1
|
Locke E, Flores-Garcia Y, Mayer BT, MacGill RS, Borate B, Salgado-Jimenez B, Gerber MW, Mathis-Torres S, Shapiro S, King CR, Zavala F. Establishing RTS,S/AS01 as a benchmark for comparison to next-generation malaria vaccines in a mouse model. NPJ Vaccines 2024; 9:29. [PMID: 38341502 DOI: 10.1038/s41541-024-00819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
New strategies are needed to reduce the incidence of malaria, and promising approaches include vaccines targeting the circumsporozoite protein (CSP). To improve upon the malaria vaccine, RTS,S/AS01, it is essential to standardize preclinical assays to measure the potency of next-generation vaccines against this benchmark. We focus on RTS,S/AS01-induced antibody responses and functional activity in conjunction with robust statistical analyses. Transgenic Plasmodium berghei sporozoites containing full-length P. falciparum CSP (tgPb-PfCSP) allow two assessments of efficacy: quantitative reduction in liver infection following intravenous challenge, and sterile protection from mosquito bite challenge. Two or three doses of RTS,S/AS01 were given intramuscularly at 3-week intervals, with challenge 2-weeks after the last vaccination. Minimal inter- and intra-assay variability indicates the reproducibility of the methods. Importantly, the range of this model is suitable for screening more potent vaccines. Levels of induced anti-CSP antibody 2A10 equivalency were also associated with activity: 105 μg/mL (95% CI: 68.8, 141) reduced liver infection by 50%, whereas 285 μg/mL (95% CI: 166, 404) is required for 50% sterile protection from mosquito bite challenge. Additionally, the liver burden model was able to differentiate between protected and non-protected human plasma samples from a controlled human malaria infection study, supporting these models' relevance and predictive capability. Comparison in animal models of CSP-based vaccine candidates to RTS,S/AS01 is now possible under well controlled conditions. Assessment of the quality of induced antibodies, likely a determinant of durability of protection in humans, should be possible using these methods.
Collapse
Affiliation(s)
- Emily Locke
- Center for Vaccine Innovation and Access, PATH, Washington, DC, 20001, USA
| | - Yevel Flores-Garcia
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan T Mayer
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Randall S MacGill
- Center for Vaccine Innovation and Access, PATH, Washington, DC, 20001, USA
| | - Bhavesh Borate
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Berenice Salgado-Jimenez
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica W Gerber
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Shamika Mathis-Torres
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Shapiro
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Richter King
- Center for Vaccine Innovation and Access, PATH, Washington, DC, 20001, USA
| | - Fidel Zavala
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
2
|
Fiechtner L, Castro I, Cheng ER, Sharifi M, Gerber MW, Luo M, Goldmann D, Sandel M, Block J, Orav EJ, Taveras EM. Characteristics of achieving clinically important weight loss in two paediatric weight management interventions. Pediatr Obes 2021; 16:e12784. [PMID: 33734583 PMCID: PMC8355061 DOI: 10.1111/ijpo.12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine characteristics and lifestyle behaviours associated with achieving clinically important weight loss (CIWL) in two paediatric weight management interventions (PWMIs). METHODS We examined 1010 children enrolled in the STAR and Connect for Health trials. We defined achieving CIWL as any participant who had decreased their BMI z-score by ≥0.2 units over 1 year. Using log-binomial regression we examined associations of child and household characteristics and lifestyle behaviours with achieving CIWL. RESULTS In multivariable analyses, children with severe obesity had a lower likelihood of achieving CIWL compared to children without severe obesity (RR: 0.68 [95% CI: 0.49, 0.95]). Children who were ≥10 years were less likely to achieve CIWL (RR: 0.56 [95% CI: 0.42, 0.74]) vs those 2-6 years of age. Children who consumed <1 sugary beverage per day at the end of the intervention were more likely to achieve CIWL vs those who did not meet the goal (RR: 1.36 [95% CI 1.09-1.70]). CONCLUSION In this analysis of children enrolled in PWMIs, achieving CIWL was associated with younger age, not having severe obesity and consuming fewer sugary beverages at the end of the intervention. Focusing on intervening earlier in life, when a child is at a lower BMI, and reducing sugary beverages could allow for more effective PWMI's.
Collapse
Affiliation(s)
- Lauren Fiechtner
- Division of General Academic Pediatrics, Department of
Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston,
MA 02114, USA,Department of Gastroenterology and Nutrition, MassGeneral
Hospital for Children, 175 Cambridge St, 5 floor, Boston, MA 02114
USA
| | - Ines Castro
- Division of General Academic Pediatrics, Department of
Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston,
MA 02114, USA
| | - Erika R. Cheng
- Children’s Health Services Research, Department of
Pediatrics, Indiana University, 410 West 10 Street, Suite 2000,
Indianapolis, IN 46202, USA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics,
Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT
06520, USA
| | - Monica W. Gerber
- Division of General Academic Pediatrics, Department of
Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston,
MA 02114, USA,Fred Hutch Cancer Research Center, 1100 Fairview Ave. N.,
P.O. Box 19024, Seattle, WA 98109, USA
| | - Man Luo
- Division of General Academic Pediatrics, Department of
Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston,
MA 02114, USA
| | - Don Goldmann
- Institute for Healthcare Improvement, 53 State Street,
19 floor, Boston, MA 02109, USA
| | - Megan Sandel
- Department of Pediatrics, Boston University School of
Medicine, 88 E. Newton St Vose Hall, Boston, MA 02118, USA
| | - Jason Block
- Harvard Center for Population and Developmental Medicine,
401 Park Drive, Suite 401 East, Boston, MA 02215, USA,Department of Medicine, Brigham and Women’s
Hospital, 75 Francis Street, Boston, MA
| | - E. John Orav
- Department of Medicine, Brigham and Women’s
Hospital, 75 Francis Street, Boston, MA,,Harvard T.H. Chan School of Public Health, 677 Huntington
Ave, Boston, MA, 02115 USA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of
Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston,
MA 02114, USA,Harvard T.H. Chan School of Public Health, 677 Huntington
Ave, Boston, MA, 02115 USA
| |
Collapse
|
3
|
Simione M, Sharifi M, Gerber MW, Marshall R, Avalon E, Fiechtner L, Horan C, Orav EJ, Skelton J, Taveras EM. Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool. Health Qual Life Outcomes 2020; 18:179. [PMID: 32527270 PMCID: PMC7291578 DOI: 10.1186/s12955-020-01431-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/07/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incorporating family-centered care principles into childhood obesity interventions is integral for improved clinical decision making, better follow-through, and more effective communication that leads to better outcomes and greater satisfaction with services. The purpose of this study is to evaluate the psychometric properties of a modified version of the Family Centered-Care Assessment (mFCCA) tool and to assess the family-centeredness of two clinical-community childhood obesity interventions. METHODS Connect for Health was a randomized trial testing the comparative effectiveness of two interventions that enrolled 721 children, ages 2-12 years, with a body mass index (BMI) ≥ 85th percentile. The two arms were (1) enhanced primary care; and (2) enhanced primary care plus contextually-tailored, health coaching. At the end of the one-year intervention, the mFCCA was administered. We used Rasch analyses to assess the tool's psychometrics and examined differences between the groups using multiple linear regression. RESULTS 629 parents completed the mFCCA resulting in an 87% response rate. The mean (SD) age of children was 8.0 (3.0) years. The exploratory factor analysis with 24 items all loaded onto a single factor. The Rasch modeling demonstrated good reliability as evidenced by the person separation reliability coefficient (0.99), and strong validity as evidenced by the range of item difficulty and overall model fit. The mean (SD, range) mFCCA score was 4.14 (0.85, 1-5). Compared to parents of children in the enhanced primary care arm, those whose children were in the enhanced primary care plus health coaching arm had higher mFCCA scores indicating greater perception of family-centeredness (β = 0.61 units [95% CI: 0.49, 0.73]). CONCLUSIONS Using the mFCCA which demonstrated good psychometric properties for the assessment of family-centered care among parents of children with obesity, we found that individualized health coaching is a family-centered approach to pediatric weight management. TRIAL REGISTRATION Clinicaltrials.gov NCT02124460.
Collapse
Affiliation(s)
- Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, USA
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
4
|
Raghunandan R, Mayer BT, Flores-Garcia Y, Gerber MW, Gottardo R, Jhun H, Herrera SM, Perez-Ramos DW, Locke E, King CR, Zavala F. Characterization of two in vivo challenge models to measure functional activity of monoclonal antibodies to Plasmodium falciparum circumsporozoite protein. Malar J 2020; 19:113. [PMID: 32183833 PMCID: PMC7079517 DOI: 10.1186/s12936-020-03181-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/03/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND New strategies are needed to reduce the incidence of malaria, and promising approaches include the development of vaccines and monoclonal antibodies (mAbs) that target the circumsporozoite protein (CSP). To select the best candidates and speed development, it is essential to standardize preclinical assays to measure the potency of such interventions in animal models. METHODS Two assay configurations were studied using transgenic Plasmodium berghei expressing Plasmodium falciparum full-length circumsporozoite protein. The assays measured (1) reduction in parasite infection of the liver (liver burden) following an intravenous (i.v) administration of sporozoites and (2) protection from parasitaemia following mosquito bite challenge. Two human CSP mAbs, AB311 and AB317, were compared for their ability to inhibit infection. Multiple independent experiments were conducted to define assay variability and resultant impact on the ability to discriminate differences in mAb functional activity. RESULTS Overall, the assays produced highly consistent results in that all individual experiments showed greater functional activity for AB317 compared to AB311 as calculated by the dose required for 50% inhibition (ID50) as well as the serum concentration required for 50% inhibition (IC50). The data were then used to model experimental designs with adequate statistical power to rigorously screen, compare, and rank order novel anti-CSP mAbs. CONCLUSION The results indicate that in vivo assays described here can provide reliable information for comparing the functional activity of mAbs. The results also provide guidance regarding selection of the appropriate experimental design, dose selection, and group sizes.
Collapse
Affiliation(s)
- Rama Raghunandan
- PATH's Malaria Vaccine Initiative, 455 Massachusetts Avenue, NW, Suite 1000, Washington, DC, 20001, USA.
| | - Bryan T Mayer
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Yevel Flores-Garcia
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica W Gerber
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA
| | - Raphael Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchison Cancer Research Center, Seattle, WA, 98109, USA.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Hugo Jhun
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Vaccine Research and Development, Pfizer, Pearl River, NY, 10965, USA
| | - Sonia M Herrera
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel W Perez-Ramos
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Locke
- PATH's Malaria Vaccine Initiative, 455 Massachusetts Avenue, NW, Suite 1000, Washington, DC, 20001, USA
| | - C Richter King
- PATH's Malaria Vaccine Initiative, 455 Massachusetts Avenue, NW, Suite 1000, Washington, DC, 20001, USA.
| | - Fidel Zavala
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
5
|
Duggan MP, Taveras EM, Gerber MW, Horan CM, Oreskovic NM. Presence of Small Screens in Bedrooms Is Associated With Shorter Sleep Duration and Later Bedtimes in Children With Obesity. Acad Pediatr 2019; 19:515-519. [PMID: 30415077 DOI: 10.1016/j.acap.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/24/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of small screens in the sleep environment has been associated with shorter sleep duration and later bedtimes in children of normal weight, but the role these devices play in the sleep environment of overweight children is unclear. We sought to examine the association of small screen presence in the sleep environment with sleep behaviors among school-age children with obesity. METHODS We surveyed 526 parents of children ages 6 to 12 years old with a body mass index ≥95th percentile who were participating in a randomized trial to treat childhood obesity. Twelve months after enrollment, parents were asked how frequently their child slept with or near a small screen (defined as a cellphone, smartphone, or texting/chat-capable device). We used multivariable linear regression to examine associations of the presence of small screens with sleep duration, waketime, and bedtime. RESULTS Compared with children who rarely/never slept with a small screen in their bedroom, children who did so 1 day or more per week had shorter sleep durations and later bedtimes. After we adjusted for television presence in the bedroom, small screen presence was still associated with shorter sleep duration (-9.9 minutes; P = .02) and later weekday (8.8 minutes; P = .03) and weekend (12.0 minutes; P = .03) bedtimes. CONCLUSIONS Children with obesity and a small screen present in their sleep environment have shorter sleep durations and later bedtimes than children who rarely/never sleep with a small screen. Pediatricians should consider inquiring about small screens in the bedroom when counseling on healthy sleep and weight management habits.
Collapse
Affiliation(s)
- Michael P Duggan
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children
| | - Elsie M Taveras
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children; Department of Pediatrics (EM Taveras, NM Oreskovic), Harvard Medical School; Department of Nutrition (EM Taveras), Harvard T. H. Chan School of Public Health (EM Taveras), Boston, Mass
| | - Monica W Gerber
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children
| | - Christine M Horan
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children
| | - Nicolas M Oreskovic
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children; Department of Pediatrics (EM Taveras, NM Oreskovic), Harvard Medical School.
| |
Collapse
|
6
|
Abstract
Family-centered childhood obesity interventions have been found to be effective. We describe the use of telehealth for tailored behavior change support in a family-centered randomized trial. Children of 2 to 12 years with body mass index ≥85th percentile were randomized to Enhanced Primary Care (EPC) or Enhanced Primary Care + Coaching (EPC + C). EPC + C received 6 health coach visits (in-person or by video or phone call) over 1 year. Telehealth modalities included interactive text messaging, video calls, and an online community resource map. There were 360 children randomized to the EPC + C arm; 87% of parents completed ≥1 health coaching contacts. Overall, 93% parents were sent text messages of which 99% responded at least once. About 72% parents were very satisfied with the message content and 97% were satisfied with information provided about community health resources. The high level of participant engagement and satisfaction suggests that telehealth is feasible and acceptable in family-centered childhood obesity programs.
Collapse
Affiliation(s)
- Natasha Bala
- 1 Massachusetts General Hospital, Boston, MA, USA
| | - Sarah N Price
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Chrissy M Horan
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Monica W Gerber
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Elsie M Taveras
- 2 Massachusetts General Hospital for Children, Boston, MA, USA.,3 Harvard University, Boston, MA, USA
| |
Collapse
|
7
|
Baskind MJ, Taveras EM, Gerber MW, Fiechtner L, Horan C, Sharifi M. Parent-Perceived Stress and Its Association With Children's Weight and Obesity-Related Behaviors. Prev Chronic Dis 2019; 16:E39. [PMID: 30925139 PMCID: PMC6464048 DOI: 10.5888/pcd16.180368] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction Psychosocial stress is associated with obesity in adult and pediatric populations, but few studies have examined the relationship between parent-perceived stress and risk of child obesity and related behaviors. Methods We studied 689 pairs of parents and children aged 2 to 12 in Massachusetts with a body mass index (BMI) at or above the 85th percentile. Recruitment occurred from June 2014 to March 2015, and data collection ended in March 2016. We asked parents about their perceived stress and categorized responses as low, moderate, or high. We examined associations of parents’ stress with children’s BMI, expressed as a percentage of the 95th percentile (%BMIp95), and obesity-related behaviors by using multivariable regression models adjusted for child and parent characteristics. We stratified results by race/ethnicity, annual household income, and the child’s age. Results In fully adjusted models, the association between high versus low parent-reported stress and children’s %BMIp95 remained significant only for children in low-income households (β = 5.12; 95% confidence interval [CI], 0.94–9.30) and for non-Hispanic black children (β = 7.76; 95% CI, 1.85–13.66). Parents with high or moderate stress versus low stress were less likely to report that their children met recommendations for fast-food consumption (high stress, prevalence ratio [PR] = 0.79; 95% CI, 0.65–0.96; moderate stress, PR = 0.70; 95% CI, 0.59–0.82), but parents with high versus low stress were more likely to report meeting daily physical activity recommendations (PR = 1.21; 95% CI, 1.01–1.45). Conclusion Among children with overweight or obesity, parent-perceived stress was associated with fast-food consumption and physical activity. Parent-perceived stress was associated with child %BMIp95 among children in low-income households and non-Hispanic black children. Obesity interventions should consider parent-perceived stress and potential differences in the nature of stress experienced by parents of different racial/ethnic and socioeconomic backgrounds.
Collapse
Affiliation(s)
- Melanie J Baskind
- Department of Pediatrics, University of California-San Francisco, San Francisco, California
| | - Elsie M Taveras
- Harvard Medical School, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Lauren Fiechtner
- Harvard Medical School, Boston, Massachusetts.,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Division of Gastroenterology and Nutrition, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Chrissy Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064.
| |
Collapse
|
8
|
Young MC, Gerber MW, Ash T, Horan CM, Taveras EM. Neighborhood social cohesion and sleep outcomes in the Native Hawaiian and Pacific Islander National Health Interview Survey. Sleep 2018; 41:4996598. [DOI: 10.1093/sleep/zsy097] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marielle C Young
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Tayla Ash
- Departments of Social and Behavioral Sciences and Nutrition, Harvard T.H Chan School of Public Health, Boston, MA
| | - Christine M Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
9
|
Whooten RC, Perkins ME, Gerber MW, Taveras EM. Effects of Before-School Physical Activity on Obesity Prevention and Wellness. Am J Prev Med 2018; 54:510-518. [PMID: 29449135 PMCID: PMC5901979 DOI: 10.1016/j.amepre.2018.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The effects of Build Our Kids Success-a 12-week, 1-hour before-school physical activity program-on BMI and social-emotional wellness among kindergarten to eighth grade students was examined. STUDY DESIGN This was a nonrandomized trial. SETTING/PARTICIPANTS Participants were from 24 schools in Massachusetts; there were 707 children from kindergarten to eighth grade. INTERVENTION Children registered for Build Our Kids Success in 2015-2016 participated in a 2 days/week or 3 days/week program. Nonparticipating children served as controls. MAIN OUTCOME MEASURES At baseline and 12 weeks, study staff measured children's heights/weights; children aged ≥8 years completed surveys. Main outcomes were 12-week change in BMI z-score, odds of a lower BMI category at follow-up, and child report of social-emotional wellness. Analyses were completed in March-June 2017. RESULTS Follow-up BMI was obtained from 67% of children and self-reported surveys from 72% of age-eligible children. Children in the 3 days/week group had improvements in BMI z-score (-0.22, 95% CI= -0.31, -0.14) and this mean change was significantly different than the comparison group (-0.17 difference, 95% CI= -0.27, -0.07). Children in the 3 days/week group also had higher odds of being in a lower BMI category at follow-up (OR=1.35, 95% CI=1.12, 1.62); significantly different than the comparison group (p<0.01). Children in the 2 days/week program had no significant changes in BMI outcomes. Children in the 3 days/week group demonstrated improvement in their student engagement scores (0.79 units, p=0.05) and had nonsignificant improvements in reported peer relationships, affect, and life satisfaction versus comparison. The 2 days/week group had significant improvements in positive affect and vitality/energy versus comparison. CONCLUSIONS A 3 days/week before-school physical activity program resulted in improved BMI and prevented increases in child obesity. Both Build Our Kids Success groups had improved social-emotional wellness versus controls. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03190135.
Collapse
Affiliation(s)
- Rachel C Whooten
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Kraft Center for Community Health, Massachusetts General Hospital, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| |
Collapse
|
10
|
Valentine SE, Nobles CJ, Gerber MW, Vaewsorn A, Shtasel DL, Marques L. The association of posttraumatic stress disorder and chronic medical conditions by ethnicity. ACTA ACUST UNITED AC 2017; 5:227-241. [PMID: 28944108 DOI: 10.1037/lat0000076] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Our study extends the literature on associations between posttraumatic stress disorder (PTSD) and chronic medical conditions by assessing differences in the magnitude of these relations by ethnicity. We examined group differences in the magnitude of the relation between PTSD and chronic medical conditions (cardiovascular disease [CVD], hypertension, obesity, diabetes). We obtained data from Latino (n = 3,224) and non-Latino white (n = 4,180) respondents from the Collaborative Psychiatric Epidemiology Surveys. Logistic regression models were constructed to test for the modification of the effect of PTSD on chronic medical conditions by ethnicity, and then by nativity. Unadjusted models revealed significant interactions between Latino ethnicity and PTSD for odds of diabetes (OR = 2.18 [Latino] v. 0.81 [non-Latino white]), CVD (OR = 3.23 [Latino] v. 1.28 [non-Latino white]), and hypertension (OR = 1.61 [Latino] v. 0.98 [non-Latino white]). Among U.S.-born Latinos, we found a significant interaction between ethnicity and PTSD for odds of CVD (OR = 4.18 [Latino] v. 1.28 [non-Latino white]) and diabetes (OR = 2.27 [Latino] v. 0.81 [non-Latino white]). These findings attenuated in adjusted models with the exception of differences in PTSD and odds of diabetes among Latinos (including aggregated group & U.S.-born) compared to non-Latino whites. Our findings support the need for further research on the complex relations between PTSD and chronic conditions, including the investigation of conditional risk by Latino sub-groups.
Collapse
Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Carrie J Nobles
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Monica W Gerber
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Adin Vaewsorn
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Derri L Shtasel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| |
Collapse
|
11
|
Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Gerber MW, Orav EJ, Price SN, Sequist T, Slater D. Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:e171325. [PMID: 28586856 PMCID: PMC6075674 DOI: 10.1001/jamapediatrics.2017.1325] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes. OBJECTIVE To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. DESIGN, SETTING, AND PARTICIPANTS This 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts. INTERVENTIONS Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI ≥ 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. MAIN OUTCOMES AND MEASURES One-year changes in age- and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. RESULTS At 1 year, we obtained BMI z scores from 664 children (92%) and family-centered outcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baseline and 1.85 (0.58) at 1 year, an improvement of -0.06 BMI z score units (95% CI, -0.10 to -0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of -0.09 BMI z score units (95% CI, -0.13 to -0.05). However, there was no significant difference between the 2 intervention arms (difference, -0.02; 95% CI, -0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child's health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, -0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, -0.56 to 2.33). CONCLUSIONS AND RELEVANCE Two interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02124460.
Collapse
Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health; Boston, MA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Christine Horan
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Monica W. Gerber
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - E. John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah N. Price
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | | | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| |
Collapse
|
12
|
Fiechtner L, Puente GC, Sharifi M, Block JP, Price S, Marshall R, Blossom J, Gerber MW, Taveras EM. A Community Resource Map to Support Clinical-Community Linkages in a Randomized Controlled Trial of Childhood Obesity, Eastern Massachusetts, 2014-2016. Prev Chronic Dis 2017; 14:E53. [PMID: 28682745 PMCID: PMC5510302 DOI: 10.5888/pcd14.160577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Novel approaches to health care delivery that leverage community resources could improve outcomes for children at high risk for obesity. Community Context We describe the process by which we created an online interactive community resources map for use in the Connect for Health randomized controlled trial. The trial was conducted in the 6 pediatric practices that cared for the highest percentage of children with overweight or obesity within a large multi-specialty group practice in eastern Massachusetts. Methods By using semistructured interviews with parents and community partners and geographic information systems (GIS), we created and validated a community resource map for use in a randomized controlled trial for childhood obesity. We conducted semistructured interviews with 11 parents and received stakeholder feedback from 5 community partners, 2 pediatricians, and 3 obesity–built environment experts to identify community resources that could support behavior change. We used GIS databases to identify the location of resources. After the resources were validated, we created an online, interactive searchable map. We evaluated parent resource empowerment at baseline and follow-up, examined if the participant families went to new locations for physical activity and food shopping, and evaluated how satisfied the families were with the information they received. Outcome Parents, community partners, and experts identified several resources to be included in the map, including farmers markets, supermarkets, parks, and fitness centers. Parents expressed the need for affordable activities. Parent resource empowerment increased by 0.25 units (95% confidence interval, 0.21–0.30) over the 1-year intervention period; 76.2% of participants were physically active at new places, 57.1% of participant families shopped at new locations; and 71.8% reported they were very satisfied with the information they received. Interpretation Parents and community partners identified several community resources that could help support behavior change. Parent resource empowerment and use of community resources increased over the intervention period, suggesting that community resource mapping should inform future interventions.
Collapse
Affiliation(s)
- Lauren Fiechtner
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, 175 Cambridge St, 5th FL, Boston, MA 02114. .,Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gabriella C Puente
- Columbia University, the College of Physicians and Surgeons, New York, New York
| | - Mona Sharifi
- Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Jason P Block
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sarah Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Jeff Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
13
|
Abstract
This study aims to analyse the influence of adding natural zeolites (clinoptilolite) to the diet or litter of broilers and their effects on growth performance, carcass yield and litter quality. Three consecutive flocks of broilers were raised on the same sawdust litter, from d 1 to d 42 of age, and distributed in three treatments (control with no added zeolites, addition of 5 g/kg zeolite to diet and addition of 100 g/kg zeolites to litter). The addition of zeolites to the diet or litter did not affect growth performance or carcass yield. The addition of zeolites to the diet did not influence moisture content of the litter, ammonia volatilisation was reduced only in the first flock and pH of litter was reduced in the second and third flock. However, the addition of zeolites to the litter reduced moisture content, litter pH and ammonia volatilisation in all flocks analysed. The addition of 5 g/kg zeolite to the diet in three consecutive flocks was not effective in maintaining litter quality, whereas the addition of 100 g/kg natural zeolites to sawdust litter reduced litter moisture and ammonia volatilisation in three consecutive flocks raised on the same litter.
Collapse
Affiliation(s)
- A F Schneider
- a Animal Production and Food , Santa Catarina State University , Lages , Brazil
| | - D S De Almeida
- a Animal Production and Food , Santa Catarina State University , Lages , Brazil
| | - F M Yuri
- a Animal Production and Food , Santa Catarina State University , Lages , Brazil
| | - O F Zimmermann
- a Animal Production and Food , Santa Catarina State University , Lages , Brazil
| | - M W Gerber
- a Animal Production and Food , Santa Catarina State University , Lages , Brazil
| | - C E Gewehr
- a Animal Production and Food , Santa Catarina State University , Lages , Brazil
| |
Collapse
|
14
|
Nobles CJ, Thomas JJ, Valentine SE, Gerber MW, Vaewsorn AS, Marques L. Association of premenstrual syndrome and premenstrual dysphoric disorder with bulimia nervosa and binge-eating disorder in a nationally representative epidemiological sample. Int J Eat Disord 2016; 49:641-50. [PMID: 27206163 PMCID: PMC4942333 DOI: 10.1002/eat.22539] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 12/07/2015] [Revised: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Bulimia nervosa (BN) and binge-eating disorder (BED) are associated with significant health impairment. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) comprise both psychological (disturbances in mood and affect) and physiological (bloating and changes in appetite) symptoms that may trigger binge-eating and/or purging. METHOD Female participants were drawn from the Collaborative Psychiatric Epidemiological Surveys, conducted from 2001 to 2003. Weighted multivariable logistic regression modeled the association between lifetime PMS and PMDD and lifetime odds of BN or BED. RESULTS Among 8,694 participants, 133 (1.0%) had BN and 185 (1.8%) BED. Additionally, 366 (4.2%) had PMDD and 3,489 (42.4%) had PMS. Prevalence of PMDD and PMS were 17.4 and 55.4% among those with BN, 10.7 and 48.9% among those with BED and 3.4 and 59.1% among those with subthreshold BED. After adjustment for age, race/ethnicity, income, education, body mass index, age at menarche, birth control use, and comorbid mental health conditions, PMDD was associated with seven times the odds of BN (OR 7.2, 95% CI 2.3, 22.4) and PMS with two times the odds of BN (OR 2.5, 95% CI 1.1, 5.7). Neither PMDD nor PMS were significantly associated with BED. DISCUSSION Women with PMS and PMDD have a higher odds of BN, independent of comorbid mental health conditions. PMS and PMDD may be important comorbidities to BN to consider in clinical settings, and future research should investigate whether PMS and PMDD affect the onset and duration of bulimic symptoms as well as the potential for shared risk factors across disorders. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:641-650).
Collapse
Affiliation(s)
- Carrie J Nobles
- Community Psychiatry PRIDE, Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, Massachusetts, 02150
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J Thomas
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place Suite 200, Boston, Massachusetts, 02114
| | - Sarah E Valentine
- Community Psychiatry PRIDE, Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, Massachusetts, 02150
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Monica W Gerber
- Community Psychiatry PRIDE, Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, Massachusetts, 02150
| | - Adin S Vaewsorn
- Community Psychiatry PRIDE, Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, Massachusetts, 02150
| | - Luana Marques
- Community Psychiatry PRIDE, Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, Massachusetts, 02150
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Nobles CJ, Valentine SE, Borba CPC, Gerber MW, Shtasel DL, Marques L. Black-white disparities in the association between posttraumatic stress disorder and chronic illness. J Psychosom Res 2016; 85:19-25. [PMID: 27212665 PMCID: PMC4879687 DOI: 10.1016/j.jpsychores.2016.03.126] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Non-Latino blacks experience a higher proportion of chronic illness and associated disabilities than non-Latino whites. Posttraumatic stress disorder (PTSD) is associated with a greater risk of chronic illness, although few studies have investigated whether the interaction of PTSD with racial disparities may lead to a greater risk of chronic illness among blacks with PTSD than among whites with PTSD. METHODS We evaluated data from the population-based National Survey of American Life and the National Comorbidity Survey Replication to investigate the association between race, lifetime PTSD and self-reported chronic illness. Weighted linear and Poisson regression models assessed differences in the magnitude of association between PTSD and chronic illness by race on both the additive and multiplicative scales. RESULTS The magnitude of the association between lifetime PTSD and diabetes was greater among blacks (RD 0.07, 95% CI 0.02, 0.11; RR 1.9, 95% CI 1.4, 2.5) than whites (RD 0.004, 95% CI -0.02, 0.03; RR 1.2, 95% CI 0.7, 1.9) on the additive (p=0.017) scale. The magnitude of the association between lifetime PTSD and heart disease was greater among blacks (RD 0.09, 95% CI 0.05, 0.13) than whites (RD 0.04, 95% CI 0.01, 0.07) on the additive scale at a level approaching significance (p=0.051). CONCLUSION A lifetime history of PTSD was associated with a significantly greater risk of diabetes among blacks as compared to whites. These findings suggest that continuous exposure to racial inequalities may be associated with a greater risk of PTSD-related health sequela.
Collapse
Affiliation(s)
- Carrie J Nobles
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA.
| | - Sarah E Valentine
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Christina P C Borba
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Monica W Gerber
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA
| | - Derri L Shtasel
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, 70 Everett Ave. Suite 516, Chelsea, MA 02150, USA; Harvard Medical School, USA
| |
Collapse
|
16
|
LeBlanc NJ, Dixon L, Robinaugh DJ, Valentine SE, Bosley HG, Gerber MW, Marques L. PTSD and Romantic Relationship Satisfaction: Cluster- and Symptom-Level Analyses. J Trauma Stress 2016; 29:259-67. [PMID: 27163435 PMCID: PMC5352989 DOI: 10.1002/jts.22100] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder-level approach is problematic for trauma theorists who posit symptom-level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist-Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time-lagged mixed-effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom-level mechanisms.
Collapse
Affiliation(s)
- Nicole J. LeBlanc
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Louise Dixon
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E. Valentine
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Hannah G. Bosley
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Monica W. Gerber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Valentine SE, Gerber MW, Nobles CJ, Shtasel DL, Marques L. Longitudinal Study of Mental Health and Pain-Related Functioning Following a Motor Vehicle Collision. Health Psychol 2016; 35:2016-13812-001. [PMID: 26998734 PMCID: PMC5031508 DOI: 10.1037/hea0000329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Relations between mental and physical health symptoms are well-established in the literature on recovery following motor vehicle collisions (MVCs). To understand the temporal sequencing and evolution of these relations, we examined the bidirectional association between mental and physical health symptoms at 4 and 16 weeks following a MVC. METHODS The sample consisted of 103 participants recruited through public MVC police reports. The study included self-report assessments for posttraumatic stress symptoms, depressive symptoms, bodily pain, and role limitations attributable to physical health. A series of multivariable linear regression analyses were conducted to estimate the associations between these mental and physical health outcomes. RESULTS The analysis revealed that mental health symptoms at 4 weeks post-MVC were associated with higher bodily pain at 16 weeks post-MVC (PTSD symptoms: β = -0.74, 95% CI: -1.06, -0.42; depressive symptoms: β = -1.34, 95% CI: -1.90, -0.78), but not higher health-related role limitations. Physical health symptoms at 4 weeks post-MVC were not associated with PTSD or depressive symptoms at 16 weeks post-MVC. CONCLUSIONS The results indicate the predictive strength of mental health symptoms at 4 weeks post-MVC in identifying individuals at risk for bodily pain at 16 weeks and shed light on the temporal sequencing of how relations between physical and mental health symptoms emerge over time. This suggests that early assessment of mental health symptoms may have significant implications for the treatment of these patients. (PsycINFO Database Record
Collapse
Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Monica W. Gerber
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Carrie J. Nobles
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Derri L. Shtasel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|