinating health care personnel (HCP) can reduce transmission of influenza virus to patients and reduce influenza-related absenteeism, enabling the health care system to meet elevated demand for care during influenza outbreaks. OBJECTIVES We evaluated the impact of California's 2006 influenza vaccination requirement for hospital workers (requiring vaccination or signed declinations) on uptake and vaccination-related attitudes, beliefs, and knowledge among hospital HCP. METHODS We used a causal difference-in-differences approach to compare changes over the prior 10 years in the self-reported frequency of influenza vaccination for California hospital HCP and those from other states without similar laws using data from a stratified sample (N = 3,529) of HCP drawn from online survey panels. We also examined cross-sectional differences in awareness of vaccination policies, promotion efforts, and attitudes toward influenza vaccination. All analyses used propensity score weighting to balance the observable characteristics of the 2 samples. RESULTS We found that compared with their counterparts in other states, California hospital HCP were (1) more likely to report working under a formal written policy for influenza vaccination, (2) no more likely to be vaccinated, and (3) less likely to report working for an employer who provided financial incentives for vaccination or rewarded or recognized employees for being vaccinated. CONCLUSION Our results suggest that state-level vaccination requirements such as those enacted by California, may not be sufficient to increase uptake among hospital HCP.
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Affiliation(s)
| | | | - Bing Han
- RAND Corporation, Santa Monica, CA
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24
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Graff M, North KE, Richardson AS, Young KM, Mohlke KL, Lange LA, Lange EM, Harris KM, Gordon-Larsen P. Screen time behaviours may interact with obesity genes, independent of physical activity, to influence adolescent BMI in an ethnically diverse cohort. Pediatr Obes 2013; 8:e74-9. [PMID: 24039247 PMCID: PMC3838440 DOI: 10.1111/j.2047-6310.2013.00195.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 11/22/2012] [Revised: 06/12/2013] [Accepted: 07/06/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND There has been little investigation of gene-by-environment interactions related to sedentary behaviour, a risk factor for obesity defined as leisure screen time (ST; i.e. television, video and computer games). OBJECTIVE To test the hypothesis that limiting ST use attenuates the genetic predisposition to increased body mass index (BMI), independent of physical activity. DESIGN Using 7642 wave II participants of the National Longitudinal Study of Adolescent Health, (Add Health; mean = 16.4 years, 52.6% female), we assessed the interaction of ST (h week(-1) ) and 41 established obesity single nucleotide polymorphisms (SNPs) with age- and sex-specific BMI Z-scores in 4788 European-American (EA), 1612 African-American (AA) and 1242 Hispanic American (HA) adolescents. RESULTS Nominally significant SNP*ST interaction were found for FLJ35779 in EA, GNPDA2 in AA and none in HA (EA: beta [SE] = 0.016[0.007]), AA: beta [SE] = 0.016[0.011]) per 7 h week(-1) ST and one risk allele in relation to BMI Z-score. CONCLUSIONS While for two established BMI loci, we find evidence that high levels of ST exacerbate the influence of obesity susceptibility variants on body mass; overall, we do not find strong evidence for interactions between the majority of established obesity loci. However, future studies with larger sample sizes, or that may build on our current study and the growing published literature, are clearly warranted.
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Affiliation(s)
- M Graff
- Department of Epidemiology, University of North Carolina, Chapel
Hill, North Carolina, USA,Carolina Population Center, University of North Carolina, Chapel
Hill, North Carolina, USA
| | - KE North
- Department of Epidemiology, University of North Carolina, Chapel
Hill, North Carolina, USA,Carolina Center for Genome Sciences, University of North Carolina,
Chapel Hill, North Carolina, USA
| | - AS Richardson
- Carolina Population Center, University of North Carolina, Chapel
Hill, North Carolina, USA
| | - K M Young
- Department of Epidemiology, University of North Carolina, Chapel
Hill, North Carolina, USA,Carolina Population Center, University of North Carolina, Chapel
Hill, North Carolina, USA
| | - KL Mohlke
- Carolina Center for Genome Sciences, University of North Carolina,
Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill,
North Carolina, USA
| | - LA Lange
- Carolina Center for Genome Sciences, University of North Carolina,
Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill,
North Carolina, USA
| | - EM Lange
- Carolina Center for Genome Sciences, University of North Carolina,
Chapel Hill, North Carolina, USA,Department of Genetics, University of North Carolina, Chapel Hill,
North Carolina, USA
| | - KM Harris
- Carolina Population Center, University of North Carolina, Chapel
Hill, North Carolina, USA,Carolina Center for Genome Sciences, University of North Carolina,
Chapel Hill, North Carolina, USA,Department of Sociology, University of North Carolina, Chapel Hill,
North Carolina, USA
| | - P Gordon-Larsen
- Carolina Population Center, University of North Carolina, Chapel
Hill, North Carolina, USA,Department of Nutrition, University of North Carolina, Chapel Hill,
North Carolina, USA
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Berry SH, Concannon TW, Morganti KG, Auerbach DI, Beckett MK, Chen PG, Farley DO, Han B, Harris KM, Jones SS, Liu H, Lovejoy SL, Marsh T, Martsolf GR, Nelson C, Okeke EN, Pearson ML, Pillemer F, Sorbero ME, Towe V, Weinick RM. CMS Innovation Center Health Care Innovation Awards: Evaluation Plan. Rand Health Q 2013; 3:1. [PMID: 28083297 PMCID: PMC5051984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services (CMS) has funded 108 Health Care Innovation Awards, funded through the Affordable Care Act, for applicants who proposed compelling new models of service delivery or payment improvements that promise to deliver better health, better health care, and lower costs through improved quality of care for Medicare, Medicaid, and Children's Health Insurance Program enrollees. CMS is also interested in learning how new models would affect subpopulations of beneficiaries (e.g., those eligible for Medicare and Medicaid and complex patients) who have unique characteristics or health care needs that could be related to poor outcomes. In addition, the initiative seeks to identify new models of workforce development and deployment, as well as models that can be rapidly deployed and have the promise of sustainability. This article describes a strategy for evaluating the results. The goal for the evaluation design process is to create standardized approaches for answering key questions that can be customized to similar groups of awardees and that allow for rapid and comparable assessment across awardees. The evaluation plan envisions that data collection and analysis will be carried out on three levels: at the level of the individual awardee, at the level of the awardee grouping, and as a summary evaluation that includes all awardees. Key dimensions for the evaluation framework include implementation effectiveness, program effectiveness, workforce issues, impact on priority populations, and context. The ultimate goal is to identify strategies that can be employed widely to lower cost while improving care.
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Liu H, Mattke S, Harris KM, Weinberger S, Serxner S, Caloyeras JP, Exum E. Do Workplace Wellness Programs Reduce Medical Costs? Evidence from a Fortune 500 Company. INQUIRY 2013; 50:150-8. [DOI: 10.1177/0046958013513677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The recent passage of the Affordable Care Act has heightened the importance of workplace wellness programs. This paper used administrative data from 2002 to 2007 for PepsiCo’s self-insured plan members to evaluate the effect of its wellness program on medical costs and utilization. We used propensity score matching to identify a comparison group who were eligible for the program but did not participate. No significant changes were observed in inpatient admissions, emergency room visits, or per-member per-month (PMPM) costs. The discrepancy between our findings and those of prior studies may be due to the difference in intervention intensity or program implementation.
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Liu H, Harris KM, Weinberger S, Serxner S, Mattke S, Exum E. Effect of an employer-sponsored health and wellness program on medical cost and utilization. Popul Health Manag 2013; 16:1-6. [PMID: 22823180 PMCID: PMC3883086 DOI: 10.1089/pop.2013.1691] [Citation(s) in RCA: 6] [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: 01/22/2023] Open
Abstract
The objective of this study was to examine the impact of PepsiCo's health and wellness program on medical cost and utilization. The authors analyzed health plan and program data of employees and dependents 19-64 years of age, who had 2 years of baseline data (2002 and 2003) and at least 1 year of data from the intervention period (2004 to 2007), resulting in a sample of 55,030 members. Program effects were measured using a difference-in-difference approach based on a multivariate regression model with an individual-level random effect. In its first year, the program was associated with a relative increase in per member per month (PMPM) cost ($66, P<0.01); a relative reduction in PMPM costs of $76 (P<0.01) and $61 (P<0.01) was seen in the second and third year, respectively. Over all 3 years, the program was associated with reduced PMPM costs of $38 (P<0.01), a decrease of 50 emergency room visits per 1000 member years (P<0.01), and a decrease of 16 hospital admissions per 1000 member years (P<0.01). The disease management component reduced PMPM costs by $154 (P<0.01), case management increased PMPM costs by $2795 (P<0.01), but no significant effects were observed for lifestyle management over the 3 intervention years. The implementation of a comprehensive health and wellness program was associated with a cost increase in the first year, followed by a decrease in the following years. These results highlight the importance of taking a long-term perspective when implementing such programs and evaluating their effectiveness.
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Affiliation(s)
- Hangsheng Liu
- The RAND Corporation, Boston, Massachusetts 02116, USA.
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Graff M, North KE, Mohlke KL, Lange LA, Luo J, Harris KM, Young KL, Richardson AS, Lange EM, Gordon-Larsen P. Estimation of genetic effects on BMI during adolescence in an ethnically diverse cohort: The National Longitudinal Study of Adolescent Health. Nutr Diabetes 2012; 2:e47. [PMID: 23168566 PMCID: PMC3461356 DOI: 10.1038/nutd.2012.20] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 08/18/2012] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The contribution of genetic variants to body mass index (BMI) during adolescence across multiethnic samples is largely unknown. We selected genetic loci associated with BMI or obesity in European-descent samples and examined them in a multiethnic adolescent sample. DESIGN AND SAMPLE In 5103 European American (EA), 1748 African American (AfA), 1304 Hispanic American (HA) and 439 Asian American (AsA) participants of the National Longitudinal Study of Adolescent Health (Add Health; ages 12-21 years, 47.5% male), we assessed the association between 41 established obesity-related single-nucleotide polymorphisms (SNPs) with BMI using additive genetic models, stratified by race/ethnicity, and in a pooled meta-analysis sample. We also compared the magnitude of effect for BMI-SNP associations in EA and AfA adolescents to comparable effect estimates from 11 861 EA and AfA adults in the Atherosclerosis Risk in Communities study (ages 45-64 years, 43.2% male). RESULTS Thirty-five of 41 BMI-SNP associations were directionally consistent with published studies in European populations, 18 achieved nominal significance (P<0.05; effect sizes from 0.19 to 0.71 kg m(-2) increase in BMI per effect allele), while 4 (FTO, TMEM18, TFAP2B, MC4R) remained significant after Bonferroni correction (P<0.0015). Of 41 BMI-SNP associations in AfA, HA and AsA adolescents, nine, three and five, respectively, were directionally consistent and nominally significant. In the pooled meta-analysis, 36 of 41 effect estimates were directionally consistent and 21 of 36 were nominally significant. In EA adolescents, BMI effect estimates were larger (P<0.05) for variants near TMEM18, PTER and MC4R and smaller for variants near MTIF3 and NRXN3 compared with EA adults. CONCLUSION Our findings suggest that obesity susceptibility loci may have a comparatively stronger role during adolescence than during adulthood, with variation across race/ethnic subpopulation.
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Affiliation(s)
- M Graff
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - K E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - K L Mohlke
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - L A Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - J Luo
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - K M Harris
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina, Chapel Hill, NC, USA
| | - K L Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - A S Richardson
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - E M Lange
- Carolina Center for Genome Sciences, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - P Gordon-Larsen
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
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Abstract
BACKGROUND Starting with the 2010-2011 influenza season, the Advisory Committee on Immunization Practices at the U.S. Centers for Disease Control and Prevention recommends annual influenza vaccination to all people aged 6 months and older unless contraindicated. OBJECTIVES To measure perceived influenza vaccination recommendation status among US adults (n = 2122) and its association with socio-demographic characteristics and recommendation status during the 2009-2010 pandemic influenza season. METHODS We analyze nationally representative data from longitudinal Internet surveys of U.S. adults conducted in November-December 2009 and September-October 2010. RESULTS During the 2010-2011 vaccination season, 46.2 percent (95%--CI: 43.3-49.1%) of U.S. adults correctly reported to be covered by a government recommendation for influenza vaccination. Awareness of being covered by a government influenza vaccination recommendation was statistically significantly higher among non-working adults and adults who had been recommended for seasonal vaccination or both seasonal and H1N1 vaccination during the 2009-2010 pandemic influenza vaccination season. CONCLUSION Our results highlight that a majority of U.S. adults do not know that they are recommended for annual influenza vaccination by the government. The fraction of adults who are unaware of their recommendation status is especially large among newly recommended healthy young adults. The universal vaccination recommendations will only be successful if they reach both patients and physicians and lead to changing vaccination practices. The universal nature of the new recommendation simplifies vaccination-related outreach and compliance with government vaccination guidelines considerably, as it does not require any identification of specific recommendation groups based on complex personal or health risk factors.
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Affiliation(s)
- Jürgen Maurer
- Institute of Health Economics and Management, University of Lausanne and RAND Corporation, Arlington, VA, USA.
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Uscher-Pines L, Harris KM, Burns RM, Mehrotra A. The growth of retail clinics in vaccination delivery in the U.S. Am J Prev Med 2012; 43:63-6. [PMID: 22704748 PMCID: PMC3710694 DOI: 10.1016/j.amepre.2012.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/07/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Retail clinics are a promising venue in which to promote and administer vaccinations; however, little is known about who receives vaccinations at a retail clinic. PURPOSE The aim of this paper was to describe the use of retail clinics in the delivery of recommended vaccinations. METHODS The three largest retail clinic operators in the U.S.--MinuteClinic, TakeCare, and LittleClinic--provided de-identified clinic data for 2007-2009. Descriptive statistics were generated in 2011 on visit type, type of vaccination, patient age, and payment method. RESULTS From 2007 to 2009, there were 8.9 million retail clinic visits across the three largest clinic operators. In 2009, vaccinations were administered at 1,952,610 visits, up from 469,330 visits in 2007. Visits in which vaccinations were administered accounted for 39.9%, 36.4%, and 42.0% of total visits in 2007, 2008, and 2009, respectively. In 2009, 1.8 million influenza vaccinations (including seasonal and H1N1 vaccinations) were administered by the two largest retail clinic operators (94% of all vaccination visits). Pneumococcal vaccination was administered at 59,849 visits (3% of all vaccination visits). In 2009, vaccinations were also administered in 0.8% of acute care visits (n=18,807); 0.8% of chronic care visits (n=261); and 1.3% of general medical exams (n=2497). CONCLUSIONS Results suggest that retail clinics play a growing role in vaccination delivery, and vaccinations constitute a substantial share of the business conducted by retail clinics. As such, retail clinics have the potential to play an important role in vaccination delivery in the U.S. Retail clinics potentially could deliver more vaccinations if they reviewed vaccination histories and counseled patients regarding the benefits of vaccination during acute care visits.
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Harris KM, Uscher-Pines L, Mattke S, Kellermann AL. A Blueprint for Improving the Promotion and Delivery of Adult Vaccination in the United States. Rand Health Q 2012; 2:15. [PMID: 28083237 PMCID: PMC4945297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Vaccine-preventable disease continues to take a heavy toll on adults despite the widespread availability of effective vaccines. This article identifies where efforts to improve the delivery of adult vaccination have stalled and recommends targeted strategies that are supported by available evidence and build on existing infrastructure. The authors conducted a comprehensive review of the published literature on adult immunization, a stakeholder workshop, and follow-up interviews with meeting participants and additional experts. They also partnered with an organization represented at the workshop to conduct a telephone survey of adults to learn about the relationship between influenza vaccination and beliefs about the safety of influenza vaccine. Findings include that office-based providers remain the primary source of vaccination, though a substantial proportion of physicians who treat adults appear not to vaccinate at all and adult vaccination is infrequently discussed at health care encounters. Adult practices also lack a strong business case to offer vaccination, as it entails substantial fixed costs. In addition, achieving substantial increases in adult vaccination will require persuading large numbers of individuals disinclined to be vaccinated. Vaccination stakeholders need to engage in a collaborative fashion to promote adult vaccination and the integration of advice about vaccination into routine office-based practice. Recommendations include strengthening evidence surrounding practice gaps and the economic value of promoting vaccination in office-based settings, improving guidance to providers about vaccinating adults, and formalizing procedures for referring patients to complementary vaccinators.
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Maurer J, Harris KM, Black CL, Euler GL. Support for seasonal influenza vaccination requirements among US healthcare personnel. Infect Control Hosp Epidemiol 2012; 33:213-21. [PMID: 22314055 DOI: 10.1086/664056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To measure support for seasonal influenza vaccination requirements among US healthcare personnel (HCP) and its associations with attitudes regarding influenza and influenza vaccination and self-reported coverage by existing vaccination requirements. DESIGN Between June 1 and June 30, 2010, we surveyed a sample of US HCP ([Formula: see text]) recruited using an existing probability-based online research panel of participants representing the US general population as a sampling frame. SETTING General community. PARTICIPANTS Eligible HCP who (1) reported having worked as medical doctors, health technologists, healthcare support staff, or other health practitioners or who (2) reported having worked in hospitals, ambulatory care facilities, long-term care facilities, or other health-related settings. METHODS We analyzed support for seasonal influenza vaccination requirements for HCP using proportion estimation and multivariable probit models. RESULTS A total of 57.4% (95% confidence interval, 53.3%-61.5%) of US HCP agreed that HCP should be required to be vaccinated for seasonal influenza. Support for mandatory vaccination was statistically significantly higher among HCP who were subject to employer-based influenza vaccination requirements, who considered influenza to be a serious disease, and who agreed that influenza vaccine was safe and effective. CONCLUSIONS A majority of HCP support influenza vaccination requirements. Moreover, providing HCP with information about the safety of influenza vaccination and communicating that immunization of HCP is a patient safety issue may be important for generating staff support for influenza vaccination requirements.
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Harris KM, Maurer J, Uscher-Pines L. Seasonal Influenza Vaccine Use by Adults in the U.S.: A Snapshot from the End of the 2009-2010 Vaccination Season. Rand Health Q 2011; 1:20. [PMID: 28083207 PMCID: PMC4945207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In March 2010, the RAND Corporation surveyed a nationally representative sample of noninstitutionalized adults age 18 and over (n=4,040) to collect data on the receipt of seasonal influenza vaccine in the United States. This overview of the survey results will inform public health officials and other stakeholders about seasonal influenza vaccination of adults shortly following the end of the vaccination season. The information on flu vaccine uptake among population groups should be of interest to those working to increase uptake among different segments of the population, including those specifically recommended for the vaccine by the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention. Survey findings indicate that during the 2009-2010 vaccination season, 39 percent of all U.S. adults were vaccinated against seasonal influenza, 45 percent of adults specifically recommended for vaccination were vaccinated, and 48 percent of vaccinated adults received the vaccine at a doctor's office or medical clinic.
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Ramchand R, Griffin BA, Suttorp M, Harris KM, Morral A. Using a cross-study design to assess the efficacy of motivational enhancement therapy-cognitive behavioral therapy 5 (MET/CBT5) in treating adolescents with cannabis-related disorders. J Stud Alcohol Drugs 2011; 72:380-9. [PMID: 21513674 DOI: 10.15288/jsad.2011.72.380] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate how adolescents with marijuana problems who received a research-based treatment (five sessions of motivational enhancement therapy plus cognitive behavioral therapy [MET/CBT5]) in an experimental setting would have fared had they received exemplary community-based outpatient treatment. METHOD Twelve-month outcomes representing six domains (substance use problems, substance use frequency, emotional problems, illegal activities, recovery, and institutionalization) were assessed for youth who received MET/CBT5 in the Cannabis Youth Treatment study and youth who received outpatient treatment from one of three community-based programs selected for evidence of efficacy. Groups were matched on pretreatment characteristics using a propensity score weighting strategy. RESULTS Youth who received MET/CBT5 exhibited greater reductions in substance use frequency, substance use problems, and illegal behaviors 12 months after treatment entry than had they entered the community based outpatient programs. Results showed no evidence that youth who received MET/CBT5 would have fared better with respect to emotional problems, the likelihood of being institutionalized, or achieving a "recovery" status at 12 months had they received community-based treatments. CONCLUSIONS The community-based treatments used in this study have not been assessed relative to "treatment as usual" but were selected as "exemplary" models of adolescent treatment. There is no evidence in this study that these exemplary programs yielded superior 12-month outcomes for the treatment of adolescents with marijuana problems; youth receiving MET/CBT5 experienced greater reductions in substance use and illegal activities. Thus, MET/CBT5 may be a promising treatment for community-based providers to adopt to treat these clients.
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Affiliation(s)
- Rajeev Ramchand
- RAND Corporation, 1200 South Hayes Street, Arlington, Virginia 22202-5050, USA.
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Maurer J, Harris KM. Contact and communication with healthcare providers regarding influenza vaccination during the 2009-2010 H1N1 pandemic. Prev Med 2011; 52:459-64. [PMID: 21457726 DOI: 10.1016/j.ypmed.2011.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 11/02/2010] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The existence of two vaccines-seasonal and pandemic-created the potential for confusion and misinformation among consumers during the 2009-2010 vaccination season. We measured the frequency and nature of influenza vaccination communication between healthcare providers and adults for both seasonal and 2009 influenza A(H1N1) vaccination and quantified its association with uptake of the two vaccines. METHODS We analyzed data from 4040 U.S. adult members of a nationally representative online panel surveyed between March 4th and March 24th, 2010. We estimated prevalence rates and adjusted associations between vaccine uptake and vaccination-related communication between patients and healthcare providers using bivariate probit models. RESULTS 64.1% (95%-CI: 61.5%-66.6%) of adults did not receive any provider-issued influenza vaccination recommendation. Adults who received a provider-issued vaccination recommendation were 14.1 (95%-CI: -2.4 to 30.6) to 32.1 (95%-CI: 24.3-39.8) percentage points more likely to be vaccinated for influenza than adults without a provider recommendation, after adjusting for other characteristics associated with vaccination. CONCLUSIONS Influenza vaccination communication between healthcare providers and adults was relatively uncommon during the 2009-2010 pandemic. Increased communication could significantly enhance influenza vaccination rates.
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Affiliation(s)
- Jürgen Maurer
- Institute of Health Economics and Management, University of Lausanne, Lausanne, Switzerland.
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Uscher-Pines L, Maurer J, Harris KM. Racial and ethnic disparities in uptake and location of vaccination for 2009-H1N1 and seasonal influenza. Am J Public Health 2011; 101:1252-5. [PMID: 21566026 DOI: 10.2105/ajph.2011.300133] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To learn more about racial and ethnic disparities in influenza vaccination during the 2009-H1N1 pandemic, we examined nationally representative survey data of US adults. We found disparities in 2009-H1N1 vaccine uptake between Blacks and Whites (13.8% vs 20.4%); Whites and Hispanics had similar 2009-H1N1 vaccination rates. Physician offices were the dominant location for 2009-H1N1 and seasonal influenza vaccinations, especially among minorities. Our results highlight the need for a better understanding of how communication methods and vaccine distribution strategies affect vaccine uptake within minority communities.
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Uscher-Pines L, Maurer J, Kellerman A, Harris KM. Healthy young and middle age adults: what will it take to vaccinate them for influenza? Vaccine 2010; 28:7420-2. [PMID: 20837079 DOI: 10.1016/j.vaccine.2010.08.095] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/18/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
Starting in 2010, healthy adults age 19-49 will be recommended for annual influenza vaccination. Because they were not previously targeted, little is known about their vaccine-related attitudes and behaviors. Using nationally representative survey data from 2009 to 2010, we found that adults newly recommended for influenza vaccination (as compared to previously recommended groups) are less likely to believe flu vaccines are safe (44% vs. 63%), to have ever been vaccinated (36% vs. 64%), to be vaccinated following a healthcare provider recommendation (44% vs. 52%), and to visit a doctor's office during vaccination season (41% vs. 69%). To boost rates of influenza vaccination in this population, new and untraditional strategies aimed at encouraging first-time vaccination are needed.
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Affiliation(s)
- Lori Uscher-Pines
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202-5050, USA.
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Maurer J, Uscher-Pines L, Harris KM. Perceived seriousness of seasonal and A(H1N1) influenzas, attitudes toward vaccination, and vaccine uptake among U.S. adults: does the source of information matter? Prev Med 2010; 51:185-7. [PMID: 20510270 DOI: 10.1016/j.ypmed.2010.05.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [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: 03/09/2010] [Revised: 05/04/2010] [Accepted: 05/19/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We estimated uptake of seasonal and 2009 influenza A(H1N1) vaccine among U.S. adults and assessed their perceptions of the seriousness of both types of influenza and corresponding attitudes toward vaccination during the 2009-2010 influenza season. We further documented how vaccine uptake and attitudes varied by main information source used in vaccination decisions. METHODS We analyzed nationally representative data from U.S. adults age 18 and older (N=3,917) who completed an influenza vaccination survey between March 4th and March 24th, 2010. RESULTS 2009 influenza A(H1N1) vaccine uptake was considerably lower than seasonal vaccine uptake. While 2009 influenza A(H1N1) was perceived to be more serious than seasonal influenza, the pandemic vaccine was perceived to be less safe than the seasonal vaccine. Vaccine uptake and attitudes displayed large variation between adults who relied on different information sources for making their vaccination decisions. CONCLUSION The information launched during the response to the 2009 pandemic appear to have generated higher levels of concern about pandemic than seasonal influenza, but did not appear to reassure adults of the safety and value of the pandemic vaccine. Differences in perceived vaccination safety may be an important factor for explaining the lower uptake of pandemic relative to seasonal vaccine.
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Maurer J, Uscher-Pines L, Harris KM. Awareness of government seasonal and 2009 H1N1 influenza vaccination recommendations among targeted US adults: the role of provider interactions. Am J Infect Control 2010; 38:489-90. [PMID: 20591535 DOI: 10.1016/j.ajic.2010.04.210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 04/01/2010] [Accepted: 04/02/2010] [Indexed: 11/17/2022]
Abstract
We present nationally representative estimates regarding awareness of government vaccination recommendations for seasonal and 2009 H1N1 influenza among US adults for whom such vaccinations are specifically recommended. We also show how awareness varies based on interactions with health care providers. Despite comprehensive media coverage of the H1N1 pandemic, awareness of government influenza vaccination recommendations among adults is low. Provider-based vaccination counseling may help increase adults' awareness of federal vaccination recommendations.
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Maurer J, Harris KM. The scope and targeting of influenza vaccination reminders among US adults: evidence from a nationally representative survey. Arch Intern Med 2010; 170:390-392. [PMID: 20177045 DOI: 10.1001/archinternmed.2009.520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
BACKGROUND Vaccination against seasonal influenza is far from universal among groups specifically recommended for vaccine. There is little research to guide communication with patients about vaccination. OBJECTIVE To assess the utility of the self-reported intention to be vaccinated against seasonal influenza in predicting vaccine uptake, reasons for being unvaccinated, and willingness to be vaccinated based on a doctor's recommendation. METHODS We analyzed data from a subset of respondents (n = 1,527) specifically recommended by the ACIP for vaccination against seasonal influenza who participated in two national surveys of adults age 18 and older conducted in November 2008 and March 2009. RESULTS Over half who intended to be vaccinated had been vaccinated. Compared to those without intentions, those with intentions were one-fifth as likely (p < 0.01) to cite lack of need and five times more likely (p < 0.01) to cite "not getting around to being vaccinated" as main reasons for not being vaccinated. Roughly two-fifths of those without the intention to be vaccinated indicated a willingness to be vaccinated based on a doctor's recommendation. CONCLUSIONS Asking simple questions about the intention to be vaccinated against seasonal influenza may be an efficient means of identifying patients with whom extended discussion of vaccine benefits is warranted.
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Maurer J, Harris KM, Parker A, Lurie N. Does receipt of seasonal influenza vaccine predict intention to receive novel H1N1 vaccine: evidence from a nationally representative survey of U.S. adults. Vaccine 2009; 27:5732-4. [PMID: 19679219 DOI: 10.1016/j.vaccine.2009.07.080] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 07/17/2009] [Accepted: 07/22/2009] [Indexed: 11/26/2022]
Abstract
We analyze data on the intention of U.S. adults to receive novel H1N1 vaccine if available this fall, and studies the relationship between the intention to be vaccinated against novel H1N1 and the uptake of seasonal influenza vaccine last year. We surveyed a nationally representative sample of U.S. adults (n=2067) via the Internet between May 26th and June 8th, 2009. Our results imply a vaccination rate for novel H1N1 of 49.6%, which corresponds to roughly 115 million adult vaccinations. Moreover, novel H1N1 vaccination intentions are strongly associated with seasonal influenza vaccinations, suggesting common attitudinal barriers to both vaccines.
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Harris KM, Maurer J, Lurie N. Is getting influenza vaccine coverage data out during mid-season feasible? Evidence from a national survey of U.S. adults. Vaccine 2009; 27:3697-9. [DOI: 10.1016/j.vaccine.2009.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee BY, Mehrotra A, Burns RM, Harris KM. Alternative vaccination locations: who uses them and can they increase flu vaccination rates? Vaccine 2009; 27:4252-6. [PMID: 19406181 DOI: 10.1016/j.vaccine.2009.04.055] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 04/14/2009] [Accepted: 04/20/2009] [Indexed: 11/26/2022]
Abstract
Since many unvaccinated individuals do not regularly contact the traditional health care system, we sought to determine the role that alternative vaccination locations (e.g., workplaces and retail clinics) could play in increasing influenza vaccination coverage. Between February 14, 2008 and March 10, 2008, a 25-question influenza vaccine questionnaire was administered to a nationally representative, stratified sample of panelists. Our results found that while alternative locations are covering some segments not captured by the traditional health care system (e.g., younger, working, white individuals in metropolitan areas), they are not serving many other segments (e.g., minority, rural, or lower income patients).
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Affiliation(s)
- Bruce Y Lee
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Ramchand R, Griffin BA, Harris KM, McCaffrey DF, Morral AR. A prospective investigation of suicide ideation, attempts, and use of mental health service among adolescents in substance abuse treatment. Psychol Addict Behav 2009; 22:524-32. [PMID: 19071977 DOI: 10.1037/a0012969] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined suicide ideation, attempts, and subsequent mental health service among a sample of 948 youth from substance abuse treatment facilities across the United States. Youth were surveyed at intake and every 3 months for a 1-year period. Thirty percent of youth reported ideating in at least one interview, and 12% reported attempting suicide; almost half of all youth reported receiving outpatient mental health treatment at least once, and close to one-third of all youth reported being on prescription drugs for an emotional or behavioral problem. Higher levels of conduct disorder symptoms were associated with both ideation and attempts, while higher levels of depressive symptoms and being female were associated with ideation only. Among all youth, older youth were less likely to receive outpatient and prescription drug treatment, and Black and Hispanic youth were less likely to receive prescription drug treatment than White youth. Among youth who reported ideating, those with conduct disorder were less likely to receive prescription drug treatment 3 months later. These findings emphasize a high prevalence of suicide risk behavior in substance abuse treatment programs and provide insight into the specialized treatment youth in substance abuse treatment at risk for suicide currently receive.
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Affiliation(s)
- Rajeev Ramchand
- Drug Policy Research Center, RAND, Arlington Virginia 22202-5050, USA.
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Abstract
Aortitis is an uncommon infection which may occur in patients with preexisting atherosclerotic disease of the aorta. The clinical features in two patients presenting with fever and nonspecific symptoms are reviewed. In these patients, transesophageal echocardiographic features of wall thickening and false aneurysm formation were suggestive of the diagnosis of aortitis. Both patients were taken for surgical excision of the descending aorta and subsequently improved.
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Affiliation(s)
- K M Harris
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Harris KM, Beeuwkes Buntin M. Choosing a health care provider. Synth Proj Res Synth Rep 2008:29683. [PMID: 22051936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In a consumer-driven health care model, consumers, armed with information, would select providers based on quality and cost, thus increasing competition. This synthesis examines the availability of quality information and the evidence of how consumers use such information to choose a provider. Key findings include: information is publicly available from multiple sources regarding hospitals, but not individual doctors. Hospital information is predominantly made available online; but this limits awareness and access. Awareness is low overall, but highest among well-educated, healthy people. Even when consumers are aware of the data available, they rarely use it because they do not find it relevant: they do not foresee needing a hospital soon; are happy with their current provider; or did not find information pertinent to their specific health condition or hospital. While there is some evidence that hospitals that do poorly on public quality scorecards lose market share, there is better evidence that the providers themselves react to the quality scores by addressing care problems. Studies consistently show that consumers value health care quality and want information, but instead they rely on input from friends, family and their personal physicians about the quality of providers.
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Harris KM, Griffin BA, McCaffrey DF, Morral AR. Inconsistencies in self-reported drug use by adolescents in substance abuse treatment: implications for outcome and performance measurements. J Subst Abuse Treat 2008; 34:347-55. [PMID: 17614240 PMCID: PMC2720834 DOI: 10.1016/j.jsat.2007.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 04/25/2007] [Accepted: 05/01/2007] [Indexed: 11/17/2022]
Abstract
This article presents an analysis of logical inconsistencies in adolescents' reporting of recent substance use to assess the potential effect of inaccurate reporting on measures of treatment outcomes and program performance. We used data on 1,463 clients from 10 adolescent treatment programs to assess the relationship between inconsistent reports and various factors that contribute to program assignment and treatment outcomes. Our results suggest that inconsistencies do not arise at random. Instead, inconsistencies are associated with program assignment and factors widely considered to influence treatment outcomes, including age at first use, living situation, race/ethnicity, and mental distress. We also found a positive relationship between level of inconsistent reporting of drug use and self-reports of improvement over time on several well-established treatment outcome measures. Our study highlights the need for greater awareness on the potential impact of inaccuracies in the reporting of substance use on outcome and performance measurements and that for the development of methodologies to improve accuracy.
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