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Greene MC, Busse A, Ventevogel P, Kane J, Ezard N. Moving from feasible to essential: Progress and future directions for promoting the implementation of substance use services for forcibly displaced populations in humanitarian settings. Addiction 2024; 119:408-410. [PMID: 37968774 DOI: 10.1111/add.16386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023]
Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, Australia
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Mootz JJ, Chantre C, Sikkema K, Greene MC, Lovero KL, Gouveia L, Santos P, Suleman A, Comé AS, Feliciano P, Uribe-Restrepo JM, Sweetland AC, Shelton RC, Kane J, Mello M, Fumo W, Cadena-Camargo Y, Weissman M, Wainberg ML. Leveraging a Digitized Mental Wellness (DIGImw) Program to Provide Mental Health Care for Internally Displaced People. Psychiatr Serv 2024; 75:98-101. [PMID: 37461818 PMCID: PMC10794516 DOI: 10.1176/appi.ps.202100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
A local insurgency has displaced many people in the northern Mozambican province of Cabo Delgado. The authors' global team (comprising members from Brazil, Mozambique, South Africa, and the United States) has been scaling up mental health services across the neighboring province of Nampula, Mozambique, now host to >200,000 displaced people. The authors describe how mental health services can be expanded by leveraging digital technology and task-shifting (i.e., having nonspecialists deliver mental health care) to address the mental health needs of displaced people. These methods can serve as a model for other researchers and clinicians aiming to address mental health needs arising from humanitarian disasters in low-resource settings.
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Affiliation(s)
- Jennifer J Mootz
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Catherine Chantre
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Kathleen Sikkema
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - M Claire Greene
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Kathryn L Lovero
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Lidia Gouveia
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Palmira Santos
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Antonio Suleman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Andrea Simone Comé
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Paulino Feliciano
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - José Miguel Uribe-Restrepo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Annika C Sweetland
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Rachel C Shelton
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Jeremy Kane
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Milena Mello
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Wilza Fumo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Yazmin Cadena-Camargo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Myrna Weissman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
| | - Milton L Wainberg
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Mootz, Sweetland, Mello, Weissman, Wainberg) Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven (Chantre, Sweetland); Departments of Sociomedical Sciences (Sikkema, Lovero, Shelton) and Epidemiology (Kane, Weissman), Mailman School of Public Health, Columbia University, New York City; Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City (Greene); Department of Mental Health, Ministry of Health, Maputo, Mozambique (Gouveia, Santos, Suleman, Comé, Feliciano, Fumo); Social and Preventive Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia (Uribe-Restrepo, Cadena-Camargo)
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Jordans MJD, Brown FL, Kane J, Taha K, Steen F, Ali R, Elias J, Meksassi B, Aoun M, Greene CM, Malik A, Akhtar A, van Ommeren M, Sijbrandij M, Bryant R. Evaluation of the Early Adolescent Skills for Emotions (EASE) intervention in Lebanon: A randomized controlled trial. Compr Psychiatry 2023; 127:152424. [PMID: 37748283 DOI: 10.1016/j.comppsych.2023.152424] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 07/21/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND There is a need for scalable evidence-based psychological interventions for young adolescents experiencing high levels of psychological distress in humanitarian settings and low- and middle-income countries. Poor mental health during adolescence presents a serious public health concern as it is a known predictor of persistent mental disorders in adulthood. This study evaluates the effectiveness of a new group-based intervention developed by the World Health Organization (Early Adolescent Skills for Emotions; EASE), implemented by non-specialists, to reduce young adolescents' psychological distress among mostly Syrian refugees in Lebanon. METHODS We conducted a two-arm, single-blind, individually randomized group treatment trial. Adolescents aged 10 to 14 years who screened positive for psychological distress using the Pediatric Symptom Checklist (PSC) were randomly allocated to EASE or enhanced treatment as usual (ETAU) (1:1.6). ETAU consisted of a single scripted psycho-education home-visit session with the adolescent and their caregivers. EASE consists of seven group sessions with adolescents and three sessions with caregivers. The primary outcome was adolescent-reported psychological distress as measured with the PSC (internalizing, externalizing, and attentional symptoms). Secondary outcomes included depression, posttraumatic stress, well-being, functioning, and caregivers' parenting and distress. All outcomes were assessed at baseline, endline, and 3 months (primary time point) and 12 months follow-up. RESULTS Due to the COVID-19 pandemic and other adversities in Lebanon at the time of this research, the study was prematurely terminated, resulting in an under-powered trial sample (n = 198 enrolled compared to n = 445 targeted). We screened 604 children for eligibility. The 198 enrolled adolescents were assigned to EASE (n = 80) and ETAU (n = 118), with retention rates between 76.1 and 88.4% across all timepoints. Intent-to-treat analyses demonstrated no between-group differences on any of the outcome measures between the EASE and ETAU. We did observe a significant improvement on the primary outcome equally in the EASE and ETAU groups (-0.90, 95% CI: -3.6, 1.8; p = .52), - a trend that was sustained at three months follow-up. Sub-group analyses, for those with higher depression symptoms at baseline, showed ETAU outperformed EASE on reducing depression symptoms (difference in mean change = 2.7, 95% CI: 0.1, 5.3; p = .04; d = 0.59) and internalizing problems (difference in mean change 1.0, 95% CI: 0.08, 1.9; p = .03; d = 0.56) . CONCLUSION No conclusions can be drawn about the comparative effectiveness of the intervention given that the sample was underpowered as a result of early termination. Both EASE and single session psycho-education home visits resulted in meaningful improvements in reducing psychological distress. We did not identify any indications in the data suggesting that EASE was more effective than a single session family intervention in the context of the COVID-19 pandemic and other crises in Lebanon. Fully powered research is needed to evaluate the effectiveness of EASE.
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Affiliation(s)
- Mark J D Jordans
- War Child, Research and Development Department, Amsterdam, the Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Felicity L Brown
- War Child, Research and Development Department, Amsterdam, the Netherlands; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jeremy Kane
- Department of Epidemiology, Columbia University, New York, USA.
| | - Karine Taha
- War Child, Lebanon Country Office, Beirut, Lebanon
| | - Frederik Steen
- War Child, Research and Development Department, Amsterdam, the Netherlands.
| | - Rayane Ali
- War Child, Lebanon Country Office, Beirut, Lebanon.
| | - Joseph Elias
- War Child, Lebanon Country Office, Beirut, Lebanon.
| | | | - May Aoun
- War Child, Lebanon Country Office, Beirut, Lebanon.
| | - Claire M Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, USA.
| | | | - Aemal Akhtar
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Sweden; School of Psychology, University of New South Wales, Australia.
| | | | - Marit Sijbrandij
- VU University, Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam, the Netherlands.
| | - Richard Bryant
- School of Psychology, University of New South Wales, Australia.
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Vinikoor MJ, Sikazwe I, Sharma A, Kanguya T, Chipungu J, Murray LK, Chander G, Cropsey K, Bosomprah S, Mulenga LB, Paul R, Kane J. Intersection of alcohol use, HIV infection, and the HIV care continuum in Zambia: nationally representative survey. AIDS Care 2023; 35:1555-1562. [PMID: 35761776 PMCID: PMC9792627 DOI: 10.1080/09540121.2022.2092589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/10/2022] [Indexed: 12/30/2022]
Abstract
Through a nationally-representative household survey, we measured the prevalence and correlates of unhealthy alcohol use (UAU) in Zambia and its association with the HIV care continuum. Adolescent and adult (ages 15-59 years) data, including the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), from the 2016 Zambia Population-based HIV Impact Assessment, were analyzed. UAU was defined as AUDIT-C of 3 + points for women and 4 + for men. Among 20,923 participants, 15.3% had UAU; this was 21.6% among people living with HIV (PLWH). Male sex, increasing age, being employed, urban residence, and having HIV were independent correlates of UAU (all P < 0.05). Among PLWH, UAU was associated with reduced HIV diagnosis (adjusted odds ratio [AOR]: 0.66, 95% CI 0.50-0.88) and non-significant trends toward reduced ART use if diagnosed (AOR: 0.73, 95% CI 0.73-1.10) and reduced viral suppression (VS) if on ART (AOR: 0.91, 95% CI 0.57-1.44). Overall, UAU was linked to 25% lower odds of VS compared to abstinence. UAU in Zambia disproportionately affects certain groups including PLWH. Achieving and sustaining HIV epidemic control in Zambia will require evidence-based approaches to screen and treat UAU.
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Affiliation(s)
- Michael J. Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Tukiya Kanguya
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Karen Cropsey
- School of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Lloyd B. Mulenga
- Zambia Ministry of Health, Lusaka, Zambia
- University of Zambia, Lusaka, Zambia
| | - Ravi Paul
- University of Zambia, Lusaka, Zambia
| | - Jeremy Kane
- Columbia University Mailman School of Public Health, New York, NY, USA
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Greene MC, Kane J, Alto M, Giusto A, Lovero K, Stockton M, McClendon J, Nicholson T, Wainberg ML, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Cochrane Database Syst Rev 2023; 5:CD013350. [PMID: 37158538 PMCID: PMC10167787 DOI: 10.1002/14651858.cd013350.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services. OBJECTIVES To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs. SEARCH METHODS We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies. SELECTION CRITERIA All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition. AUTHORS' CONCLUSIONS In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Melissa Stockton
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Jasmine McClendon
- Department of Psychiatry, UC Davis Medical Center, Sacramento, CALIFORNIA, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, USA
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Brown FL, Taha K, Steen F, Kane J, Gillman A, Aoun M, Malik A, Bryant R, Sijbrandij M, El Chammay R, Servili C, van Ommeren M, Akhtar A, Zoghbi E, Jordans MJD. Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon. BMC Psychiatry 2023; 23:131. [PMID: 36858980 PMCID: PMC9979451 DOI: 10.1186/s12888-023-04571-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Globally, there is a vast mental health treatment gap, whereby the majority of adolescents living in low- and middle-income countries requiring mental health services, do not have access to adequate care. To improve access, the World Health Organization (WHO) developed a range of interventions, designed to be low-cost and delivered by non-specialists. We conducted a two-arm, individually randomised group treatment feasibility trial of a new WHO group intervention for young adolescents with emotional distress ('Early Adolescent Skills for Emotions'; EASE) in Lebanon. METHOD The aim of this study was to determine the feasibility of the intervention and study procedures. Adolescents aged 10 to 14 years were eligible to take part if they scored above a validated cut-off on the Child Psychosocial Distress Screener. Participants were randomized to EASE or enhanced treatment as usual (ETAU) control using a 1:1 ratio. EASE consisted of seven group sessions with adolescents and three sessions with caregivers. ETAU consisted of a single brief psychoeducation home visit. Child and caregiver outcomes were measured by blind assessors at baseline, endline (8 weeks post-randomisation), and three month follow-up (20 weeks post-randomisation), with the primary outcome measure being child psychological symptoms on the Pediatric Symptom Checklist. Qualitative interviews were conducted with adolescents (n = 13), caregivers (n = 17), facilitators (n = 6), trainers (n = 3), and outreach staff (n = 1) at endline to assess barriers and facilitators related to the feasibility and delivery of EASE and study procedures. RESULTS Of 154 adolescents screened, 67 (43%) were eligible, completed baseline, and were randomized. Sixty adolescents (90%) completed endline assessments (31 EASE, 29 ETAU), and fifty-nine (88%) completed three-month assessments (29 EASE, 30 ETAU). Qualitatively, participants provided overall positive feedback about the intervention. Several challenges and suggestions for improvement were raised around logistics, intervention content, and acceptability of assessment measures. Implementation data highlighted challenges with intervention uptake and attendance. Outcome measures generally had strong psychometric properties (range: α = 0.77 to α = 87), however did not demonstrate change over time in either group. CONCLUSIONS The EASE intervention and study procedures are acceptable and feasible for implementation with vulnerable adolescents in Lebanon, however several improvements are necessary prior to full-scale evaluation. TRIAL REGISTRATION #ISRCTN60799626, retrospectively registered on 04/10/2022.
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Affiliation(s)
- Felicity L Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands. .,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Karine Taha
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,War Child Lebanon, Beirut, Lebanon
| | - Frederik Steen
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Jeremy Kane
- Mailman School of Public Health, Columbia University, New York, USA
| | | | - May Aoun
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,War Child Lebanon, Beirut, Lebanon
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Rabih El Chammay
- Ministry of Public Health, Beirut, Lebanon.,Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Mark J D Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands. .,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands.
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Dachepally R, Prodhan P, Bhakta RT, Eble BK, Cunningham TW, Seib PM, Garcia X, Moss MM, Gatlin SW, Kane J. Sustained reduction in cardiac arrest events in a cardiac intensive care unit: a single center quality improvement experience. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00179-9] [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: 01/28/2023]
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Pascoe S, Fox M, Kane J, Mngadi S, Manganye P, Long LC, Metz K, Allen T, Sardana S, Greener R, Zheng A, Thea DM, Murray LK. Study protocol: A randomised trial of the effectiveness of the Common Elements Treatment Approach (CETA) for improving HIV treatment outcomes among women experiencing intimate partner violence in South Africa. BMJ Open 2022; 12:e065848. [PMID: 36549749 PMCID: PMC9772682 DOI: 10.1136/bmjopen-2022-065848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intimate partner violence (IPV) is a barrier to consistent HIV treatment in South Africa. Previous trials have established that the Common Elements Treatment Approach (CETA), a cognitive-behavioural-based intervention, is effective in reducing mental and behavioural health problems but has not been trialled for effectiveness in improving HIV outcomes. This paper describes the protocol for a randomised trial that is testing the effectiveness of CETA in improving HIV treatment outcomes among women experiencing IPV in South Africa. METHODS AND ANALYSIS We are conducting a randomised trial among HIV-infected women on antiretroviral therapy, who have experienced sexual and/or physical IPV, to test the effect of CETA on increasing retention and viral suppression and reducing IPV. Women living with HIV who have an unsuppressed viral load or are at high risk for poor adherence and report experiencing recent IPV, defined as at least once within in the last 12 months, will be recruited from HIV clinics and randomised 1:1 to receive CETA or an active attention control (text message reminders). All participants will be followed for 24 months. Follow-up HIV data will be collected passively using routinely collected medical records. HIV outcomes will be assessed at 12 and 24 months post-baseline. Questionnaires on violence, substance use and mental health will be administered at baseline, post-CETA completion and at 12 months post-baseline. Our primary outcome is retention and viral suppression (<50 copies/mL) by 12 months post-baseline. We will include 400 women which will give us 80% power to detect an absolute 21% difference between arms. Our primary analysis will be an intention-to-treat comparison of intervention and control by risk differences with 95% CIs. ETHICS AND DISSEMINATION Ethics approval provided by University of the Witwatersrand Human Research Ethics Committee (Medical), Boston University Institutional Review Board and Johns Hopkins School Institutional Review Board. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04242992.
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Affiliation(s)
- Sophie Pascoe
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Fox
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sithabile Mngadi
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Pertunia Manganye
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence C Long
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | - Kristina Metz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Taylor Allen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Srishti Sardana
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ross Greener
- Department of Internal Medicine, Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Zheng
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kane J. Do Clinicians Need to Rethink Antipsychotic Maintenance Treatment? Eur Psychiatry 2022. [PMCID: PMC9565429 DOI: 10.1192/j.eurpsy.2022.43] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Schizophrenia remains a challenging illness to treat despite considerable progress. The heterogeneity of symptoms and variability in course, outcome, and treatment response lead to considerable uncertainties in treatment guidelines. One of the most challenging issues is how to determine the need for and duration of the maintenance treatment that is intended to reduce the risk of exacerbation, relapse, and hospitalization. It is clear that in large populations, antipsychotic medication is very effective in reducing those risks, however, there is likely a subpopulation of patients with diminished risk for such outcomes even when medication is discontinued. Although attempts have been made to utilize “intermittent” or “targeted” treatment, those randomized controlled trials that have been conducted show a statistically significant advantage for continuous treatment. At the same time, many patients continue to receive higher than necessary doses of antipsychotic medication and practice needs to be reevaluated in terms of dosage requirements. The challenge remains that there are no good biomarkers or predictors of who is at risk and, therefore, dosage reduction is only titrated against exacerbation or relapse. We need to proactively reconsider who requires maintenance treatment by establishing predictive biomarkers (clinical or biological) that can help us to have a more personalized approach.
Disclosure
Consultant to or receives honoraria: Alkermes, Allergan, Dainippon Sumitomo, H. Lundbeck, Indivior, Intracellular Therapies, Janssen Pharmaceutical, Johnson & Johnson, LB Pharmaceuticals, Merck, Minerva, Neurocrine, Novartis Pharmaceuticals,
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De Filippis R, De Fazio P, Kane J, Schoretsanitis G. Co-occurrence of clozapine-related DRESS syndrome core clinical manifestations: results of a systematic review. Eur Psychiatry 2022. [PMCID: PMC9567655 DOI: 10.1192/j.eurpsy.2022.1854] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome refers to a cluster of clinical symptoms/signs related to drug hypersensitivity. The main clinical features include fever, skin rash, eosinophilia, enlarged lymph nodes, atypical lymphocytosis, and involvement of at least one internal organ. Clozapine-related DRESS syndrome has been rarely reported, but this may be due to a different clinical presentation pattern compared to DRESS for other culprit drugs. Objectives We aimed to assess clusters of main clinical features of clozapine-related DRESS. Methods We ran a network analysis for clinical manifestations in the pooled sample of all previous published cases of clozapine-related DRESS. Results We observed a triad of core symptoms (i.e., organ implication, fever, and eosinophilia) among DRESS criteria co-occurring in 59.3% (n=16) of 27 patients. The organs most likely to be involved in clozapine-related DRESS included lungs, liver, heart, and kidneys. Fever was also present in almost all cases (n=25 patients), while eosinophilia was observed in two thirds of the sample (n=18 patients). Conclusions Regarding clinical manifestations clozapine-related DRESS may differ from DRESS for other culprit drugs as skin reaction is not very typical; thus, clinicians need to consider DRESS as a potential diagnosis even in absence of a skin reaction. When managing clozapine-treated patients with the core triad of organ implication, fever, and eosinophilia clinicians should consider guidelines for DRESS treatment. Disclosure No significant relationships.
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Wiginton JM, Murray SM, Poku O, Augustinavicius J, Jackman KMP, Kane J, Billong SC, Diouf D, Ba I, Mothopeng T, Njindam IM, Turpin G, Tamoufe U, Sithole B, Zlotorzynska M, Sanchez TH, Baral SD. Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries. BMC Public Health 2021; 21:2206. [PMID: 34861835 PMCID: PMC8641177 DOI: 10.1186/s12889-021-12151-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. METHODS We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d'Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. RESULTS Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. CONCLUSIONS Research to determine the factors driving disclosure's differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.
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Affiliation(s)
- John Mark Wiginton
- grid.21107.350000 0001 2171 9311Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Sarah M. Murray
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Ohemaa Poku
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jura Augustinavicius
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Kevon-Mark Phillip Jackman
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jeremy Kane
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY USA
| | - Serge C. Billong
- grid.412661.60000 0001 2173 8504Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon
| | | | | | | | - Iliassou Mfochive Njindam
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Gnilane Turpin
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Ubald Tamoufe
- grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | | | - Maria Zlotorzynska
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Travis H. Sanchez
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Stefan D. Baral
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
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Al-Sadawi M, Kane J, Stevens GA, Parikh P. Sex-related differences in long-term mortality after coronary artery bypass graft surgery: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This meta-analysis assessed the sex-related differences in long-term mortality (>7 years) after Coronary Artery Bypass Graft (CABG) Surgery.
Purpose
Women has higher incidence of short-term cardiovascular mortality after CABG compared to men. However, data about long-term differences are controversial.
Methods
We searched the databases for studies reporting sex-specific mortality following CABG including Ovid MEDLINE, Ovid, Embase, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 31st, 2020. The search was not restricted to time or publication status. Outcomes included rates of long-term mortality (>7 year or longer).
Results
A total of 518 studies were resulted from literature search. A total of 14 studies and 204,223 patients; 158,663 men and 45,556 women, with a mean age of the men 60.2 years and 63.2 years for women, were included in our systematic review and meta-analysis. Our analysis suggested sex-related differences in long-term mortality (>7 years) following CABG (odds ratio (1), 1.15; 95% confidence interval (2), 1.017–1.30; P<.02).
Conclusions
Our results suggest that women had higher long-term mortality following CABG compared with men. It is the largest study to date of sex-specific differences in long-term mortality (>7 years).
Funding Acknowledgement
Type of funding sources: None. Meta-analysisDemographics
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Affiliation(s)
- M Al-Sadawi
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| | - J Kane
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| | - G A Stevens
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
| | - P Parikh
- Stony Brook University Medical Center, Cardiovascular Medicine, Stony Brook, United States of America
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Murray LK, Kane J, Bolton P, Skavenski S, Mayeya J, Alfonso YN, Webb S, Bishai D. Not all costs should be treated equally: Commentary on the article 'What will it cost to prevent violence against women and girls in low- and middle-income countries? Evidence from Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia'. Health Policy Plan 2021; 36:221-222. [PMID: 33367676 DOI: 10.1093/heapol/czaa154] [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] [Accepted: 10/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laura K Murray
- Department of Mental Health and International Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th floor, Baltimore, MD 21205, USA
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, Room 519, New York, NY 10032, USA
| | - Paul Bolton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Stephanie Skavenski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - John Mayeya
- Department of Mental Health and Substance Use, Ministry of Health, Lusaka, Zambia
| | - Y Natalie Alfonso
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
| | - Sarah Webb
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205 & Carey Business School 100 International Drive, Baltimore, MD 21202, USA
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA
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Hagi K, Nosaka T, Kane J, Correll C. Efficacy and tolerability of lurasidone in schizophrenia: A systematic review and meta-analysis of short-term, randomized, placebo controlled trials. Eur Psychiatry 2021. [PMCID: PMC9471728 DOI: 10.1192/j.eurpsy.2021.424] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Lurasidone is an atypical antipsychotic approved for the treatment of patients with schizophrenia. We report on a meta-analysis focusing on both the efficacy and safety/tolerability of lurasidone in the treatment of patients with schizophrenia. Objectives To obtain pooled estimates from placebo-controlled clinical trials on the efficacy and safety/tolerability of lurasidone in schizophrenia. Methods We selected acute, randomized placebo-controlled trials of lurasidone for schizophrenia. Primary outcome for efficacy was the Positive and Negative Syndrome Scale (PANSS) change and for “acceptability” was all-cause discontinuation. Secondary outcomes included specific adverse events, body weight change, ≥7% weight gain, and glucose and lipid parameter change. Results Across 10 RCTs (n=3,963, age=40.5±2.3 years, males=64.7 %, trial duration=6.0 weeks), lurasidone outperformed placebo regarding the PANSS total score (N=10, n=3,354, SMD=-0.34, 95% CI: -0.47−-0.21, p<0.001). Stratifying the analysis by dose, lurasidone significantly outperformed placebo at doses 40-160 mg/day. Lurasidone was associated with significantly lower all-cause discontinuation than placebo (N=10, n=3,410, RR=0.87, 95% CI: 0.78−0.97, p=0.014). Lurasidone had significantly higher body weight change compared with placebo (N=10, n=3,359, SMD=0.17, 95% CI: 0.09−0.24, p<0.001), but without significant differences regarding ≥7% body weight gain (N=9, n=3,186, p=0.112). Lurasidone did not differ from placebo in total cholesterol (N=10, n=3,140, p=0.439), LDL-cholesterol (N=7, n=2,414, p=0.849), triglycerides (N=10, n=3,140, p=0.238), and fasting glucose change (N=10, n=3,112, p=0.633). Conclusions In short-term trials, lurasidone was efficacious, acceptable and safe, having minimal effect on body weight gain and glucose and lipid metabolism. Disclosure K. Hagi is a full time employee of Sumitomo Dainippon Phrma Co., Ltd.
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Gastaldon C, Raschi E, Kane J, Barbui C. Safety of esketamine nasal spray: Analysis of post-marketing reports submitted to the FDA adverse event reporting system in the first year on the market. Eur Psychiatry 2021. [PMCID: PMC9471491 DOI: 10.1192/j.eurpsy.2021.410] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The approval of the esketamine nasal spray for treatment-resistant depression in March 2019 by the Food and Drug Administration (FDA), and few months later by the European Medicine Agency, triggered a vivid debate and many concerns, mainly because of the lack of convincing evidence on its efficacy and safety, based on the development programs, approval trials and few post-marketing trials. Objectives We aimed to detect and characterize safety signals for esketamine, by analyzing relevant adverse events (AEs) reports in the FDA Adverse Event Reporting System (FAERS) database (March 2019-March 2020). Methods We performed disproportionality analysis through the case/non-case approach: reporting odds ratios (ROR) and information components (IC) with 95% confidence intervals (95%CI) were estimated for esketamine-related AEs with at least four counts. We compared serious and non-serious AEs using non-parametrical tests. Results The FAERS database registered 962 reports of esketamine-related AEs in one year. Signals (i.e., statistically significant disproportionality) were detected for several AEs, such as dissociation, sedation, feeling drunk, suicidal ideation and completed suicide. Signals for suicidal ideation, but not suicide attempt and completed suicide, remained significant when comparing esketamine to venlafaxine. The comparison of patients with serious vs. non-serious esketamine AEs revealed that females, patients receiving antidepressant polypharmacy, co-medication with antipsychotics, mood stabilizers, benzodiazepines or somatic medications were more likely to suffer from serious AEs. Conclusions This real-world pharmacovigilance analysis detected signals of serious unexpected esketamine-related AEs, thus reinforcing current worries regarding esketamine safety/acceptability. Further real-world studies are urgently needed to unravel the safety profile of esketamine. Disclosure No significant relationships.
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Jackman KMP, Kane J, Kharrazi H, Johnson RM, Latkin C. Correction: Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study. J Med Internet Res 2021; 23:e28358. [PMID: 33667179 PMCID: PMC7980112 DOI: 10.2196/28358] [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] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kevon-Mark P Jackman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Batimore, MD, United States
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Blooomberg School of Public Health, Baltimore, MD, United States
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Surendranathan A, Kane J, Bentley A, Barker S, McNally R, Bamford C, Taylor JP, Thomas A, McKeith I, Burn D, O'Brien JT. Introduction of an assessment toolkit associated with increased rate of DLB diagnosis. Alzheimers Res Ther 2021; 13:50. [PMID: 33608039 PMCID: PMC7896389 DOI: 10.1186/s13195-021-00786-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
Background Dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) are recognised to be under-recognised in clinical practice in the UK, with only one third to a half of expected cases diagnosed. We aimed to assess whether clinical diagnostic rates could be increased by the introduction of a structured assessment toolkit for clinicians. Methods We established baseline diagnostic rates for DLB and PDD in four memory clinics and three movement disorder/Parkinson’s disease (PD) clinics in two separate geographical regions in the UK. An assessment toolkit specifically developed to assist with the recognition and diagnosis of DLB and PDD was then introduced to the same clinical teams and diagnostic rates for DLB and PDD were reassessed. For assessing DLB diagnosis, a total of 3820 case notes were reviewed before the introduction of the toolkit, and 2061 case notes reviewed after its introduction. For PDD diagnosis, a total of 1797 case notes were reviewed before the introduction of the toolkit and 3405 case notes after it. Mean values and proportions were analysed using Student’s t test for independent samples and χ2 test, respectively. Results DLB was diagnosed in 4.6% of dementia cases prior to the introduction of the toolkit, and 6.2% of dementia cases afterwards, an absolute rise of 1.6%, equal to a 35% increase in the number of DLB cases diagnosed when using the toolkit (χ2 = 4.2, P = 0.041). The number of PD patients diagnosed with PDD was not found overall to be significantly different when using the toolkit: 9.6% of PD cases before and 8.2% of cases after its introduction (χ2 = 1.8, P = 0.18), though the ages of PD patients assessed after the toolkit’s introduction were lower (73.9 years vs 80.0 years, t = 19.2, p < 0.001). Conclusion Introduction of the assessment toolkit was associated with a significant increase in the rate of DLB diagnosis, suggesting that a structured means of assessing symptoms and clinical features associated with DLB can assist clinicians in recognising cases. The assessment toolkit did not alter the overall rate of PDD diagnosis, suggesting that alternate means may be required to improve the rate of diagnosis of dementia in Parkinson’s disease.
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Affiliation(s)
- A Surendranathan
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 189, Cambridge, CB2 0QQ, UK.
| | - J Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - A Bentley
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 189, Cambridge, CB2 0QQ, UK
| | - S Barker
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - R McNally
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - C Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J-P Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - A Thomas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - I McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Burn
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - J T O'Brien
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 189, Cambridge, CB2 0QQ, UK
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Smith HJ, Topp SM, Hoffmann CJ, Ndlovu T, Charalambous S, Murray L, Kane J, Sikazwe I, Muyoyeta M, Herce ME. Addressing Common Mental Health Disorders Among Incarcerated People Living with HIV: Insights from Implementation Science for Service Integration and Delivery. Curr HIV/AIDS Rep 2021; 17:438-449. [PMID: 32779099 DOI: 10.1007/s11904-020-00518-x] [Citation(s) in RCA: 3] [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] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-Saharan Africa (SSA). This paper aims to summarize current knowledge on mental health interventions of relevance to incarcerated PLHIV and apply implementation science theory to highlight strategies and approaches to deliver mental health services for PLHIV in correctional settings in SSA. RECENT FINDINGS Scarce evidence-based mental health interventions have been rigorously evaluated among incarcerated PLHIV in SSA. Emerging evidence from low- and middle-income countries and correctional settings outside SSA point to a role for cognitive behavioral therapy-based talking and group interventions implemented using task-shifting strategies involving lay health workers and peer educators. Several mental health interventions and implementation strategies hold promise for addressing common mental health disorders among incarcerated PLHIV in SSA. However, to deliver these approaches, there must first be pragmatic efforts to build corrections health system capacity, address human rights abuses that exacerbate HIV and mental health, and re-conceptualize mental health services as integral to quality HIV service delivery and universal access to primary healthcare for all incarcerated people.
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Affiliation(s)
- Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Christopher J Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | | | | | - Izukanji Sikazwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Monde Muyoyeta
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Jackman KMP, Kane J, Kharrazi H, Johnson RM, Latkin C. Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study. J Med Internet Res 2021; 23:e18750. [PMID: 33565987 PMCID: PMC7935249 DOI: 10.2196/18750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/24/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied. Objective The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM. Methods A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma. Results The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV. Conclusions PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.
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Affiliation(s)
- Kevon-Mark P Jackman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Batimore, MD, United States
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Blooomberg School of Public Health, Baltimore, MD, United States
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Baradaran Eftekhari M, Mahmoodi Z, Dejman M, Forouzan AS, Falahat K, Shati M, Jandaghi J, Kane J. Local perceptions of mental health in Iran, Semnan Province. Brain Behav 2021; 11:e01971. [PMID: 33325630 PMCID: PMC7882184 DOI: 10.1002/brb3.1971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Understanding local perceptions of mental health in different cultures and contexts is crucial for designing and implementing appropriate mental healthcare services. METHODS This qualitative study was conducted to investigate local perceptions of mental health in two highly populated provincial districts in Iran. Data were collected using the free list technique and interviews. A two-phase training workshop was held with the research team at a local health center, followed by a pilot study with the participation of six subjects. All the interviews were audio-recorded, transcribed, and then analyzed by the third and fourth authors in DEDOOSE. RESULTS A total of 30 individuals (20 in the free list and 10 as key informants in the interviews) took part in the study. Based on the study findings and the key informants' ideas, mental health problems were categorized into three categories of depression, anxiety, and obsessive-compulsive disorder (OCD). CONCLUSIONS Mental health problems appear to be expressed in different ways and with different symptoms in different cultures, and there is a distinct need for examining mental disorders in each culture and nationality separately using culturally appropriate tools for disease screening.
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Affiliation(s)
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Masoumeh Dejman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ameneh Setareh Forouzan
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Katayoun Falahat
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohsen Shati
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Jandaghi
- Deputy of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Murray LK, Haroz E, Dorsey S, Kane J, Bolton PA, Pullmann MD. Understanding mechanisms of change: An unpacking study of the evidence-based common-elements treatment approach (CETA) in low and middle income countries. Behav Res Ther 2019; 130:103430. [PMID: 31780251 DOI: 10.1016/j.brat.2019.103430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/28/2018] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022]
Abstract
There is a recognized need to better understand "essential ingredients" of psychological treatments, and refine interventions to be more scalable and sustainable. The goal of the present study was to look within a specific modular, flexible, multi-problem transdiagnostic psychological intervention -the Common Elements Treatment Approach (CETA) - and examine questions that would lead to optimizing CETA for scale up and sustainment. Utilizing data from two trials of CETA in two different countries (Thailand and Iraq), this manuscript aims to: 1) determine the "active treatment dose" or how many sessions are needed to achieve clinically meaningful change overall, in CETA); and 2) test how trajectories of client symptom change varied based on client characteristics and/or on delivery of certain elements. Results showed that overall 50% of CETA clients show some improvement after 4-6 sessions (1 SD) and large improvement (2 SD) after 7-10 sessions. Trajectories of change show steady symptom decline over time. Results support gradual exposure as one of the "active ingredients". Findings suggest that modular, flexible transdiagnostic models may allow for more efficient, targeted treatment as we gain more knowledge about key ingredients, their timing within treatment, and client outcomes.
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Affiliation(s)
- Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA.
| | - Emily Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA.
| | - Shannon Dorsey
- Department of Psychology, Guthrie Hall, University of Washington, Seattle, WA 98195, USA.
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA.
| | - Paul A Bolton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 8th Floor, Baltimore, MD 21205, USA.
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 74th Street, Building 29, 98115, USA.
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Greene MC, Kane J, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Hippokratia 2019. [DOI: 10.1002/14651858.cd013350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Claire Greene
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
- Columbia University/New York State Psychiatric Institute; Department of Psychiatry; 40 Haven Avenue New York New York USA 10005
| | - Jeremy Kane
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
| | - Renee M Johnson
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Rm. 888 Baltimore Maryland USA 21205
- HealthRight International; Peter C. Alderman Program for Global Mental Health; New York USA
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Krueger S, Kane J, Dabjan M, Hanna A, Wilson G, Guerrero T, Marples B. Characterizing Pulmonary Damage After Thoracic Irradiation Using Magnetic Resonance Imaging, Positron Emission Tomography, and Computed Tomography. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2037] [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: 10/20/2022]
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Kalavalapalli S, Reid H, Kane J, Buckler H, Trainer P, Heald AH. Silent growth hormone secreting pituitary adenomas: IGF-1 is not sufficient to exclude growth hormone excess. Ann Clin Biochem 2016; 44:89-93. [PMID: 17270100 DOI: 10.1258/000456307779596075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Circulating insulin-like growth factor-1 (IGF-1) is increasingly being used as a screening test and in ongoing monitoring of treated acromegaly. We here present three cases of women (two of whom were on the oestrogen containing contraceptive pill at the time of presentation) who had normal circulating IGF-1 and no overt clinical features of acromegaly at the time of their pituitary surgery. Postoperatively, all were confirmed to have growth hormone excess in keeping with the presence of active somatotroph pituitary adenomas. We suggest that for optimal patient management, formal evaluation of growth hormone status with oral glucose tolerance testing should ideally be performed on all individuals for whom pituitary surgery is planned.
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Affiliation(s)
- S Kalavalapalli
- Department of Endocrinology, University of Manchester, Salford NHS Trust, Salford M6 8HD, UK
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Livingston M, Birch K, Guy M, Kane J, Heald A. No role for tri-iodothyronine (T3) testing in the assessment of levothyroxine (T4) over-replacement in hypothyroid patients. Br J Biomed Sci 2015; 72:160-3. [DOI: 10.1080/09674845.2015.11665746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M. Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall
| | - K. Birch
- Department of Clinical Biochemistry, Salford Royal Hospitals Foundation Trust, Salford
| | - M. Guy
- Department of Clinical Biochemistry, Salford Royal Hospitals Foundation Trust, Salford
| | - J. Kane
- Department of Clinical Biochemistry, Salford Royal Hospitals Foundation Trust, Salford
| | - A.H. Heald
- Department of Endocrinology, Leighton Hospital,Crewe
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester,Manchester, UK
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Affiliation(s)
- M. Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall
| | - P. Twomey
- Department of Clinical Biochemistry, The Ipswich Hospital, Ipswich
| | - A. Basu
- Departments of Endocrinology and Biochemistry, Bishop Auckland Hospital, Bishop Auckland
| | - S. Smellie
- Department of Biochemistry, Bishop Auckland Hospital, Bishop Auckland
| | - J. Kane
- Clinical Biochemistry, Salford Royal Hospital, Salford
| | - A. Heald
- Endocrinology, Leighton Hospital, Crewe, United Kingdom
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Loebel A, Silva R, Goldman R, Watabe K, Pikalov A, Cucchiaro J, Kane J. Optimizing Treatment with Lurasidone in Patients with Schizophrenia: Results of a Randomized, Double-blind, Placebo-controlled Trial. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)32096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Patel PA, Ravi KA, Ripley DP, Kane J, Wass E, Carr A, Wilson D, Watchorn N, Hobman RK, Gill D, Brooksby WP, Kilcullen N, Artis N. Clinician referrals for stress echocardiography: are we compliant with the NICE guidelines? Echo Res Pract 2014; 1:17-21. [PMID: 26693288 PMCID: PMC4676440 DOI: 10.1530/erp-14-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/14/2014] [Accepted: 07/09/2014] [Indexed: 11/25/2022] Open
Abstract
Accurate diagnosis of stable angina is of paramount importance, and where possible, this should be based on clinical history. In cases of uncertainty, the National Institute for Health and Care Excellence (NICE) provides a framework for assisting diagnosis based on pre-test likelihood (PTL) of coronary artery disease. Functional testing such as stress echocardiography (SE) is recommended as a first-line investigation in patients with PTL of 30–60%. This study evaluated hospital clinicians' adherence to this recommendation. A prospective analysis of patients referred for SE at a district general hospital between March and May 2013 was performed. Data were extracted from an electronic database of SE reports and medical notes. A total of 193 patients were assessed. The most common PTL was 61–90%, accounting for 40% of the cohort. Of them, 14% had a PTL of 30–60%. Of these, 15% had positive SE; 57% described non-anginal pain, as defined by NICE, of whom only nine cases had SE positivity. None of these patients required revascularisation. Findings suggest that SE is being used in a much broader selection group than advocated by NICE. This may often be for its exclusion value rather than to stratify risk. Although utility may be justified in high-risk patients to avoid proceeding directly to invasive angiography, SE appears to add little in those with non-anginal pain and with low PTL. Greater focus should be directed towards characterisation of symptoms, which may negate the need for subsequent investigation.
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Affiliation(s)
- P A Patel
- Correspondence should be addressed to P A Patel
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Baker R, Fleischhacker W, Sanchez R, Tsai L, Peters-Strickland T, Eramo A, Kostic D, Kane J. EPA-0790 – All-cause discontinuation and safety of aripiprazole once-monthly for the treatment of schizophrenia: A pooled analysis of two double-blind, randomized, controlled trials. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Prendergast H, Dudley S, Kane J, Bunney E, Acosta A, Marcucci J. Antihypertensive medications and diastolic dysfunction progression in an African American population. Afr J Emerg Med 2013. [DOI: 10.1016/j.afjem.2013.08.060] [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: 10/26/2022] Open
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Wang D, Zhang Q, Eisenberg B, Kane J, Li X, Lucas D, Freeman C, Trotti A, Hitchcock Y, Kirsch D. Significant Reduction of Radiation Related Morbidities in the Extremity Sarcoma Patients Treated With Image Guided Radiation Therapy to Reduced Target Volume: Results of RTOG 0630. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gratzer B, Cates K, Stephenson R, Sullivan P, Kane J, Hoehnle S. P3.424 Testing Together: HIV/STI Testing and Diagnoses Among Male Couples, Chicago, 2011–2012. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0875] [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]
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Turaga K, Levine E, Barone R, Sticca R, Petrelli N, Lambert L, Nash G, Morse M, Adbel-Misih R, Alexander HR, Attiyeh F, Bartlett D, Bastidas A, Blazer T, Chu Q, Chung K, Dominguez-Parra L, Espat NJ, Foster J, Fournier K, Garcia R, Goodman M, Hanna N, Harrison L, Hoefer R, Holtzman M, Kane J, Labow D, Li B, Lowy A, Mansfield P, Ong E, Pameijer C, Pingpank J, Quinones M, Royal R, Salti G, Sardi A, Shen P, Skitzki J, Spellman J, Stewart J, Esquivel J. Consensus guidelines from The American Society of Peritoneal Surface Malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States. Ann Surg Oncol 2013; 21:1501-5. [PMID: 23793364 DOI: 10.1245/s10434-013-3061-z] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American Society of Peritoneal Surface Malignancies (ASPSM) is a consortium of cancer centers performing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). This is a position paper from the ASPSM on the standardization of the delivery of HIPEC. METHODS A survey was conducted of all cancer centers performing HIPEC in the United States. We attempted to obtain consensus by the modified method of Delphi on seven key HIPEC parameters: (1) method, (2) inflow temperature, (3) perfusate volume, (4) drug, (5) dosage, (6) timing of drug delivery, and (7) total perfusion time. Statistical analysis was performed using nonparametric tests. RESULTS Response rates for ASPSM members (n = 45) and non-ASPSM members (n = 24) were 89 and 33 %, respectively. Of the responders from ASPSM members, 95 % agreed with implementing the proposal. Majority of the surgical oncologists favored the closed method of delivery with a standardized dual dose of mitomycin for a 90-min chemoperfusion for patients undergoing cytoreductive surgery for peritoneal carcinomatosis of colorectal origin. CONCLUSIONS This recommendation on a standardized delivery of HIPEC in patients with colorectal cancer represents an important first step in enhancing research in this field. Studies directed at maximizing the efficacy of each of the seven key elements will need to follow.
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Affiliation(s)
- K Turaga
- Medical College of Wisconsin, Milwaukee, WI, USA
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Kane J, Jasperse M, Egan R, Pullon S, McBain L, McKinley E. EP-1111: The role of General Practitioners in supportive care of cancer patients after completion of specialist oncology care. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Naber D, Kollack-Walker S, Chen J, Stauffer V, Kinon B, Case M, Ascher-Svanum H, Kapur S, Kane J. Predicting a ‘Combined Treatment Outcome' in Chronic Schizophrenia: The Role of Demographics, Symptomatology, Functioning and Subjective Well-being. Pharmacopsychiatry 2013; 46:114-9. [DOI: 10.1055/s-0032-1331703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D. Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | | | - J. Chen
- Lilly, USA, LLC, Indianapolis, IN, USA
| | - V. Stauffer
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - B. Kinon
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - M. Case
- Lilly, USA, LLC, Indianapolis, IN, USA
| | - H. Ascher-Svanum
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - S. Kapur
- Institute of Psychiatry, King's College of London, London, U.K
| | - J. Kane
- Zucker Hillside Hospital, Glen Oaks, NY, USA
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Baker R, Carson W, Perry P, Sanchez R, Jin N, McQuade R, Kane J, Fleischhacker W. 2281 – Psychosocial and overall effectiveness of aripiprazole once-monthly vs. placebo once-monthly for maintenance treatment in schizophrenia. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)77141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Scargill JJ, Reed P, Kane J. Consideration of the degree of increase in urine metadrenalines provides superior specificity in the diagnosis of phaeochromocytoma than additional urine catecholamine measurement. Ann Clin Biochem 2013; 50:73-5. [DOI: 10.1258/acb.2012.012083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Measurement of fractionated plasma or urine metadrenalines is the recommended screening test in the diagnosis of phaeochromocytoma, with clinical cut-offs geared towards diagnostic sensitivity. Current practice at Salford Royal Hospital is to add urine catecholamines onto samples with raised urine metadrenalines, with the aim of adding specificity to a diagnosis of phaeochromocytoma. Methods This practice was reviewed by identifying a series of patients with raised urine metadrenalines who had catecholamines reflectively added. A total of 358 samples were identified from 242 patients, of which 228 had urine catecholamines measured. Results A diagnosis of ‘phaeochromocytoma‘ (n = 41) or ‘no phaeochromocytoma‘ (n = 90) was obtained in 131 of 228 patients, giving raised urine metadrenalines a positive predictive value for phaeochromocytoma of 31%. The finding of increased urine catecholamines in samples with raised urine metadrenalines increased specificity for phaeochromocytoma to 70%. However, 95% diagnostic specificity for phaeochromocytoma could be achieved by the introduction of a second cut-off for urine metadrenalines geared towards maximizing specificity. Conclusions Consideration of the degree of increase in urine metadrenalines is a superior method of determining the likelihood of phaeochromocytoma than measurement of urine catecholamines.
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Affiliation(s)
- J J Scargill
- Department of Clinical Biochemistry, Salford Royal Hospital, Stott Lane, Salford, Manchester M6 8HD, UK
| | - P Reed
- Department of Clinical Biochemistry, Salford Royal Hospital, Stott Lane, Salford, Manchester M6 8HD, UK
| | - J Kane
- Department of Clinical Biochemistry, Salford Royal Hospital, Stott Lane, Salford, Manchester M6 8HD, UK
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Goff B, Lowe K, Kane J, Robertson M, Gaul M, Andersen M. The safety of symptom based screening for ovarian cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.027] [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: 11/25/2022]
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Heald AH, Blantern E, Anderson SG, Radford D, Qureshi Z, Nair S, Waldron J, Davies M, McCulloch A, Kane J. Quantitative adjustment for macroprolactin is an integral part of laboratory assessment of hyperprolactinaemia. Exp Clin Endocrinol Diabetes 2012; 120:376-80. [PMID: 22576261 DOI: 10.1055/s-0032-1304618] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Prolactin circulates predominantly as a 23-kDa monomer, and a high-molecular-weight form largely consisting of a complex of prolactin and an anti-prolactin IgG autoantibody, called macroprolactin. This cross-reacts with conventional laboratory assays for prolactin. We here describe how quantitative adjustment for this may assist patient management.In a consecutive series of 218 patients with prolactin elevated to 400 mu/L or more in men (normal range ≤ 180) (n=79, 36.2% of sample) and 1 000 mu/L or more in women (normal range ≤ 500) (n=139, 63.8%) a macroprolactin screen was performed using PEG precipitation. RESULTS Where present, median macroprolactin as a proportion of total prolactin was in women 13% (percentile 25-percentile 75: 7-25%) and in men 15% (7-30%).The distribution of macroprolactin as a proportion of total prolactin was markedly skewed to the left with 69.7% of women and 62.9% of men having macroprolactin proportion of 20% or less. There was no relation between %macroprolactin and total measured prolactin, age or gender.Of relevance to clinical management, in 24% of men and 20.5% of women, correction for estimated macroprolactin gave an adjusted monomeric prolactin level below the agreed threshold for further investigation, potentially avoiding unnecessarily referral.In our clinical series, quotation of an adjusted monomeric prolactin would have resulted in unnecessary further investigation being avoided in a number of cases. DISCUSSION Screening for macroprolactin is a key element of laboratory assessment for hyperprolactinaemia.In cases where measured total prolactin is significantly raised, quantitative reporting of estimated monomeric prolactin instead of just 'macroprolactin' positive' can avoid unnecessary investigations.
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Affiliation(s)
- A H Heald
- Department of Endocrinology, Leighton Hospital, Crewe, CW1 4QJ, UK.
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Abstract
1 The effect of propranolol 2 h following doses of 10, 30, or 100 mg upon the blood oxygen-haemoglobin dissociation curves has been studied in four normal subjects. 2 The pO(2) at 50% saturation (p50) was not changed significantly under control conditions or after 10 and 100 mg doses. There was a just significant increase of 2 mmHg in the p50 value after the 30 mg dose. 3 There was no significant change in red cell adenosine triphosphate or 2,3-diphosphoglycerate nor in plasma phosphate. 4 There was no correlation between plasma propranolol concentration and changes in blood p50.
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Affiliation(s)
- M C Brain
- McMaster University Medical Centre, Hamilton, Ontario, Canada
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Ellsworth DL, Croft DT, Field LA, Deyarmin B, Kane J, Ellsworth RE, Hooke JA, Shriver CD. P3-03-03: Congruence between Patterns of microRNA Expression and Histologic Grading of Invasive Breast Carcinomas. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Histologic grading may be used as an indicator of prognosis in breast cancer; patients with low-grade carcinomas have ∼85% ten-year survival compared to just 45% survival in patients with high-grade disease. Although useful for risk stratification, assigning nuclear grade is subjective, and a large proportion of carcinomas are classified as intermediate-grade with uncertain prognosis, thus limiting clinical utility. MicroRNAs (miRNAs) regulate gene expression and serve an important role in breast cancer development. In this study we examined miRNA expression profiles in low-grade and high-grade breast carcinomas to determine if miRNA expression is associated with pathological classifications of tumor grade.
Methods: Breast tumors were obtained from 69 patients enrolled in the Clinical Breast Care Project. Samples were partitioned into low-grade (n=30) or high-grade (n=39) categories using the Nottingham Histologic Score. Following laser microdissection of frozen tissue sections, miRNA was isolated from pure populations of breast tumor cells and hybridized to Affymetrix GeneChip® miRNA arrays containing over 800 human miRNA probes. Expression profiles were analyzed with Partek Genomics Suite using the miRNA Expression Module.
Results: We identified 30 unique miRNAs that showed differential expression at a False Discovery Rate (FDR) p<0.05 between low-grade and high-grade breast carcinomas. Gene targets for these miRNAs function primarily in metabolism and cell communication. Expression of hsa-miR-18a and hsa-miR-572 was significantly different between histologic grades at an FDR p<1×10−8 and hierarchical clustering based on these miRNAs correctly classified 97% (29/30) of low-grade and 90% (35/39) of high-grade tumors. miR-18a has been shown to inhibit ER signaling and promote cellular differentiation, while the role of miR-572 in breast carcinogenesis is not well known.
Conclusions: Dysregulation of miRNAs may accompany changes in cellular morphology typically used in histologic classification of breast carcinomas. Patterns of miRNA expression may improve reproducibility and clinical utility of tumor grading and may prove useful for prediction of recurrence and survival for patients with intermediate-grade carcinomas.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-03-03.
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Affiliation(s)
- DL Ellsworth
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - DT Croft
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - LA Field
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - B Deyarmin
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - J Kane
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - RE Ellsworth
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - JA Hooke
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
| | - CD Shriver
- 1Windber Research Institute, Windber, PA; Henry M Jackson Foundation, Rockville, MD; Walter Reed Army Medical Center, Washington, DC
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Dennis M, Wall J, Xie H, Cotton A, Mooney R, Kane J, Wang X. SU-E-I-111: Freesurfer MRI Data Analysis of Brain Cortical Thickness Variations in Individuals. Med Phys 2011. [DOI: 10.1118/1.3611686] [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: 11/07/2022] Open
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Bichay T, Kane J, Ebrom P, Chen C. SU-E-T-551: Analysis of a Non-Invasive Patient Mask Immobilization System for Cranial SRS with TomoTherapy. Med Phys 2011. [DOI: 10.1118/1.3612513] [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: 11/07/2022] Open
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Malik J, Carruthers L, Burton J, Kane J, Al-Shahi Salman R, Keston P, White P, Sellar R, Gregor A, Erridge S. Retrospective Review of Effectiveness and Toxicity of Linac-based Stereotactic Radiosurgery (SRS) for Intra-cranial Arteriovenous Malformations (AVMs): Experience from Edinburgh Cancer Centre. Clin Oncol (R Coll Radiol) 2011. [DOI: 10.1016/j.clon.2011.01.453] [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: 11/15/2022]
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Goff B, Lowe K, Kane J, Robertson M, Gaul M, Andersen M. Symptom-triggered screening for ovarian cancer: A pilot study of feasibility and acceptability. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Manu P, Kane J, Correll C. Sudden death in psychiatric patients. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72870-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IntroductionStudies using death certificates have indicated an excess of sudden cardiac deaths among users of antipsychotic drugs compared to the general population, but may have underestimated the presence of other known causes of sudden and unexpected death.ObjectivesTo assess the cause and risk factors for sudden death discovered by contemporaneous investigation of all deaths occurring over a 26-year period (1984–2009) in adult patients registered for care in one large psychiatric hospital in New York.MethodsCircumstances of death, psychiatric diagnoses, psychotropic drugs and past medical history were extracted from the root cause analyses of sudden unexpected deaths. After the exclusion of suicides, homicides and drug overdoses, explained and unexplained cases were compared regarding clinical variables and the utilization of antipsychotics.ResultsOne hundred cases of sudden death were identified among of 119, 500 patient-years. The death remained unexplained in 52 cases. The incidence of unexplained sudden death was 125/100,000 (95% CI 88.9–175.1/100,000) patient-years in 2005–2009, 53/100,000 (95% CI 31.7–88.5/100,000) patient-years in 1999–2004 and 7/100,000 (95% CI 3.7–19.4/100,000) patient-years in 1984–1998. Explained and unexplained cases were similar regarding psychiatric diagnoses and treatment with any psychotropic class, including first- and second-generation antipsychotics. Dyslipidemia (p = 0.012), diabetes (p = 0.055) and co-morbid dyslipidemia and diabetes (p = 0.008) were more common in the unexplained than in the explained cases.ConclusionsIn a consecutive cohort of psychiatric patients, the unexplained sudden deaths were associated with known risk factors for coronary artery disease, but not with higher utilization of first- or second-generation antipsychotics.
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Zhou J, Somiari S, Lubert S, Saini J, Kane J, Deyarmin B, Hooke J, Mural R, Shriver C, Brinckerhoff C. Abstract P4-07-09: The Impact of Matrix Metalloproteinase-1 Promoter 1G/2G Polymorphism on Breast Diseases. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-07-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Matrix Metalloproteinase-1 (MMP-1) is a ubiquitously expressed interstitial collagenase. Overexpression of MMP-1 has a role in initiating mammary tumorigenesis by degrading stroma and by releasing growth factors. A single guanine insertion polymorphism in the MMP-1 promoter creates the binding site, 5'-GGAA-3', for the Ets transcription factor, and increases transcription of MMP-1. The MMP-1 2G polymorphism is linked to early onset, increased risk or aggressiveness of several cancers. Its relationship with other potential markers in invasion and metastasis of breast cancer is unknown.
Experimental Design: To study the impact of the 2G polymorphism on breast cancer we analyzed the genotypes of 109 patients (52 invasive breast cancer [IBC], 29 ductal carcinoma in situ [DCIS], 13 atypical ductal hyperplasia [ADH] and 15 benign breast disease). Immunohistochemical (IHC) data for MMP-1, HER2, ER/PR and P53 from these donors were also analyzed. IHC results for MMP-1 were scored as 0 (no expression) or increasing expression of+1, +2 or +3. Data were analyzed using Pearson's chi-square test to identify statistical significance.
Results: A significantly higher number of patients in the IBC group expressed high MMP-1 (+2 and +3; p <0.001) while the benign group had the least number of patients expressing higher MMP-1 (score +3; p = 0.0075). In the IBC group, among patients with low levels of MMP-1 (+1), 57% had the 1G/1G phenotype, and among those expressing high levels of MMP-1 (+2 and +3), over 70% were 1G/2G heterozygotes or 2G/2G homozygotes. The 2G allele frequency in the ADH group was 0.62 and these patients had higher MMP-1 expression (+2 and +3). Further analyses of HER2, ER/PR and P53 in relation to the MMP-1 polymorphism within the IBC group showed MMP-1 allelic variation in Her-2 positive group was significantly different compared with Her-2 negative group (p = 0.039), with a distribution curve shifted to a greater frequency of 2G homozygosity. A similar result was also observed in P53 positive group when compared with P53 negative group (p = 0.043).
Conclusions: 1) In the IBC group, the 2G insertion polymorphism contributes to MMP-1 over expression. 2) Increased expression of MMP-1 in ADH and higher 2G allele frequency are consistent with the hypothesis that increased MMP-1 2G polymorphism plays a role in initiation of ADH through up regulation of MMP-1 expression. 3) Earlier studies show prognostic role for the coexistence of increased expression of HER2 and P53 in breast cancer. Our observation of a significant increase in the 2G homozygotes in HER2 and P53 positive patients supports a prognostic role for this polymorphism and suggests its possible association with other breast cancer markers. Thus, the MMP-1 2G polymorphism may both contribute to breast disease onset and serve as a prognostic marker for breast cancer.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-07-09.
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Affiliation(s)
- J Zhou
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - S Somiari
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - S Lubert
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Saini
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Kane
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - B Deyarmin
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - J Hooke
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - R Mural
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - C Shriver
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - C. Brinckerhoff
- Windber Research Institute, Windber, PA; Walter Reed Army Medical Center, Washington DC; Dartmouth-Hitchcock Medical Center, Lebanon, NH
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