1
|
Nanayakkara KDL, Viswanath NG, Wilson M, Mahawar K, Baig S, Rosenberg J, Rosen M, Sheen AJ, Goodman E, Prabhu A, Madhok B. An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study. Hernia 2023; 27:1235-1243. [PMID: 37310493 DOI: 10.1007/s10029-023-02818-8] [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: 12/11/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. METHODS A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). RESULTS A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. CONCLUSION This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.
Collapse
Affiliation(s)
- K D L Nanayakkara
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK.
| | - N G Viswanath
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK
| | - M Wilson
- Forth Valley NHS Trust, Larbert, UK
| | - K Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - S Baig
- Belle Vue Hospital, Kolkata, India
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Rosen
- Cleveland Clinic, Cleveland, USA
| | - A J Sheen
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - A Prabhu
- Cleveland Clinic, Cleveland, USA
| | - B Madhok
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK
| |
Collapse
|
2
|
García Campelo M, Zhou C, Ramalingam S, Lin H, Kim T, Riely G, Mekhail T, Nguyen D, Biber J, Romero H, Goodman E, Popat S, Jänne P. EP08.02-171 PRO-CTCAE Analysis of Mobocertinib in EGFR Exon 20 Insertion‒Positive Metastatic Non‒Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.853] [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: 10/14/2022]
|
3
|
Agarwal K, Maki KA, Vizioli C, Carnell S, Goodman E, Hurley M, Harris C, Colwell R, Steele K, Joseph PV. The Neuro-Endo-Microbio-Ome Study: A Pilot Study of Neurobiological Alterations Pre- Versus Post-Bariatric Surgery. Biol Res Nurs 2022; 24:362-378. [PMID: 35426747 PMCID: PMC9343885 DOI: 10.1177/10998004221085976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Plausible phenotype mechanisms following bariatric surgery include changes in neural and gastrointestinal physiology. This pilot study aims to investigate individual and combined neurologic, gut microbiome, and plasma hormone changes pre- versus post-vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), and medical weight loss (MWL). We hypothesized post-weight loss phenotype would be associated with changes in central reward system brain connectivity, differences in postprandial gut hormone responses, and increased gut microbiome diversity. METHODS Subjects included participants undergoing VSG, n = 7; RYGB, n = 9; and MWL, n = 6. Ghrelin, glucagon-like peptide-1, peptide-YY, gut microbiome, and resting state functional magnetic resonance imaging (rsfMRI; using fractional amplitude of low-frequency fluctuations [fALFF]) were measured pre- and post-intervention in fasting and fed states. We explored phenotype characterization using clustering on gut hormone, microbiome, and rsfMRI datasets and a combined analysis. RESULTS We observed more widespread fALFF differences post-bariatric surgery versus post-MWL. Decreased post-prandial fALFF was seen in food reward regions post-RYGB. The highest number of microbial taxa that increased post-intervention occurred in the RYGB group, followed by VSG and MWL. The combined hormone, microbiome, and MRI dataset most accurately clustered samples into pre- versus post-VSG phenotypes followed by RYGB subjects. CONCLUSION The data suggest surgical weight loss (VSG and RYGB) has a bigger impact on brain and gut function versus MWL and leads to lesser post-prandial activation of food-related neural circuits. VSG subjects had the greatest phenotype differences in interactions of microbiome, rsfMRI, and gut hormone features, followed by RYGB and MWL. These results will inform future prospective research studying gut-brain changes post-bariatric surgery.
Collapse
Affiliation(s)
- Khushbu Agarwal
- National Institute on Alcohol Abuse and
Alcoholism, National Institutes of Health, Bethesda, MD, USA
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Katherine A. Maki
- Translational Biobehavioral and Health
Disparities Branch, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Carlotta Vizioli
- National Institute on Alcohol Abuse and
Alcoholism, National Institutes of Health, Bethesda, MD, USA
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Susan Carnell
- Department of Psychiatry and Behavioral
Sciences, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Ethan Goodman
- Department of Psychiatry and Behavioral
Sciences, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Matthew Hurley
- Department of Psychiatry and Behavioral
Sciences, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Civonnia Harris
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Rita Colwell
- CosmosID Inc., Rockville, MD, USA
- Center for Bioinformatics and Computational
Biology, University of Maryland Institute for Advanced
Computer Studies, University of Maryland, College Park, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kimberley Steele
- Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA
| | - Paule V. Joseph
- National Institute on Alcohol Abuse and
Alcoholism, National Institutes of Health, Bethesda, MD, USA
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
4
|
Bray CE, Witcher KG, Adekunle-Adegbite D, Ouvina M, Witzel M, Hans E, Tapp ZM, Packer J, Goodman E, Zhao F, Chunchai T, O'Neil S, Chattipakorn SC, Sheridan J, Kokiko-Cochran ON, Askwith C, Godbout JP. Chronic Cortical Inflammation, Cognitive Impairment, and Immune Reactivity Associated with Diffuse Brain Injury Are Ameliorated by Forced Turnover of Microglia. J Neurosci 2022; 42:4215-4228. [PMID: 35440489 PMCID: PMC9121837 DOI: 10.1523/jneurosci.1910-21.2022] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with an increased risk of cognitive, psychiatric, and neurodegenerative complications that may develop after injury. Increased microglial reactivity following TBI may underlie chronic neuroinflammation, neuropathology, and exaggerated responses to immune challenges. Therefore, the goal of this study was to force turnover of trauma-associated microglia that develop after diffuse TBI and determine whether this alleviated chronic inflammation, improved functional recovery and attenuated reduced immune reactivity to lipopolysaccharide (LPS) challenge. Male mice received a midline fluid percussion injury (mFPI) and 7 d later were subjected to a forced microglia turnover paradigm using CSF1R antagonism (PLX5622). At 30 d postinjury (dpi), cortical gene expression, dendritic complexity, myelin content, neuronal connectivity, cognition, and immune reactivity were assessed. Myriad neuropathology-related genes were increased 30 dpi in the cortex, and 90% of these gene changes were reversed by microglial turnover. Reduced neuronal connectivity was evident 30 dpi and these deficits were attenuated by microglial turnover. TBI-associated dendritic remodeling and myelin alterations, however, remained 30 dpi independent of microglial turnover. In assessments of functional recovery, increased depressive-like behavior, and cognitive impairment 30 dpi were ameliorated by microglia turnover. To investigate microglial priming and reactivity 30 dpi, mice were injected intraperitoneally with LPS. This immune challenge caused prolonged lethargy, sickness behavior, and microglial reactivity in the TBI mice. These extended complications with LPS in TBI mice were prevented by microglia turnover. Collectively, microglial turnover 7 dpi alleviated behavioral and cognitive impairments associated with microglial priming and immune reactivity 30 dpi.SIGNIFICANCE STATEMENT A striking feature of traumatic brain injury (TBI), even mild injuries, is that over 70% of individuals have long-term neuropsychiatric complications. Chronic inflammatory processes are implicated in the pathology of these complications and these issues can be exaggerated by immune challenge. Therefore, our goal was to force the turnover of microglia 7 d after TBI. This subacute 7 d postinjury (dpi) time point is a critical transitional period in the shift toward chronic inflammatory processes and microglia priming. This forced microglia turnover intervention in mice attenuated the deficits in behavior and cognition 30 dpi. Moreover, microglia priming and immune reactivity after TBI were also reduced with microglia turnover. Therefore, microglia represent therapeutic targets after TBI to reduce persistent neuroinflammation and improve recovery.
Collapse
Affiliation(s)
- Chelsea E Bray
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Kristina G Witcher
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | | | - Michelle Ouvina
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Mollie Witzel
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Emma Hans
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Zoe M Tapp
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Jonathan Packer
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Ethan Goodman
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Fangli Zhao
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
| | - Titikorn Chunchai
- Neurophysiology unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Shane O'Neil
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Siriporn C Chattipakorn
- Neurophysiology unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - John Sheridan
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Olga N Kokiko-Cochran
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| | - Candice Askwith
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
| | - Jonathan P Godbout
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
- Chronic Brain Injury Program, The Ohio State University, Columbus, Ohio 43210
- Institute for Behavioral Medicine Research, The Ohio State University, Columbus, Ohio 43210
| |
Collapse
|
5
|
Cordner ZA, Khambadkone SG, Zhu S, Bai J, Forti RR, Goodman E, Tamashiro KL, Ross CA. Ankyrin-G Heterozygous Knockout Mice Display Increased Sensitivity to Social Defeat Stress. Complex Psychiatry 2021; 7:71-79. [DOI: 10.1159/000518819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
The <i>ANK3</i> locus has been repeatedly found to confer an increased risk for bipolar disorder. <i>ANK3</i> codes for Ankyrin-G (Ank-G), a scaffold protein concentrated at axon initial segments, nodes of Ranvier, and dendritic spines, where it organizes voltage-gated sodium and potassium channels and cytoskeletal proteins. Mice with homozygous conditional knockout of Ank-G in the adult forebrain display hyperactivity and reduced anxiety-like behaviors, responsive to mood stabilizers. Their behavior switches to a depression-like phenotype when exposed to chronic social defeat stress (SDS), and then spontaneously reverts to baseline hyperactivity. Ank-G heterozygous conditional knockouts (Ank-G Het cKO) have not previously been characterized. Here, we describe the behavior of Ank-G Het cKO mice compared to littermate controls in the open field, elevated plus maze, and forced swim test, under both unstressed and stressed conditions. We found that Ank-G Het cKO is not significantly different from controls at baseline or after chronic SDS. The chronic stress-induced “depression-like” behavioral phenotype is persistent for at least 28 days and is responsive to fluoxetine. Strikingly, Ank-G Het cKO mice display increased sensitivity to a short duration SDS, which does not affect controls. The heterozygous Ank-G genetic model may provide novel insights into the role of Ank-G in the pathophysiology of stress sensitivity and “depression-like” phenotypes and could be useful for studying Ank-G-related gene-environment interactions.
Collapse
|
6
|
Campelo MG, Zhu Y, Lin H, Pérol M, Jahanzeb M, Popat S, Zhang P, Goodman E, Camidge D. 1305P Health-related quality of life (HRQoL) in a phase III study of first-line brigatinib (BRG) vs crizotinib (CRZ) in NSCLC: Updated results from ALTA-1L. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1619] [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: 11/28/2022] Open
|
7
|
Lakins M, Munoz-Olaya J, Jones D, Giambalvo R, Hall C, Knudsen A, Masque Soler N, Pechouckova S, Goodman E, Gradinaru C, Koers A, Marshall S, Wydro M, Wollerton F, Batey S, Gliddon D, Davies M, Morrow M, Tuna M, Brewis N. Optimising TNFRSF agonism and checkpoint blockade with a novel CD137/PD-L1 bispecific antibody. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487.014] [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: 11/13/2022] Open
|
8
|
Morales-Raveendran E, Goodman E, West E, Cone JE, Katz C, Weiss J, Feldman JM, Harrison D, Markowitz S, Federman A, Wisnivesky JP. Associations between asthma trigger reports, mental health conditions, and asthma morbidity among world trade center rescue and recovery workers. J Asthma 2018; 56:833-840. [PMID: 30073876 DOI: 10.1080/02770903.2018.1502300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r2=0.05, p < 0.01), physical activity (partial r2=0.03, p < 0.01) and air pollution (partial r2=0.02, p = 0.04) subscales while PD was significantly associated with air pollution (partial r2=0.03, p = 0.03) and general allergens (partial r2=0.02, p = 0.03). ATI subscales explained a large percentage of variance in asthma control (r2=0.37, p < 0.01) and quality of life scores (r2=0.40, p < 0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r2= 0.11, p = 0.72) and AQLQ (partial r2=0.14, p = 0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.
Collapse
Affiliation(s)
- E Morales-Raveendran
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,c Ferkauf Graduate School of Psychology, Yeshiva University , Bronx , NY , USA
| | - E Goodman
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E West
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J E Cone
- b New York City Department of Health and Mental Hygiene, World Trade Center Health Registry , New York , NY , USA
| | - C Katz
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J Weiss
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J M Feldman
- c Ferkauf Graduate School of Psychology, Yeshiva University , Bronx , NY , USA.,d Department of Pediatrics (Academic General Pediatrics), Albert Einstein College of Medicine/Children's Hospital at Montefiore , Bronx , NY , USA
| | - D Harrison
- e Department of Medicine, New York University , New York , NY , USA
| | - S Markowitz
- f Queens College, City University of New York , Flushing , NY , USA
| | - Alex Federman
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - J P Wisnivesky
- a Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,g Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| |
Collapse
|
9
|
Shahmarvand N, Oak JS, Cascio MJ, Alcasid M, Goodman E, Medeiros BC, Arber DA, Zehnder JL, Ohgami RS. A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D-dimer levels are a sensitive indicator of acute promyelocytic leukemia. Int J Lab Hematol 2017; 39:375-383. [DOI: 10.1111/ijlh.12636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - J. S. Oak
- Stanford University; Stanford CA USA
| | - M. J. Cascio
- Oregon Health and Science University; Portland OR USA
| | | | - E. Goodman
- Virginia Office of the Chief Medical Examiner; Roanoke VA USA
| | | | | | | | | |
Collapse
|
10
|
Mindlis I, Morales-Raveendran E, Goodman E, Xu K, Vila-Castelar C, Keller K, Crawford G, James S, Katz CL, Crowley LE, de la Hoz RE, Markowitz S, Wisnivesky JP. Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers. J Asthma 2016; 54:723-731. [PMID: 27905829 DOI: 10.1080/02770903.2016.1263650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. METHODS Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. RESULTS Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). CONCLUSIONS There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.
Collapse
Affiliation(s)
- I Mindlis
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E Morales-Raveendran
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E Goodman
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - K Xu
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - C Vila-Castelar
- b The Graduate Center, City University of New York , New York , NY , USA.,c Queens College, City University of New York , Flushing , NY , USA
| | - K Keller
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - G Crawford
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - S James
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - C L Katz
- d Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - L E Crowley
- e Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - R E de la Hoz
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - S Markowitz
- c Queens College, City University of New York , Flushing , NY , USA
| | - J P Wisnivesky
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| |
Collapse
|
11
|
Gilthorpe MS, Dahly DL, Tu YK, Kubzansky LD, Goodman E. Growth Mixture Models in Epidemiology and the Impact of an Incorrectly Specified Random Structure on Model Inferences. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.193] [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: 11/14/2022] Open
|
12
|
Gilthorpe MS, Dahly DL, Tu YK, Kubzansky LD, Goodman E. Challenges in modelling the random structure correctly in growth mixture models and the impact this has on model mixtures. J Dev Orig Health Dis 2014; 5:197-205. [PMID: 24901659 PMCID: PMC4098080 DOI: 10.1017/s2040174414000130] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/26/2014] [Accepted: 01/30/2014] [Indexed: 12/03/2022]
Abstract
Lifecourse trajectories of clinical or anthropological attributes are useful for identifying how our early-life experiences influence later-life morbidity and mortality. Researchers often use growth mixture models (GMMs) to estimate such phenomena. It is common to place constrains on the random part of the GMM to improve parsimony or to aid convergence, but this can lead to an autoregressive structure that distorts the nature of the mixtures and subsequent model interpretation. This is especially true if changes in the outcome within individuals are gradual compared with the magnitude of differences between individuals. This is not widely appreciated, nor is its impact well understood. Using repeat measures of body mass index (BMI) for 1528 US adolescents, we estimated GMMs that required variance-covariance constraints to attain convergence. We contrasted constrained models with and without an autocorrelation structure to assess the impact this had on the ideal number of latent classes, their size and composition. We also contrasted model options using simulations. When the GMM variance-covariance structure was constrained, a within-class autocorrelation structure emerged. When not modelled explicitly, this led to poorer model fit and models that differed substantially in the ideal number of latent classes, as well as class size and composition. Failure to carefully consider the random structure of data within a GMM framework may lead to erroneous model inferences, especially for outcomes with greater within-person than between-person homogeneity, such as BMI. It is crucial to reflect on the underlying data generation processes when building such models.
Collapse
Affiliation(s)
- M. S. Gilthorpe
- Division of Epidemiology & Biostatistics, School
of Medicine, University of Leeds,
Leeds, UK
| | - D. L. Dahly
- Department of Epidemiology and Public Health, University
College Cork, Cork, Ireland
| | - Y.-K. Tu
- Institute of Epidemiology & Preventive Medicine,
College of Public Health, National Taiwan
University, Taipei, Taiwan
| | - L. D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard
School of Public Health, Boston,
MA, USA
| | - E. Goodman
- Mass General Hospital for Children, Department of
Pediatrics, Harvard Medical School,
Boston, MA, USA
| |
Collapse
|
13
|
Ulirsch J, Ballina L, Soward A, Rossi C, Hauda W, Holbrook D, Wheeler R, Foley K, Batts J, Collette R, Goodman E, McLean S. Pain and somatic symptoms are sequelae of sexual assault: Results of a prospective longitudinal study. Eur J Pain 2013; 18:559-66. [DOI: 10.1002/j.1532-2149.2013.00395.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 01/27/2023]
Affiliation(s)
- J.C. Ulirsch
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
| | - L.E. Ballina
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
| | - A.C. Soward
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
| | - C. Rossi
- Forensic Nursing Program; Medicine; Cone Health System; Greensboro USA
| | - W. Hauda
- Pediatric Emergency Medicine; Inova Fairfax Hospital; Falls Church; USA
| | - D. Holbrook
- Forensic Nursing Program; Mercy Medical Center; Baltimore USA
| | - R. Wheeler
- Department of Emergency Medicine; University of North Carolina; Chapel Hill USA
| | - K.A. Foley
- Department of Emergency Medicine; Sentara Norfolk Hospital; USA
| | - J. Batts
- Department of Emergency Medicine; Carolinas Medical Center; Charlotte USA
| | - R. Collette
- SANE Program; Mission Health System; Asheville USA
| | - E. Goodman
- SANE Program; Wake Forest Baptist Medical Center; Winston-Salem USA
| | - S.A. McLean
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
- Department of Emergency Medicine; University of North Carolina; Chapel Hill USA
| |
Collapse
|
14
|
Llaguna OH, Avgerinos DV, Nagda P, Elfant D, Leitman IM, Goodman E. Does Prophylactic Biologic Mesh Placement Protect Against the Development of Incisional Hernia in High-risk Patients? World J Surg 2011; 35:1651-5. [DOI: 10.1007/s00268-011-1131-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Woolston A, Baxter PD, Gilthorpe MS, Goodman E, Tu YK. An analysis of the structure of the components of metabolic syndrome using matroids. Br J Soc Med 2009. [DOI: 10.1136/jech.2009.096719r] [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: 11/03/2022]
|
16
|
McPherson M, Foster A, Goodman E. Defining physician advocacy for adolescent reproductive health: results from a mixed methods study with adolescent medicine physicians. Contraception 2009. [DOI: 10.1016/j.contraception.2009.05.111] [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: 11/30/2022]
|
17
|
Chen B, Goodman E, Lu Z, Bandyopadhyay A, Magraw C, He T, Raghavan S. Function of beta1 integrin in oral epithelia and tooth bud morphogenesis. J Dent Res 2009; 88:539-44. [PMID: 19587159 PMCID: PMC2882240 DOI: 10.1177/0022034509338008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 02/06/2009] [Accepted: 02/13/2009] [Indexed: 01/06/2023] Open
Abstract
Integrin beta1 is critical for basement membrane organization and hair follicle morphogenesis in the skin epidermis; however, less is known about its function in the developing oral epithelium. Since the skin and oral epithelia share structural similarity, we hypothesized that beta1 integrin function would be critical for the normal development of oral epithelium and tooth buds. The conditional (oral mucosa-specific) beta1 integrin knockout (KO) mice displayed severe disruption of the basement membrane of the tongue epithelium and developing tooth buds. Interestingly, unlike the developing hair follicles, early morphological development of the KO molar tooth buds was normal. However, subsequent morphogenetic events, such as cusp formation, cervical loop down-growth, and ameloblast polarization, did not occur normally. Primary KO oral keratinocytes showed defective cell spreading and robust focal adhesions. Our studies indicate that beta1 integrin plays an essential role in the normal development of the oral epithelium and its appendages.
Collapse
Affiliation(s)
- B. Chen
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - E. Goodman
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - Z. Lu
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - A. Bandyopadhyay
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - C. Magraw
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - T. He
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
| | - S. Raghavan
- Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Columbia University, New York, NY 10032, USA
- Department of Dermatology, Columbia University, New York, NY 10032, USA
| |
Collapse
|
18
|
Godoy R, Goodman E, Reyes-Garcia V, Eisenberg DTA, Leonard WR, Huanca T, McDade TW, Tanner S, Jha N. Rain, temperature, and child-adolescent height among Native Amazonians in Bolivia. Ann Hum Biol 2008; 35:276-93. [PMID: 18568593 DOI: 10.1080/03014460801968540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Global climate change and recent studies on early-life origins of well-being suggest that climate events early in life might affect health later in life. AIM The study tested hypotheses about the association between the level and variability of rain and temperature early in life on the height of children and adolescents in a foraging-farming society of native Amazonians in Bolivia (Tsimane'). SUBJECT AND METHODS Measurements were taken for 525 children aged 2-12 and 218 adolescents aged 13-23 in 13 villages in 2005. Log of standing height was regressed on mean annual level and mean intra-annual monthly coefficient of variation (CV) of rain and mean annual level of temperature during gestation, birth year, and ages 2-4. Controls include age, quinquennium and season of birth, parent's attributes, and dummy variables for surveyors and villages. RESULTS Climate variables were only related with the height of boys age 2-12. The level and CV of rain during birth year and the CV of rain and level of temperature during ages 2-4 were associated with taller stature. There were no secular changes in temperature (1973-2005) or rain (1943-2005). CONCLUSION The height of young females and males is well protected from climate events, but protection works less well for boys ages 2-12.
Collapse
Affiliation(s)
- R Godoy
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts 02454, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Lee DE, Koppaka S, Kishore P, Li W, Tonelli J, Scherer PE, Goodman E, Hawkins M. 79 ADIPOSE TISSUE MACROPHAGES EXPRESS HIGH LEVELS OF PLASMINOGEN ACTIVATOR INHIBITOR 1 IN HUMANS AND ARE HIGHLY RESPONSIVE TO INCREASED FREE FATTY ACIDS. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0015.157] [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: 11/18/2022]
|
20
|
Lee DE, Koppaka S, Kishore P, Li W, Tonelli J, Scherer P, Goodman E, Hawkins M. Adipose Tissue Macrophages Express High Levels of Plasminogen Activator Inhibitor 1 in Humans and are Highly Responsive to Increased Free Fatty Acids. J Investig Med 2006. [DOI: 10.1177/108155890605402s158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- D.-E. Lee
- Albert Einstein College of Medicine, Bronx, NY
| | - S. Koppaka
- Albert Einstein College of Medicine, Bronx, NY
| | - P. Kishore
- Albert Einstein College of Medicine, Bronx, NY
| | - W. Li
- Albert Einstein College of Medicine, Bronx, NY
| | - J. Tonelli
- Albert Einstein College of Medicine, Bronx, NY
| | | | - E. Goodman
- Albert Einstein College of Medicine, Bronx, NY
| | - M. Hawkins
- Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
21
|
Abstract
AIM The study analysed variability in physical stature, weight, and body mass index (BMI) in the USA during 1971-2002. SUBJECTS Subjects were non-Hispanic Blacks and Whites, 2-74 years of age from the National Health and Nutrition Examination Surveys (NHANES I-III and 1999-2002). METHODS The coefficient of variation and the standard deviation of the logarithm of stature, weight, and BMI were used to assess anthropometric variability for groups defined by age, race, sex, income, and survey year. Weighted ordinary least squares regressions were used to estimate the effect of socio-economic variables on anthropometric variability. RESULTS (a) The relation between age and variability in weight or BMI resembles an inverted U, (b) men have lower variability in BMI than women, (c) Blacks and the poor have greater variability in weight and BMI than Whites or than the non-poor, and (d) variability in anthropometric indices increased during 1971-2002. Results were robust to the measure of variability used and to the use of the mean and mean square of the anthropometric indicators as explanatory variables. CONCLUSION Since anthropometric indices correlate reliably with canonical indicators of well-being (e.g. income), growing variability in anthropometric indices, particularly among the Blacks and the poor, signals growing inequality in quality of life--a worrisome trend.
Collapse
Affiliation(s)
- R Godoy
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454-9110, USA.
| | | | | | | |
Collapse
|
22
|
Kishore P, Li WJ, Tonelli J, Weaver C, Scherer P, Goodman E, Hawkins M. 29 PIOGLITAZONE RAPIDLY AFFECTS ADIPOSE TISSUE GENE EXPRESSION AND INSULIN ACTION IN HUMANS WITH TYPE 2 DIABETES MELLITUS (T2DM). J Investig Med 2004. [DOI: 10.1136/jim-52-suppl2-103] [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: 11/04/2022]
|
23
|
Abstract
PURPOSE To describe the psychometric properties of a scale created to measure communication with the provider regarding Papanicolaou (Pap) smears. METHODS A scale based on expectancy-value theory was developed and administered to 490 young women aged 12 to 24 years in an urban adolescent clinic. Psychometric properties were assessed using factor analysis to evaluate latent variables, intraclass correlation coefficient to evaluate test-retest reliability, and Cronbach coefficient alpha to evaluate internal consistency reliability. Content validity was assessed by qualitative interviews, feedback on a pilot survey, and expert review. Construct validity was evaluated by examining whether relevant health care characteristics, knowledge, and attitudes were significantly associated with perceived communication. RESULTS Mean respondent age was 18.2 +/- 2.1 years; 50% were black and 22% Hispanic. The scale items loaded on one factor. The intraclass correlation coefficient was 0.83 and Cronbach alpha 0.95. Report of a consistent provider, report that a provider recommended a Pap smear, knowledge of Pap smears and Human Papillomavirus (HPV), intention to return for follow-up Pap smears, and positive attitudes about Pap follow-up were significantly associated with good communication. CONCLUSIONS The scale appears to be reliable and valid as a measure of young women's communication with providers regarding Pap smears. Future research should focus on whether this newly developed scale is useful in the design and evaluation of cervical cancer prevention programs for young women.
Collapse
Affiliation(s)
- J A Kahn
- Division of Adolescent Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | | | | |
Collapse
|
24
|
Abstract
BACKGROUND This article discusses the importance of psychological evaluation of gastric bypass (GBP) surgery candidates and post-surgical psychological support services, using the Center for Weight Reduction Surgery at Montefiore Medical Center as a model. The study of psychological predictors of post-operative outcome is in its beginning stages, and the small body of literature on this topic is reviewed. METHODS 115 GBP surgery candidates completed a clinical interview and a self-report measure, the MMPI-2. RESULTS AND CONCLUSIONS A high prevalence of psychopathology and personality disturbance was found in this population. The impact that psychological disturbance may have on post-operative outcome is discussed. The authors also provide a qualitative analysis of the psychological themes commonly found among this population, as well as psychosocial interventions that have been found helpful.
Collapse
Affiliation(s)
- J Glinski
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | | |
Collapse
|
25
|
Abstract
This article examines relationships among socioeconomic status (SES), depression, and health services utilization among 5,735 adolescent women. In cross-sectional analyses, effects of SES on having obtained a routine physical examination and use of psychological/emotional counseling in the past year are examined. Then, longitudinal analyses determine the effects of health service utilization on depression at 1 year follow-up (T2) controlling for baseline depression and SES. SES was associated with medical but not mental health service use. SES and health service use independently predicted T2 depression and an income x baseline depression interaction was noted. The findings and their implications are discussed.
Collapse
Affiliation(s)
- E Goodman
- Division of Adolescent Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | |
Collapse
|
26
|
Abstract
OBJECTIVE Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physical and psychological health. METHODS A cross-sectional study of 10 843 adolescents and a subsample of 166 paired adolescent/mother dyads who participated in the Growing Up Today Study was conducted. The newly developed MacArthur Scale of Subjective Social Status (10-point scale) was used to measure SSS. Paternal education was the measure of SES. Indicators of psychological and physical health included depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression determined the association of SSS to overweight and obesity, controlling for sociodemographic factors and SES. RESULTS Mean society ladder ranking, a subjective measure of SES, was 7.2 +/- 1.3. Mean community ladder ranking, a measure of perceived placement in the school community, was 7.6 +/- 1.7. Reliability of the instrument was excellent: the intraclass correlation coefficient was 0.73 for the society ladder and 0.79 for the community ladder. Adolescents had higher society ladder rankings than their mothers (micro(teen) = 7.2 +/- 1.3 vs micro(mom) = 6.8 +/- 1.2; P =.002). Older adolescents' perceptions of familial placement in society were more closely correlated with maternal subjective perceptions of placement than those of younger adolescents (Spearman's rho(teens <15 years) = 0.31 vs Spearman's rho(teens 15 years) = 0.45; P <.001 for both). SSS explained 9.9% of the variance in depressive symptoms and was independently associated with obesity (odds ratio(society) = 0.89, 95% confidence interval = 0.83, 0.95; odds ratio(community) = 0.91, 95% confidence interval = 0.87, 0.97). For both depressive symptoms and obesity, community ladder rankings were more strongly associated with health than were society ladder rankings in models that controlled for both domains of SSS. CONCLUSIONS This new instrument can reliably measure SSS among adolescents. Social stratification as reflected by SSS is associated with adolescents' health. The findings suggest that as adolescents mature, SSS may undergo a developmental shift. Determining how these changes in SSS relate to health and how SSS functions prospectively with regard to health outcomes requires additional research.
Collapse
Affiliation(s)
- E Goodman
- Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
PURPOSE To determine the internal consistency and 1-week test-retest reliability of the Problem Oriented Screening Instrument for Teenagers (POSIT) among adolescent medical patients. METHODS A research assistant administered the POSIT to a consecutive sample of 15- to 18-year-old patients arriving for routine medical care at a hospital-based adolescent medical practice. Each subject returned for a retest 1 week later. Internal consistency for each scale on test and retest was calculated using Cronbach alpha, and 1-week test-retest reliability by the intraclass correlation coefficient (r) and the kappa coefficient (kappa). RESULTS The Substance Use/Abuse, Mental Health Status, Educational Status, and Aggressive Behavior/Delinquency scales had favorable alpha scores (>.70). Others, including Physical Health Status, had lower alpha scores. High intraclass correlation coefficients were found for all 10 POSIT scales (r =.72 to.88), although (r) was lower for males on two of the scales. Kappa coefficients for all scales indicated good reproducibility beyond chance (kappa =.42 to.73). CONCLUSIONS This study provided supportive evidence for the reliability of the POSIT in primary care medical settings, although some POSIT scales could likely be improved. The 20- to 30-min administration time is most practical in settings that are dedicated to adolescent medicine, and computerized administration and scoring are needed.
Collapse
Affiliation(s)
- J R Knight
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE Depression, impulsivity, and aggression during adolescence have been associated with both adoption and suicidal behavior. Studies of adopted adults suggest that impulsivity, even more than depression, may be an inherited factor that mediates suicidal behavior. However, the association between adoption and adolescent suicide attempts and the mechanisms that might explain it remain unknown. The objective of this study was to determine the following: 1) whether suicide attempts are more common among adolescents who live with adoptive parents rather than biological parents; 2) whether the association is mediated by impulsivity, and 3) whether family connectedness decreases the risk of suicide attempt regardless of adoptive or biological status. METHODS A secondary analysis of Wave I data from the National Longitudinal Study of Adolescent Health was conducted, which used a school-based, clustered sampling design to identify a nationally representative sample of 7th- to 12th-grade students, with oversampling of underrepresented groups. Of the 90 118 adolescents who completed the National Longitudinal Study of Adolescent Health in-school survey, 17 125 completed the in-home interview and had parents of identified gender who completed separate in-home questionnaire. The subset of adolescents for this study was drawn from the in-home sampling according to the following criteria: 1) adolescent living with adoptive or biological mother at the time of the interview, 2) adolescent had never been separated from mother for more than 6 months, 3) mother was in first marriage at the time of the interview, and 4) the adoptive mother had never been married to the adolescent's biological father. Of the 6577 adolescents in the final study sample, 214 (3.3%) were living with adoptive mothers and 6363 (96.7%) were living with biological mothers. Variables. The primary outcome measured was adolescent report of suicide attempt(s) in the past year. Other variables included in the analyses were sociodemographics characteristics (gender, age, race/ethnicity, family income, parental education), general health (self-rated health, routine examination in the past year, need for medical care in the past year that was not obtained), mental health (depressive symptoms, self-image, trouble relaxing in the past year, bad temper, psychological or emotional counseling in the past year), risk behaviors (cigarettes, alcohol, marijuana, sexual intercourse ever, delinquency, physical fighting in the past year, impulsive decision making), school-related characteristics (grade point average, school connectedness), and family interaction (family connectedness, parental presence, maternal satisfaction with parent-adolescent relationship). Data Analysis. Univariate analyses were used to compare adoptees versus nonadoptees, suicide attempters versus nonsuicide attempters, and adopted suicide attempters versus nonadopted suicide attempters on all variables. Variables that were associated with attempted suicide were entered into a forward stepwise logistic regression procedure, and variables that were associated with the log odds of attempt were retained in the model. The area under the model's receiver operating characteristic curve was calculated as a measure of its overall performance. After the association of adoption with attempted suicide was demonstrated, the potential mediating effect of impulsivity was explored by adding it to the model. The same procedure was followed for any variable that was associated with adoption in the full sample or the subsample of suicide attempters. To determine whether any variable in the model moderated the association between adoption and suicide attempt, the interaction term for that variable x adoption was forced into the model. RESULTS Adoptees differed significantly from nonadoptees on 4 of 26 variables. They were more likely to have attempted suicide (7.6% vs 3.1%) and to have received psychological or emotional counseling in the past year (16.9% vs 8.2%), and their mothers reported higher parental education and family income. Attempters differed significantly from nonattempters on all variables except for age, race/ethnicity, parental education, family income, and routine examination in the past year. On logistic regression, 9 variables were independently associated with attempted suicide: depression (adjusted odds ratio [AOR]: 3.41), counseling (AOR: 2.83), female gender (AOR: 2.31), cigarette use (AOR: 2.31), delinquency (AOR: 2.17), adoption (AOR: 1.98), low self-image (AOR: 1.78), aggression (AOR: 1.48), and high family connectedness (AOR: 0.60). The receiver operating characteristic curve for the model had an area of 0.834, indicating performance significantly better than chance. The AOR for adoption did not change when parental education, family income, and impulsivity were forced into the model. (ABSTRACT TRUNCATED)
Collapse
Affiliation(s)
- G Slap
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
| | | | | |
Collapse
|
29
|
Abstract
OBJECTIVE Sexually active adolescent girls have high rates of abnormal cervical cytology. However, little is known about factors that influence intention to return for Papanicolaou screening or follow-up. The aim of this study was to determine whether a theory-based model that assessed knowledge, attitudes, and behaviors predicted intention to return. METHODS The study design consisted of a self-administered, cross-sectional survey that assessed knowledge, beliefs, perceived control over follow-up, perceived risk, cues for Papanicolaou smears, impulsivity, risk behaviors, and past compliance with Papanicolaou smear follow-up. Participants were recruited from a hospital-based adolescent clinic that provides primary and subspecialty care, and the study sample consisted of all sexually active girls and young women who were aged 12 to 24 years and had had previous Papanicolaou smears. The main outcome measure was intention to return for Papanicolaou smear screening or follow-up. RESULTS The enrollment rate was 92% (N = 490), mean age was 18.2 years, 50% were black, and 22% were Hispanic. Eighty-two percent of participants intended to return. Variables that were independently associated with intention to return included positive beliefs about follow-up (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.02-1.11), perception that important others believe that the participant should obtain a Papanicolaou smear (OR: 1.93; 95% CI: 1.38-2.74), perceived control over returning (OR: 1.24; 95% CI: 1.06-1.46), and having received cues to obtain a Papanicolaou smear (OR: 1.31; 95% CI: 1.08-1.60). CONCLUSIONS Analysis of this novel theoretical framework demonstrated that knowledge and previous behaviors were not associated with intention to return for Papanicolaou smear screening and follow-up in this population of young women. However, modifiable attitudinal components, including personal beliefs, perception of others' beliefs, and cues to obtaining Papanicolaou smears, were associated with intention to return.
Collapse
Affiliation(s)
- J A Kahn
- Division of Adolescent Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
| | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE To develop a standardized case-based curriculum for pediatric residents on child growth, development, behavior, and adolescent medicine that incorporates the Bright Futures health supervision guidelines. DESIGN This project included a needs assessment, development of a list of important topics, writing and revising of standardized cases, formative evaluation of cases, and efficacy pilot testing of 2 cases. SETTING A large pediatric teaching hospital continuity clinic. PARTICIPANTS Pediatric residents, fellows, and faculty. INTERVENTIONS Preparation of standardized cases, facilitator training, and resident-led teaching conferences. OUTCOME MEASURES Learner and facilitator evaluation forms and two 10-item diagnostic skills assessments. RESULTS During the project, faculty-fellow teams wrote 29 case-teaching modules. All participants gave high ratings to cases, and resident facilitators reported increased comfort with the case discussion method. Resident learners' ability to accurately interpret developmental screening tests and growth charts improved following sessions on those topics. CONCLUSIONS Further evaluation is required, but these standardized cases appear promising for teaching pediatric residents. The curriculum is now freely available to faculty nationwide.
Collapse
Affiliation(s)
- J R Knight
- Divisions of General Pediatrics, Childrens Hospital, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Kahn J, Goodman E, Kaplowitz R, Slap G, Emans S. Validity of Adolescent and Young Adult Self-Report of Papanicolaou Smear Results. J Low Genit Tract Dis 2001. [DOI: 10.1046/j.1526-0976.2001.52011-10.x] [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: 11/20/2022]
|
33
|
Golombok S, MacCallum F, Goodman E. The "test-tube" generation: parent-child relationships and the psychological well-being of in vitro fertilization children at adolescence. Child Dev 2001; 72:599-608. [PMID: 11333087 DOI: 10.1111/1467-8624.00299] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The introduction of in vitro fertilization (IVF) at the end of the 20th century constituted a fundamental change in the way in which families could be created, and by the start of the new millennium an increasing number of children have been (and are being) born as a result of this procedure. This article presents findings of a longitudinal study of the first cohort of children conceived by IVF to reach adolescence. Thirty-four IVF families, 49 adoptive families, and 38 families with a naturally conceived child were compared on standardized interview and questionnaire measures of parent-child relationships and children's psychological well-being. The few differences in parent-child relationships that were identified appeared to be associated with the experience of infertility rather than with IVF per se. The IVF children were found to be functioning well and did not differ from the adoptive or naturally conceived children on any of the assessments of social or emotional adjustment.
Collapse
Affiliation(s)
- S Golombok
- Family and Child Psychology Research Centre, City University, London, UK.
| | | | | |
Collapse
|
34
|
Shrier LA, Ancheta R, Goodman E, Chiou VM, Lyden MR, Emans SJ. Randomized controlled trial of a safer sex intervention for high-risk adolescent girls. Arch Pediatr Adolesc Med 2001; 155:73-9. [PMID: 11177066 DOI: 10.1001/archpedi.155.1.73] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the effect of an individualized safer sex intervention on condom use and recurrent sexually transmitted disease (STD) among female adolescents diagnosed as having an STD. DESIGN Randomized controlled trial. SETTING Urban children's hospital adolescent clinic and inpatient service. PARTICIPANTS One hundred twenty-three adolescents with cervicitis or pelvic inflammatory disease. INTERVENTION Participants completed a questionnaire and then were randomized to receive standard STD education or to watch a videotape and have an individualized intervention session. Follow-up questionnaires were completed at 1, 3, 6, and 12 months. Intervention participants met with an educator at 1, 3, and 6 months to discuss interim sexual history and review the intervention. MAIN OUTCOME MEASURES Change in self-reported condom use and recurrence of STD. Other self-reported behaviors, sexual risk knowledge, attitudes toward condoms, and condom use negotiation skills were also assessed. RESULTS At 1 month, compared with control participants, intervention participants had increased sexual risk knowledge and more positive attitudes toward condoms and tended to use condoms more with a nonmain partner. At 6 months, fewer intervention participants than controls had sex with a nonmain sexual partner in the previous 6 months. At 12 months, intervention participants were less likely to have a current main partner and had a lower rate of recurrent STD than controls, but these differences were not significant. CONCLUSIONS This individualized safer sex intervention may improve condom use and decrease the number of partners among adolescent girls who have had an STD. Studies with larger samples are needed to determine definitive intervention effects on recurrent STD in this high-risk population.
Collapse
Affiliation(s)
- L A Shrier
- Division of Adolescent/Young Adult Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Huba GJ, Melchior LA, Panter AT, Trevithick L, Woods ER, Wright E, Feudo R, Tierney S, Schneir A, Tenner A, Remafedi G, Greenberg B, Sturdevant M, Goodman E, Hodgins A, Wallace M, Brady RE, Singer B. Risk factors and characteristics of youth living with, or at high risk for, HIV. AIDS Educ Prev 2000; 12:557-575. [PMID: 11220507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Over 8,000 adolescents and young adults (4,111 males; 4,085 females) reported on several HIV-related risk behaviors during enrollment into 10 service demonstration projects targeted to youth living with, or at risk for, HIV. Distinct risk patterns emerged by gender when predicting HIV serostatus (versus unknown serostatus/negative serostatus). Males who had injection drug risk histories, had sex with an HIV positive partner, had sexually transmitted diseases, had sex with males, and/or were homeless had an inflated risk of being HIV positive. Females who engaged in sex with an HIV partner, had sex with an injection drug user, and/or had sexually transmitted diseases, were at the highest HIV risk. For both samples, engaging in sex with women reduced the likelihood of HIV positive status. Very basic information about risk factors obtained at service intake offers important information about HIV status of "high risk" youth presenting for care in community programs, as well as suggests clear risk factors for targeted preventive efforts.
Collapse
Affiliation(s)
- G J Huba
- The Measurement Group, Culver City, CA 90230, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE To assess the validity of adolescent and young adult report of Papanicolaou smear results and to determine sociodemographic, cognitive, and behavioral factors associated with incorrect reporting. METHODS We conducted a cross-sectional study of 477 female subjects aged 12 to 24 years who attended an adolescent clinic and had a previous Papanicolaou smear. Subjects completed a self-administered survey assessing self-report of Papanicolaou smear results, knowledge about Papanicolaou smears and human papillomavirus (HPV), attitudes about Papanicolaou screening and follow-up, and risk behaviors. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported results were calculated using the cytology report as the standard. Variables significantly associated with incorrect reporting were entered into logistic regression models controlling for age and race to determine independent predictors for incorrect reporting. RESULTS Of the 477 participants, 128 (27%) had abnormal cytology reports and 66 (14%) had incorrect self-reports. Sensitivity of self-report was 0.79, specificity 0.89, positive predictive value 0.72, negative predictive value 0.92, and kappa (kappa) 0.66. The adjusted odds ratios (OR) and 95% confidence intervals (CI) of the variables comprising a logistic regression model predicting incorrect reporting were an HPV knowledge source of zero (OR 2.4, CI 1.0, 5.8), low perceived communication with the provider (OR 2.1, CI 1.1, 4.0), and no contraception at last intercourse (OR 5.5, CI 2.7, 11.0). CONCLUSION The validity of adolescent and young adult self-reported Papanicolaou smear result is high, except among those who lack knowledge of HPV, perceive poor communication with the provider, and use contraception inconsistently.
Collapse
Affiliation(s)
- J A Kahn
- Division of Adolescent Medicine, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | | | | | | | | |
Collapse
|
37
|
Abstract
CONTEXT Although several risk factors for tobacco use have been implicated in the development of depression, smoking progression has typically been viewed as a consequence of depression. The results of limited longitudinal studies are controversial. OBJECTIVE To assess the nature and direction of the relationship between cigarette smoking and depression among teens. DESIGN Prospective analysis of baseline and 1-year follow-up data from the National Longitudinal Study of Adolescent Health. SETTING In-home teen and parent interviews. PARTICIPANTS Two samples were identified. For the first sample, 8704 adolescents who were not depressed at baseline based on CES-D scores were identified for analyses of the effects of cigarette smoking on development of high depressive symptomatology. Baseline smoking status, which could vary in this group, was the predictor of interest in these analyses. For the second sample, 6947 teens who had not smoked cigarettes in the 30 days before the baseline survey (noncurrent smokers) were identified for analyses on the effect of high depressive symptoms on subsequent moderate to heavy cigarette use at 1 year of follow-up. Baseline high depressive symptomatology based on CES-D score was the predictor of interest in this sample. MAIN OUTCOME MEASURES Among the nondepressed, developing high depressive symptoms at 1 year of follow-up. Among noncurrent smokers, smoking at least 1 pack per week at 1 year of follow-up. RESULTS For the nondepressed, multivariate modeling revealed that current cigarette smoking was the strongest predictor of developing high depressive symptoms in all models (final model odds ratio [OR]: 3.90; 95% confidence interval [CI]: 1.85,8.20). For noncurrent smokers, although in bivariate analyses, baseline high depressive symptoms increased the risk of heavy smoking nearly threefold, multivariate modeling revealed that baseline high depressive symptoms were not predictive of heavy smoking when controlling for other determinants of smoking in teens. Previous experimentation with smoking was the strongest predictor of becoming a heavy smoker (OR: 3.04; 95% CI: 1.93,4.88). CONCLUSIONS In contrast to common dictum, depression does not seem to be an antecedent to heavy cigarette use among teens. However, current cigarette use is a powerful determinant of developing high depressive symptoms.
Collapse
Affiliation(s)
- E Goodman
- Division of Adolescent Medicine, Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA. goode?@chmcc.org
| | | |
Collapse
|
38
|
Goodman E, Amick BC, Rezendes MO, Levine S, Kagan J, Rogers WH, Tarlov AR. Adolescents' understanding of social class: a comparison of white upper middle class and working class youth. J Adolesc Health 2000; 27:80-3. [PMID: 10899467 DOI: 10.1016/s1054-139x(99)00116-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Social class is increasingly being recognized as an important factor in the development of population-based variation in health among teens. However, little consensus exists regarding its measurement or conceptualization. METHODS This study examined beliefs about social class of 48 working class and 50 upper middle class 16-year-old, white teens. RESULTS Working class teens were more likely to misclassify themselves with regard to social class position. Significant class differences were present in beliefs regarding social mobility, parents' equity, equality of opportunity within society, and financial status as adults. How this conceptualization of social class translates into population-based variation in health remains an important area for further inquiry.
Collapse
Affiliation(s)
- E Goodman
- Division of Adolescent/Youth Adult Medicine, Children's Hospital, Cincinnati, Ohio 45229, USA
| | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
OBJECTIVES Adolescent obesity is becoming an increasing public health problem. This study determines: 1) differences in teen and parental report of obesity, 2) amount of misclassification using body mass index (BMI) from self-reported versus measured height and weight as an indicator of obesity, and 3) whether misclassification varies by gender and socioeconomic status. DESIGN Weighted data from 15 483 baseline (T1) youth and parental interviews from the National Longitudinal Study of Adolescent Health were used. Seventy-four percent of teens were reinterviewed 1 year later (T2). Parents reported socioeconomic status indicators and whether their teen was obese. Teens reported height, weight, and weight perception. BMI was calculated from both self-reported height and weight at T1 and T2 and from measured height and weight at T2. Those with a BMI > or =95% corrected for age and gender were considered obese. RESULTS At T1, nearly one half of teens (47%) reporting they were very overweight were not obese by BMI. For teens obese by BMI, 19.6% were reported to be obese by both parent and teen, 6.4% by teen only, 29. 9% by parent only, and 44.2% by neither teen nor parent. For those with persistent obesity, teen and/or parental report failed to identify more than one third (34%) as obese; 23.4% were identified by both teen and parent report, 5.4% by teen report only, and 37.2% by parent only. At T2, the correlation between BMI calculated from self-reported versus measured height and weight for the overall population was very strong (r = .92). Specificity of obesity status based on self-reported BMI, compared with obesity status based on measured BMI was .996; sensitivity, .722; positive predictive value, .860; and negative predictive value, .978. Overall, 3.8% of teens were misclassified using self-report measures. Girls were no more likely than boys to be misclassified as obese using BMI from self-reported height and weight. CONCLUSIONS Parental report is a better indicator of obesity than teen report of weight status, but parental and teen reports are both poor predictors of adolescent obesity. Using BMI based on self-reported height and weight correctly classified 96% as to obesity status. Thus, studies can use self-reported height and weight to understand teen obesity and its correlates/sequelae.
Collapse
Affiliation(s)
- E Goodman
- Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, Massachusetts, USA.
| | | | | |
Collapse
|
40
|
Huba GJ, Melchior LA, Woods ER, Panter AT, Feudo R, Schneir A, Trevithick L, Wright E, Martinez R, Sturdevant M, Remafedi G, Greenberg B, Tierney S, Wallace M, Goodman E, Tenner A, Marconi K, Brady RE, Singer B. Service use patterns of youth with, and at high risk for, HIV: a care typology. AIDS Patient Care STDS 2000; 14:359-79. [PMID: 10935053 DOI: 10.1089/108729100413239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4679 youth who received services from 10 national HIV/AIDS demonstration models of youth-appropriate and youth-attractive services funded by the Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from one another in the areas of emphasis in their service models, each is targeted to youth at high risk for HIV, or those youth who have already contracted HIV. Collectively, the projects represent a comprehensive adolescent HIV service model. This paper examines the characteristics of the services provided to young people ranging from outreach to intensive participation in medical treatment. Major typologies of service utilization are derived empirically through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory results using a derivation and replication strategy and methods of statistical estimation appropriate for non-normally distributed service utilization indicators. The model hypothesizes that youth enter the service system through a general construct of connectedness to a comprehensive service model and through service-specific methods, primarily of outreach or emergency services. Estimates are made of the degree to which a comprehensive service model drives the services as opposed to specific service entry points.
Collapse
Affiliation(s)
- G J Huba
- Measurement Group, Culver City, California, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Tuinstra R, Goodman E, Greenebaum B. Protein kinase C activity following exposure to magnetic field and phorbol ester. Bioelectromagnetics 2000; 19:469-76. [PMID: 9849916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We examined the separate and combined effects of 60 Hz sinusoidal magnetic fields (MFs) and a phorbol ester on protein kinase C (PKC) activity in HL60 cells. No enhancement in PKC activity was observed when a cell culture was exposed to a 1.1 mT (rms) MF alone or to a combination of MF and 2 microM phorbol 12-myristate 13-acetate (PMA) for 1 h. In a second set of experiments, cells were preexposed to a less than optimal concentration of PMA (50 nM) for 45 min, followed by a 15 min exposure to both PMA and MF. The data showed a greater decrease in cytosolic PKC activity and a larger increase in membrane activity than was induced by either 1 h PMA treatment alone or PMA and sham MF exposure. One logical conclusion from these data is that MFs may be acting in a synergistic manner on a pathway that has already been activated. Therefore, we suggest that MFs, rather than producing biological effects by a new pathway or mechanism of interaction, exert their effect(s) by interacting with already functioning reactions or pathways. If correct, the question of an MF's mechanism of interaction refocuses on how weak fields might enhance or depress a molecular reaction in progress, rather than on finding a new transduction pathway.
Collapse
Affiliation(s)
- R Tuinstra
- Biomedical Research Institute, University of Wisconsin-Parkside, Kenosha 53141, USA
| | | | | |
Collapse
|
42
|
Knight JR, Goodman E, Pulerwitz T, DuRant RH. Reliabilities of short substance abuse screening tests among adolescent medical patients. Pediatrics 2000; 105:948-53. [PMID: 10742352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To determine the internal consistency and 1-week test-retest reliability of the Simple Screening Instrument for Alcohol and Other Drug Abuse (SSI-AOD), the CAGE-AA (CAGE questions adapted for adolescents), and 4 modified items from the Drug and Alcohol Problem QuickScreen (DAP-4) among adolescents. METHODS Fifteen- to 18-year-old medical patients (n = 173) completed screening tests during a routine medical visit and then again 1 week later. Internal consistency for each test and retest was calculated using Cronbach's alpha, and 1-week test-retest reliability was calculated by using Winer's unbiased estimate of the intraclass correlation coefficient (r). RESULTS The SSI-AOD has good internal consistency (alpha =.83) and the CAGE-AA questions acceptable internal consistency (alpha =.60). Alpha varied with gender and race, and item analysis indicated the CAGE-AA test could be improved. As expected, the DAP-4 had a lower alpha score (.46). All screening instruments studied had high 1-week test-retest reliabilities (range r =.82-.90). CONCLUSIONS The SSI-AOD is a reliable substance abuse screening instrument among adolescent medical patients. The CAGE-AA questions must be further revised and tested before their use can be recommended. The DAP-4 questions are likely measuring different, but important, constructs.
Collapse
Affiliation(s)
- J R Knight
- Division on Addictions and Department of Pediatrics, Harvard Medical School, Division of General Pediatrics, Children's Hospital, Boston, Massachusetts 02115, USA.
| | | | | | | |
Collapse
|
43
|
Abstract
PURPOSE The purpose of this study was to describe the spectrum of adolescent spirituality and to determine the association between dimensions of spirituality and voluntary sexual activity (VSA) in adolescents. DESIGN A sample of 141 consecutive youth aged 11-25 years presenting to an urban, hospital-based adolescent medicine clinic completed a 153-item instrument assessing sociodemographics, psychosocial parameters, and eight specific aspects of spirituality including: (1) religious attendance, (2) religious importance, (3) intrinsic and (4) extrinsic religious motivation, (5) belief in God, (6) belief in divine support, (7) existential aspects of spirituality, and (8) spiritual interconnectedness. Adolescents were also asked about VSA. RESULTS Sixty-one percent of respondents were African-American and 67.4%, female; mean age was 16.0+/-2.4 years. Adolescent religious attendance was equally distributed across the categories from "none" to "weekly or greater" attendance. Over 90% felt religion was somewhat important in their lives. Over 85% reported belief in God. Fifty-six percent of respondents reported a history of VSA. Greater importance of religion (p = 0.035) and higher spiritual interconnectedness with friends (p = 0.033) were inversely associated with VSA. A multiple logistic regression model including age, gender, race, socioeconomic status, and specific denomination of religious faith, importance of religion, and spiritual interconnectedness found that spiritual interconnectedness with friends (OR = 0.92, 95% CI = 0.85, 0.99) and age (OR = 1.75, 95% CI = 1.34, 2.28) were independent predictors of VSA. CONCLUSIONS Spirituality is a common facet of adolescents' lives. Younger age and higher spiritual interconnectedness, particularly interconnectedness among spiritual friends, are independently associated with a lower likelihood of VSA.
Collapse
Affiliation(s)
- D W Holder
- Division of Adolescent Medicine, Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Jacobs RO, Goodman E. Splitting fees or splitting hairs? Fee splitting and health care--the Florida experience. Ann Health Law 2000; 8:239-74. [PMID: 10622905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Attorneys Jacobs and Goodman review the prohibitions against fee-splitting under Florida law and argue that Florida and other states need a clear statutory definition of prohibited activities. In addition, the authors argue that the Florida Board of Medicine has applied the prohibition against fee-splitting arbitrarily and in contrast to legal precedent set by the Second District Court of Appeals. Finally, the authors suggest that Minnesota provides clear legislative guidance on the issue of fee-splitting and that the approach adopted by Minnesota is more practical in today's complex health care reimbursement environment.
Collapse
Affiliation(s)
- R O Jacobs
- Holland & Knight, LLP, St. Petersburg, Florida, USA
| | | |
Collapse
|
46
|
Frazer C, Emans SJ, Goodman E, Luoni M, Bravender T, Knight J. Teaching residents about development and behavior: meeting the new challenge. Arch Pediatr Adolesc Med 1999; 153:1190-4. [PMID: 10555724 DOI: 10.1001/archpedi.153.11.1190] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the teaching methods, materials currently used, and unmet needs for teaching developmental-behavioral pediatrics (DBP) at pediatric training programs in the United States. DESIGN Cross-sectional survey of US pediatric residency training programs. The survey questionnaire consisted of 3 instruments: a program director survey, a developmental-behavioral pediatrics survey, and an adolescent medicine survey. PARTICIPANTS Survey packets were mailed in January 1997 to 211 programs identified by mailing labels from the Association of Pediatric Program Directors. RESULTS Data from 148 programs (70%) completing both the DBP survey and program director survey were analyzed. Ninety-five percent of programs reported a block rotation, and 95% of those stated that the rotation was mandatory. Eighty-seven percent had a formal curriculum. Most programs reported using articles, lecture outlines, and precepting for teaching DBP. Few programs used standardized case-based or computerized materials. Most programs, however, indicated a desire for these materials. Few programs felt that 4 topics were covered adequately: adoption (12%), violence (24%), substance use (28%), and conduct problems (41%). Programs that perceived that they covered these topics adequately were more likely to use written cases as part of their curriculum (Mann-Whitney test, 1373.5; P=.04). Barriers to teaching included lack of adequate faculty, time, money, and curricular resources. CONCLUSIONS Pediatric residency programs have made significant gains in mandatory DBP training. However, many programs report a lack of adequate faculty, teaching materials, and methods. Responding programs indicated an interest in case-based materials. This approach may represent an alternative and underutilized resource for teaching DBP.
Collapse
Affiliation(s)
- C Frazer
- Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
With the advent of new therapies for HIV, case identification through HIV counseling and testing (CTS) has become critically important. Young women, youth of color, and disenfranchised youth are at significant risk of acquiring HIV. This study describes clients who access CTS at a program of comprehensive care for high-risk youth (aged 12 to 24 years), and assessed, using logistic regression analyses, whether youth at highest risk utilized CTS. Most of the 531 youth were female (72 percent) and nonwhite (60 percent). Sixty-eight percent received CTS. Logistic regression modeling revealed that white race and receiving care at the teaching hospital were the only independent predictors of testing. Data indicate that, despite targeted, youth-specific, developmentally appropriate and culturally sensitive outreach and intervention efforts, youth of color and high-risk youth are poorly accessing CTS. A greater understanding of the barriers to and cultural norms regarding CTS is needed.
Collapse
Affiliation(s)
- E Goodman
- Children's Hospital, Harvard Medical School, USA
| | | | | | | | | | | |
Collapse
|
48
|
Kahn JA, Chiou V, Allen JD, Goodman E, Perlman SE, Emans SJ. Beliefs about Papanicolaou smears and compliance with Papanicolaou smear follow-up in adolescents. Arch Pediatr Adolesc Med 1999; 153:1046-54. [PMID: 10520612 DOI: 10.1001/archpedi.153.10.1046] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To explore qualitatively adolescent girls' understanding of Papanicolaou smears and barriers to compliance with Papanicolaou smear follow-up appointments. DESIGN Qualitative analysis, using 3 focus groups and 15 in-depth, semistructured individual interviews. SETTING Adolescent Clinic and Young Parents' Program at Children's Hospital, Boston, Mass. MAIN OUTCOME MEASURES Beliefs and attitudes about Papanicolaou smears and barriers to compliance with Papanicolaou smear follow-up. RESULTS The mean (+/- SD) age of the 15 interview participants was 18.7 (+/- 1.9) years. Knowledge about Papanicolaou smears and pelvic examinations was poor. Most participants believed that their peers receive Papanicolaou smear screening and perceived teenagers to be susceptible to cervical cancer. Perceived benefits to getting Papanicolaou smears were prevention and early detection or diagnosis, and reported barriers included pain or discomfort, embarrassment, fear of finding a problem, fear of the unknown, denial, poor communication or rapport with the provider, not wanting to look for trouble, lack of knowledge, and peers' advice. Participant-generated strategies for how providers could overcome barriers to Papanicolaou smear screening included education and the development of trusting, consistent relationships with providers. Participant-generated strategies for how providers could enhance appointment-keeping among adolescents included telephone and written reminders. CONCLUSIONS These data support a behavioral theory-based model of adolescent compliance with Papanicolaou smear follow-up, which may help to develop strategies to enhance compliance with Papanicolaou smear follow-up appointments. These strategies include providing in-depth education about Papanicolaou smears, addressing barriers to Papanicolaou smear follow-up, focusing on appropriate provider behaviors, and instituting an appointment reminder system.
Collapse
Affiliation(s)
- J A Kahn
- Division of Adolescent Medicine, Harvard Medical School, Boston, Mass, USA
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
OBJECTIVE This study sought to determine whether socioeconomic status (SES) gradients exist among US adolescents for self-rated health and for 5 diseases that cause serious adolescent and continuing adult morbidity. METHODS Baseline data from 15,483 adolescent and parental surveys from the National Longitudinal Study of Adolescent Health were used. SES indicators included parental education and occupation, and household income. Dependent variables included self-rated health and the presence of depression, obesity, asthma, suicide attempt in the past year, and prior sexually transmitted disease. RESULTS SES gradients were found for self-rated health, depression, and obesity (P < .01). Suicide attempt was linearly associated with income (P < .01). After adjustment for other SES and sociodemographic factors, education and income remained independent correlates of both depression and obesity; income remained an independent correlate of attempted suicide. CONCLUSIONS Differences in susceptibility to socially mediated etiologic mechanisms of disease may exist during adolescence. Understanding the sociostructural context and patterning of adolescents' lives is crucial to clearly understanding health and disease etiology throughout the course of life.
Collapse
Affiliation(s)
- E Goodman
- Division of Adolescent Medicine, Children's Hospital Medical Center, University of Cincinnati, Ohio 45229, USA.
| |
Collapse
|
50
|
Kahn JA, Chiang VW, Shrier LA, Emans SJ, Fishman SJ, Goodman E, Laufer MR. Microlaparoscopy with conscious sedation in adolescents with suspected pelvic inflammatory disease. J Pediatr Adolesc Gynecol 1999; 12:149-54. [PMID: 10546907 DOI: 10.1016/s1038-3188(99)00008-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/22/2022]
Abstract
STUDY OBJECTIVE To develop a protocol for emergency department microlaparoscopy with conscious sedation in adolescents with clinically suspected pelvic inflammatory disease (PID), and to evaluate the feasibility and tolerability of microlaparoscopy in this population. DESIGN Prospective study involving adolescents and young adults age 13 to 24 meeting clinical criteria for uncomplicated PID. Laparoscopy subjects underwent microlaparoscopy in the Children's Hospital Emergency Department (ED) and comparison subjects were admitted for treatment of PID. Chi-square, Mann-Whitney U tests, Wilcoxon Rank Sum tests, and repeated measures of analysis of variance (MANOVA) were used for analysis. RESULTS Twenty-four patients were enrolled: 6 laparoscopy subjects and 18 comparison subjects. Laparoscopy and comparison subjects did not differ with respect to age, mean white blood cell (WBC) count, mean temperature, or mean erythrocyte sedimentation rate. Mean surgical induction time was 13.5 minutes, operative time 19.0 minutes, and total procedure time 32.5 minutes. Mean requirement for midazolam was 2.8 mg and for fentanyl 225 microg. Pain assessment over the first 90 minutes did not differ significantly between laparoscopy and comparison subjects. Four of 6 laparoscopy subjects (67%) and 10 of 18 comparison subjects (56%) were diagnosed with PID (p = NS). CONCLUSIONS ED microlaparoscopy appears to be feasible, safe, and well tolerated in this small sample of adolescents and young adults with suspected PID.
Collapse
Affiliation(s)
- J A Kahn
- Department of Medicine, Children's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | | | |
Collapse
|